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Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were actively in labor.

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 states. “They executed everybody inside the hospital. Survival meant running for your life.”

This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the African nation apart. Combatants raided the hospital, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have described it as “a crime beyond words,” and a clear case of the deteriorating protection for civilians caught in conflict zones in multiple global hotspots.

A Record of Violence On Childbirth Services

Although world powers have signed the international laws of war, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of violence targeting health services. Mothers in labor are highly exposed 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 maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They form a pattern of reproductive violence.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of women bearing children are confined.

Deaths have occurred, blocked from reaching help, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 kidnapped, and 101 arrested—sometimes during medical procedures.

The Global Crisis for Mothers and Newborns

These figures likely represent a significant underestimate, as they capture solely incidents covered by the media. In many areas of fighting, reporting is limited.

Last year, it was reported that one in two mothers who perished while pregnant or giving birth 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.

The Situation in Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as one reason behind genocide allegations.

Even after ceasefires, doctors report that women and children are still perishing from medical shortages, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were inaccessible.

“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 aiming to influence birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to problems during delivery.

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

“The reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”

Accountability Evaporates

For the hundreds of millions of women living near active conflicts, there are minimal protections and rare trials for atrocities for those attacking childbirth services.

This void of justice has created 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 increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is restricted due to a lack of access from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.

The End of Safe Deliveries

A large proportion of mother deaths are preventable with routine care, but war destroys healthcare networks. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“The deliberate attack on maternity wards indicates a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” observes a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has increasingly been used as a justification.”