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Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he states. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This horrifying event stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Combatants stormed the facility, leaving dead more than 460 innocent people inside.

Rights organizations have described it as “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence Against Maternal Care

Despite every significant nation have agreed to the international laws of war, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Women undergoing childbirth are highly exposed due to their need for locally available medical care.

An investigation of records show an alarming level of violence: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These are not standard wartime hazards. They form a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where countless of pregnant women are trapped.

Women have been killed, denied medical attention, or forced to give birth in deplorable situations. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 taken into custody—sometimes in the act of delivering babies.

The Global Crisis for Mothers and Newborns

These figures likely represent a significant underestimate, as they are limited to incidents reported in news outlets. In many conflict zones, 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 wrecking maternal and neonatal care facilities, jeopardizing the future to community survival.

Conditions within Gaza

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

Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were out of reach.

“Direct shelling hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or aiming to influence birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and extreme psychological pressure leading to problems during delivery.

“The attacks on us are intentional,” claims 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 is now a potential target,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

A Culture of Impunity

For the hundreds of millions of women living close to deadly warfare, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.

This lack of accountability has created a “environment where anything goes,” argues a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”

Additional Hotspots

In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, 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 struck a baby care unit, causing fatalities among patients and staff.

In Myanmar, medical facilities have been bombed 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 destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted indicates a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to break societal cohesion,” 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 now become a standard defence.”