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A group of thirty mothers were seeking shelter in a maternity hospital 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, Abdo-Rabo Ahmed, became one of the few known survivors. “I heard the screams of women and children,” he recounts. “They executed everybody inside the hospital. We who were able to escape, did so.”

This appalling incident stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 patients and their companions.

Rights organizations have called it “a crime beyond words,” and a stark illustration of the collapse in safety for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence Against Maternal Care

While all major powers are signatories to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Mothers in labor are particularly at risk due to their need for locally available medical care.

Research and compiled data uncover an unprecedented scale of attacks: nearly 300 attacks on and disruptions to places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These are not standard wartime hazards. They form a deliberate strategy of violence against reproduction.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.

Women have been killed, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 kidnapped, and 101 taken into custody—sometimes in the act of delivering babies.

The Global Crisis in Maternal Health

These figures likely represent a grave undercount, as they capture solely incidents reported in news outlets. In many conflict zones, reporting is limited.

Last year, findings indicated that one in two mothers who lost their lives in maternal circumstances were in a conflict area. This underscores a horrifying trend.

Apart from fatalities, these attacks are wrecking hospitals and wards, jeopardizing the future to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as one reason behind genocide allegations.

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

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

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to maternal health issues.

“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

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

Accountability Evaporates

For the hundreds of millions of women living close to deadly warfare, there are minimal protections and rare trials for atrocities for those attacking childbirth services.

This void of justice has led to a “environment where anything goes,” says 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 was isolated from humanitarian aid long before the hospital attack, with malnutrition rising sharply, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is scarce because of a lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, 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

Most maternal 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, pushing them toward risky home births devoid of emergency care.

“When childbirth centers become intentional targets points toward a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to break societal cohesion,” says 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.”