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Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, as the slaughter began. Several had recently given birth, while others were actively in labor.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “I heard the screams of women and children,” he explains. “They were killing everyone inside the hospital. We who were able to escape, did so.”

This brutal attack stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Armed soldiers stormed the facility, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have labeled it “an act of unspeakable brutality,” and a stark illustration of the collapse in safety for civilians living amidst warfare in multiple global hotspots.

A Record of Violence On Childbirth Services

Despite every significant nation are signatories 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. Mothers in labor are exceptionally vulnerable 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 bombardments of hospitals and delivery wards.

“These incidents do not represent standard wartime hazards. They represent a pattern of reproductive violence.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where countless of pregnant women are trapped.

Deaths have occurred, blocked from reaching help, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 abducted, and 101 taken into custody—sometimes during medical procedures.

A Worldwide Emergency for Mothers and Newborns

Statistics are thought to be a substantial underreporting, as they capture solely incidents documented publicly. In many conflict zones, communications are sparse.

Last year, analysis showed that 50% of women who lost their lives in maternal circumstances resided in a war zone. This underscores a devastating pattern.

Beyond killing women and staff, these attacks are destroying critical infrastructure for mothers and babies, creating a grave danger to demographic stability.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as part of the basis for accusations of genocidal acts.

Following truces, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. Accounts describe women giving birth in rubble because hospitals could not be reached.

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

Ukraine's Ordeal

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

“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris could impact a hospital.”

Accountability Evaporates

For the more than 676 million women living within range of fighting, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.

This absence of consequences has created a “culture of impunity,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially 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 scarce because of a communication blackout 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

The majority of childbirth fatalities are preventable with routine care, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, resulting in risky home births without skilled assistance.

“The deliberate attack on maternity wards speaks to a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to destroy community bonds,” observes 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 ‘harmful to the enemy’, which has increasingly been used as a justification.”