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Thirty women were seeking shelter in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were actively in labor.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he explains. “They executed everybody inside the hospital. Survival meant running for your life.”

This brutal attack stands as a particularly egregious examples in the ongoing war tearing the African nation apart. Combatants forced their way into the building, reportedly killing more than 460 patients and their companions.

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

An Unprecedented Assault Against Maternal Care

Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are highly exposed due to their reliance on locally available medical care.

Research and compiled data uncover an shocking trend: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They form a systematic assault on childbirth.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where a vast number 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 maternal health workers have been slain, 15 kidnapped, and 101 detained—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

These figures likely represent a significant underestimate, as they capture solely incidents covered by the media. In many conflict zones, information is scarce.

Last year, it was reported that half of all women who died during pregnancy or childbirth lived amidst hostilities. This underscores a devastating pattern.

In addition to the loss of life, these attacks are destroying critical infrastructure for mothers and babies, jeopardizing the future to community survival.

Conditions within Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind accusations of genocidal acts.

Even after ceasefires, doctors report that women and children continue to die from inadequate care, owing to severe deficits of medicine and equipment. Accounts describe women giving birth in rubble because hospitals could not be reached.

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

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births forced underground and skyrocketing stress leading to birth complications.

“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The reality is, every facility is now a potential target,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

A Culture of Impunity

For the over half a billion females living near active conflicts, there are few safeguards and even fewer war crimes prosecutions for those targeting maternity care.

This absence of consequences has led to a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute acts of genocide by hindering reproduction.”

Additional Hotspots

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 damaged a maternity hospital, killing mothers, babies, and nurses.

In Myanmar, medical facilities have been bombed 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

Most maternal deaths are preventable with routine care, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“When childbirth centers become intentional targets 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,” says a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has often been cited as an excuse.”