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A group of thirty mothers were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.

On duty during that fateful 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 states. “They were killing everyone inside the hospital. Survival meant running for your life.”

This brutal attack stands as a particularly egregious examples in the ongoing war tearing the North African nation apart. Armed soldiers raided the hospital, allegedly slaughtering 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 living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence On Childbirth Services

Although world powers are signatories to the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Mothers in labor are exceptionally vulnerable due to their reliance on locally available medical care.

Research and compiled data show an alarming level of violence: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“This is not inevitable outcomes of conflict. They constitute a pattern of reproductive violence.”

The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of expectant mothers are stranded.

Mothers have lost their lives, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 kidnapped, and 101 detained—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a significant underestimate, as they are limited to incidents covered by the media. In many war-torn areas, reporting is limited.

Last year, it was reported that one in two mothers who lost their lives in maternal circumstances were in a conflict area. This underscores a devastating pattern.

Apart from fatalities, these attacks are destroying hospitals and wards, creating a grave danger 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 genocide allegations.

Despite periods of calm, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.

“Direct shelling targeting 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 trying to alter birthrates.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births occurring in shelters and extreme psychological pressure leading to problems during delivery.

“Russia is targeting us deliberately,” asserts 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,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

A Culture of Impunity

For the more than 676 million women living close to deadly warfare, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.

This absence of consequences has created a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute 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 spiking dangerously, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is restricted due to a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.

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, leading them to 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 tool for terror 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 may forfeit their immunity if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”