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Thirty women were seeking shelter in a childbirth facility in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were in the midst of labor.

Present at the hospital after dark, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This horrifying event stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have called it “an act of unspeakable brutality,” and a prime example of the deteriorating protection for civilians trapped in war-torn areas in multiple global hotspots.

An Unprecedented Assault Against Maternal Care

While all major powers have signed the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are particularly at risk due to their reliance on locally available medical care.

Data analysis and investigations show an shocking trend: nearly 300 violent acts against 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 inevitable outcomes of conflict. They form a deliberate strategy of violence against reproduction.”

The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of pregnant women are trapped.

Deaths have occurred, blocked from reaching help, or compelled to deliver 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 in Maternal Health

Statistics are thought to be a substantial underreporting, as they are limited to incidents documented publicly. In many war-torn areas, reporting is limited.

Last year, it was reported that half of all women who lost their lives in maternal circumstances lived amidst hostilities. This underscores a devastating pattern.

In addition to the loss of life, these attacks are destroying hospitals and wards, posing a long-term threat to community survival.

Conditions within Gaza

In Gaza, the catastrophic impact 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 a lack of proper treatment, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.

“Direct shelling hitting the wards, operating rooms, and maternity wards,” states 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 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Accounts from embattled medical centers describe births occurring in shelters and extreme psychological pressure leading to birth complications.

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

“In fact, every facility can be under attack now,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

Accountability Evaporates

For the hundreds of millions of women living within range of fighting, there are minimal protections and rare trials for atrocities for those attacking childbirth services.

This absence of consequences has created a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, 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 limited by a inability to report 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 shatters health systems. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“If maternity hospitals are being deliberately targeted indicates 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.

“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”