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Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were in the midst of labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he states. “They executed everybody inside the hospital. We who were able to escape, did so.”

This appalling incident stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen stormed the facility, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “a crime beyond words,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in several nations at war.

A Record of Violence Against Maternal Care

Despite every significant nation have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of violence targeting health services. Women undergoing childbirth are particularly at risk due to their reliance on locally available medical care.

Research and compiled data show 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 incidents do not represent inevitable outcomes of conflict. They constitute a deliberate strategy of violence against reproduction.”

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

Mothers have lost their lives, prevented from accessing care, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been murdered, 15 taken hostage, and 101 detained—sometimes while assisting births.

The Global Crisis in Maternal Health

These figures likely represent a grave undercount, as they capture solely incidents reported in news outlets. In many war-torn areas, information is scarce.

Last year, analysis showed that half of all women who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are destroying hospitals and wards, creating a grave danger to demographic stability.

Conditions within Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for declaring certain actions a genocide.

Following truces, doctors report that women and children continue to die from medical shortages, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were inaccessible.

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

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and skyrocketing stress leading to problems during delivery.

“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“In fact, every facility is now a potential target,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.

This absence of consequences has fostered a “culture of impunity,” says a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by hindering reproduction.”

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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, killing mothers, babies, and nurses.

In Myanmar, medical facilities have been bombed and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.

The Collapse of Safe Childbirth

A large proportion of mother deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births lacking professional help.

“The deliberate attack on maternity wards points toward a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” observes a legal researcher.

“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”