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Dozens of women had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were in the midst of labor.

Working that night, 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 recounts. “A massacre was taking place 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 African nation apart. Militiamen stormed the facility, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have labeled it “an act of unspeakable brutality,” and a clear case 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

Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.

An investigation of records show an unprecedented scale of attacks: 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 are not inevitable outcomes of conflict. They represent a systematic assault on childbirth.”

The majority of these incidents have happened in Ukraine, Gaza, and Sudan, where countless of women bearing children are confined.

Mothers have lost their lives, blocked from reaching help, or compelled to deliver in deplorable situations. The data also indicates that at least 68 maternal health workers have been killed, 15 abducted, and 101 detained—sometimes during medical procedures.

A Worldwide Emergency in Maternal Health

The numbers are probably a significant underestimate, as they are limited to incidents reported in news outlets. In many conflict zones, reporting is limited.

Last year, findings indicated that 50% of women who perished while pregnant or giving birth resided in a war zone. This underscores a catastrophic reality.

In addition to the loss of life, these attacks are obliterating critical infrastructure for mothers and babies, creating a grave danger to community survival.

The Situation in Gaza

In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for 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. Agencies have reported women having children by the roadside 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 rejected deliberately targeting maternity care or trying to alter birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been struck and ruined in Ukraine. Journalism from conflict zones describe births forced underground and skyrocketing stress leading to birth complications.

“Russia is targeting us deliberately,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The reality is, every facility faces the threat of assault,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris could impact a hospital.”

Accountability Evaporates

For the more than 676 million women living close to deadly warfare, there are few safeguards and rare trials for atrocities for those attacking childbirth services.

This void of justice has led to a “atmosphere of lawlessness,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by destroying a group's future.”

Additional Hotspots

In El Fasher, the area lacked access to 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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.

In Myanmar, clinics have been attacked and dozens of midwives and patients have suffered violence over the past two years of civil war.

The Collapse of Safe Childbirth

The majority of childbirth fatalities 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.

“The deliberate attack on maternity wards speaks to a larger and alarming strategy: the use of violence against hospitals as a means of intimidation and to tear apart the social fabric,” says a legal researcher.

“Hospitals are not completely safe for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘militarily advantageous’, which has now become a standard defence.”