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A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Among them were new mothers, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he explains. “They executed everybody inside the hospital. Those who could run, fled.”

This appalling incident stands as one of the most shocking examples in the protracted internal conflict tearing the African nation apart. Armed soldiers stormed the facility, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have described it as “an unspeakable atrocity,” and a clear case of the vanishing safeguards for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence Against Maternal Care

Although world powers are signatories to the international laws of war, which commit them to defending civilians, the past year has seen a record number of violence targeting health services. Expectant mothers are highly exposed due to their dependence on locally available medical care.

Data analysis and investigations 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 targeted attacks against hospitals and delivery wards.

“This is not natural consequences of war. They constitute a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where countless of expectant mothers are stranded.

Mothers have lost their lives, prevented from accessing care, or compelled to deliver 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.

A Worldwide Emergency for Mothers and Newborns

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

Last year, findings indicated that 50% of women who perished while pregnant or giving birth resided in a war zone. This underscores a horrifying trend.

In addition to the loss of life, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat to demographic stability.

Conditions within Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as a factor in declaring certain actions a genocide.

Following truces, doctors report that women and children continue to die from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals were inaccessible.

“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or trying to alter birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births taking place in basements 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. 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 can strike a hospital.”

A Culture of Impunity

For the hundreds of millions of women living near active conflicts, there are few safeguards and rare trials for atrocities for those attacking childbirth services.

This void of justice has fostered a “atmosphere of lawlessness,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, can be understood as acts of genocide by preventing births.”

Additional Hotspots

In El Fasher, the area was isolated 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, causing fatalities among patients and staff.

In Myanmar, clinics have been attacked 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 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 indicates a broader and more sinister pattern: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” notes 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.”