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Thirty women were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “The sounds of screaming reached me of women and children,” he explains. “They were killing everyone inside the hospital. Those who could run, fled.”

This appalling incident stands as one of the most shocking examples in the ongoing war tearing the African nation apart. Militiamen stormed the facility, leaving dead more than 460 innocent people inside.

Rights organizations have called it “a crime beyond words,” and a clear case of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence Against Maternal Care

Although world powers have agreed to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Mothers in labor are exceptionally vulnerable due to their reliance on locally available medical care.

Research and compiled data uncover an shocking trend: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These are not natural consequences of war. They form a systematic assault on childbirth.”

The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of expectant mothers are stranded.

Deaths have occurred, prevented from accessing care, or compelled to deliver 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 taken into custody—sometimes in the act of delivering babies.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a significant underestimate, as they capture solely incidents documented publicly. In many conflict zones, information is scarce.

Last year, analysis showed that half of all women who lost their lives in maternal circumstances were in a conflict area. This underscores a horrifying trend.

Apart from fatalities, these attacks are obliterating maternal and neonatal care facilities, posing a long-term threat to community survival.

Conditions within Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind genocide allegations.

Even after ceasefires, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were out of reach.

“Our facility has endured missile strikes fired at 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 trying to alter birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to maternal health issues.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“The truth of the matter is, every facility faces the threat of assault,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

Accountability Evaporates

For the over half a billion females living close to deadly warfare, there are few safeguards and a stark lack of legal accountability for those attacking childbirth services.

This void of justice has created a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by preventing births.”

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 scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.

The Collapse of Safe Childbirth

Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.

“The deliberate attack on maternity wards points toward a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” notes a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”