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Dozens of women had taken refuge in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were experiencing childbirth.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “There were cries of women and children,” he explains. “They were killing everyone inside the hospital. Survival meant running for your life.”

This brutal attack stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Combatants forced their way into the building, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have called it “an act of unspeakable brutality,” and a clear case of the vanishing safeguards for civilians caught in conflict zones in multiple global hotspots.

A Record of Violence Against Maternal Care

While all major powers are signatories to the Geneva conventions, which commit them to defending civilians, the past year has seen a record number of violence targeting health services. Expectant mothers are exceptionally vulnerable due to their need for locally available medical care.

An investigation of records reveal 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 targeted attacks against hospitals and delivery wards.

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

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

Deaths have occurred, blocked from reaching help, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 taken hostage, and 101 taken into custody—sometimes in the act of delivering babies.

A Worldwide Emergency in Maternal Health

Statistics are thought to be a significant underestimate, as they are limited to incidents documented publicly. In many conflict zones, information is scarce.

Last year, analysis showed that one in two mothers who lost their lives in maternal circumstances lived amidst hostilities. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are destroying hospitals and wards, creating a grave danger to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the ruinous consequences on the right to maternal care has been cited by a UN commission as a factor in declaring certain actions a genocide.

Following truces, doctors report that women and children continue to die from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.

“Our facility has endured missile strikes fired at 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 hospitals for mothers and babies have been attacked and rendered unusable in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to maternal health issues.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are few safeguards 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. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by preventing births.”

Other Conflict Zones

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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.

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 avoidable with standard medicine, but war shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, leading them to risky home births without skilled assistance.

“When childbirth centers become intentional targets speaks to a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” observes 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 increasingly been used as a justification.”