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Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were in the midst of labor.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This brutal attack stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Militiamen raided the hospital, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have called it “an act of unspeakable brutality,” and a prime example of the deteriorating protection for civilians living amidst warfare in several nations at war.

An Unprecedented Assault On Childbirth Services

Although world powers are signatories to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of violence targeting health services. Expectant mothers are exceptionally vulnerable due to their reliance on locally available medical care.

An investigation of records reveal an alarming level of violence: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These incidents do not represent inevitable outcomes of conflict. They form a pattern of reproductive violence.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number of pregnant women are trapped.

Mothers have lost their lives, denied medical attention, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 taken hostage, and 101 arrested—sometimes in the act of delivering babies.

The Global Crisis in Maternal Health

These figures likely represent a substantial underreporting, as they are limited to incidents covered by the media. In many areas of fighting, reporting is limited.

Last year, analysis showed that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are destroying hospitals and wards, posing a long-term threat to community survival.

Conditions within Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.

Following truces, doctors report that women and children are still perishing from inadequate care, owing to severe deficits of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were inaccessible.

“We’ve had rockets hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to problems during delivery.

“The attacks on us are intentional,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The reality is, every facility can be under attack now,” states a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are few safeguards and a stark lack of legal accountability for those assaulting reproductive health.

This lack of accountability has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, may constitute acts of genocide by destroying a group's future.”

Other Conflict Zones

In El Fasher, the area had been cut off from humanitarian aid long before the hospital attack, with malnutrition increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is limited by a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.

The Collapse of Safe Childbirth

A large proportion of mother deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“The deliberate attack on maternity wards points toward a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to destroy community bonds,” says a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has increasingly been used as a justification.”