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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. Several had recently given birth, while others were in the midst of labor.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he explains. “They executed everybody inside the hospital. Those who could run, fled.”

This appalling incident stands as one of the most shocking examples in the ongoing war tearing the African nation apart. Combatants raided the hospital, leaving dead more than 460 innocent people inside.

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

A Record of Violence On Childbirth Services

Despite every significant nation have agreed to the Geneva conventions, which commit them to defending civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are exceptionally vulnerable due to their reliance on locally available medical care.

An investigation of records show an shocking trend: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“This is not standard wartime hazards. They represent a deliberate strategy of violence against reproduction.”

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

Women have been killed, 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 slain, 15 taken hostage, and 101 arrested—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

Statistics are thought to be a significant underestimate, as they are limited to incidents covered by the media. In many conflict zones, information is scarce.

Last year, findings indicated that 50% of women who lost their lives in maternal circumstances resided in a war zone. This underscores a horrifying trend.

In addition to the loss of life, these attacks are obliterating hospitals and wards, posing a long-term threat to demographic stability.

Conditions within Gaza

In Gaza, the ruinous consequences on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.

Even after ceasefires, doctors report that women and children continue to die from medical shortages, owing to critical shortages of medicine and equipment. Agencies have reported 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,” explains the head of a major hospital’s gynecology department. A military spokesperson has rejected deliberately targeting maternity care or trying to alter 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,” says 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 is now a potential target,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

Accountability Evaporates

For the more than 676 million women living near active conflicts, there are scarce guarantees and even fewer war crimes prosecutions for those assaulting reproductive health.

This void of justice has fostered a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, may constitute 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 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 hit a neonatal ward, killing mothers, babies, and nurses.

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

The Collapse of Safe Childbirth

A large proportion of mother deaths are preventable with routine care, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“When childbirth centers become intentional targets speaks to a larger and alarming strategy: the use of attacks on medical facilities as a means of intimidation and to break societal cohesion,” says 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.”