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A group of thirty mothers were huddled for safety in a childbirth facility in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were in the midst of labor.

On duty during that fateful night, 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 explains. “They executed everybody inside the hospital. Survival meant running for your life.”

This brutal attack stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Combatants raided the hospital, reportedly killing more than 460 patients and their companions.

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 several nations at war.

An Unprecedented Assault Against Maternal Care

Although world powers have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has experienced a historic high of violence targeting health services. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.

An investigation of records show 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 direct strikes on hospitals and delivery wards.

“This is not inevitable outcomes of conflict. They constitute a systematic assault on childbirth.”

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

Mothers have lost their lives, denied medical attention, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been murdered, 15 taken hostage, and 101 detained—sometimes while assisting births.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a significant underestimate, as they are limited to incidents reported in news outlets. In many conflict zones, information is scarce.

Last year, analysis showed that one in two mothers who died during pregnancy or childbirth were in a conflict area. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are destroying hospitals and wards, posing a long-term threat to community survival.

The Situation in Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as part of the basis for declaring certain actions a genocide.

Following truces, doctors report that women and children succumb from a lack of proper treatment, owing to critical shortages of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals were inaccessible.

“Direct shelling targeting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has contested deliberately targeting maternity care or seeking to affect birthrates.

Ukraine's Ordeal

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

“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The truth of the matter is, every facility can be under attack now,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

A Culture of Impunity

For the hundreds of millions of women living near active conflicts, there are minimal protections and even fewer war crimes prosecutions for those attacking childbirth services.

This void of justice has created a “culture of impunity,” argues a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, may constitute acts of genocide by hindering reproduction.”

Other Conflict Zones

In El Fasher, the area was isolated from humanitarian aid long before the hospital attack, with malnutrition spiking dangerously, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is scarce because of a inability to report from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, clinics have been attacked and dozens of midwives and patients have been arrested, killed, or injured over the past two years of civil war.

The End of Safe Deliveries

The majority of childbirth fatalities are averted with basic healthcare, but war collapses medical infrastructure. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.

“The deliberate attack on maternity wards points toward a broader and more sinister pattern: the use of violence against hospitals as a means of intimidation and to tear apart the social fabric,” observes a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities may forfeit their immunity if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”