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Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were experiencing childbirth.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Combatants forced their way into the building, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have called it “a crime beyond words,” and a clear case of the vanishing safeguards for civilians living amidst warfare in multiple global hotspots.

An Unprecedented Assault On Childbirth Services

Despite every significant nation have agreed to the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are particularly at risk due to their need for locally available medical care.

Data analysis and investigations reveal an shocking trend: nearly 300 attacks on and disruptions to 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 standard wartime hazards. They constitute a pattern of reproductive violence.”

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

Mothers have lost their lives, blocked from reaching help, or forced to give birth in perilous and unsafe environments. The data also indicates that at least 68 childbirth professionals and specialists have been slain, 15 abducted, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a substantial underreporting, as they are limited to incidents reported in news outlets. In many war-torn areas, reporting is limited.

Last year, it was reported that 50% of women who died during pregnancy or childbirth resided in a war zone. This underscores a devastating pattern.

Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, jeopardizing the future 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 one reason behind accusations of genocidal acts.

Following truces, doctors report that women and children are still perishing from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women having children by the roadside 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 childbirth centers have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to maternal health issues.

“Russia is targeting us deliberately,” 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 faces the threat of assault,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”

Accountability Evaporates

For the more than 676 million women living near active conflicts, there are few safeguards and a stark lack of legal accountability for those targeting maternity care.

This lack of accountability has created a “environment where anything goes,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, can be understood as acts of genocide by preventing births.”

Additional Hotspots

In El Fasher, the area lacked access to 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 faced detention, death, or harm over the past two years of civil war.

The Collapse of Safe Childbirth

The majority of childbirth fatalities are preventable with routine care, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted indicates a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to break societal cohesion,” notes a legal researcher.

“Safeguards are not guaranteed 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.”