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Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were actively in labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he states. “They executed everybody inside the hospital. Those who could run, fled.”

This appalling incident stands as among the worst examples in the two-year civil war tearing the African nation apart. Armed soldiers stormed the facility, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “a crime beyond words,” and a clear case of the vanishing safeguards for civilians trapped in war-torn areas in several nations at war.

An Unprecedented Assault On Childbirth Services

Despite every significant nation have signed the international laws of war, which require them to safeguard civilians, the past year has seen a record number of assaults against medical infrastructure. Mothers in labor are particularly at risk due to their dependence on locally available medical care.

An investigation of records uncover an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They form a pattern of reproductive violence.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.

Women have been killed, prevented from accessing care, or made to have their babies in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 abducted, and 101 taken into custody—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

Statistics are thought to be a substantial underreporting, as they only include incidents documented publicly. In many areas of fighting, communications are sparse.

Last year, findings indicated that 50% of women who died during pregnancy or childbirth were in a conflict area. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are destroying maternal and neonatal care facilities, creating a grave danger to community survival.

Conditions within Gaza

In Gaza, the catastrophic impact 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 inadequate care, owing to severe deficits of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals were inaccessible.

“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or seeking to affect 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 taking place in basements and extreme psychological pressure leading to maternal health issues.

“We are being singled out,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“The reality is, every facility can be under attack now,” states a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

Accountability Evaporates

For the hundreds of millions of women living close to deadly warfare, there are scarce guarantees and rare trials for atrocities for those assaulting reproductive health.

This void of justice has created a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, 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 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 damaged a maternity hospital, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.

The End of Safe Deliveries

Most maternal deaths are preventable with routine care, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in 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 weapon to spread fear and to tear apart the social fabric,” notes 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 now become a standard defence.”