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Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Some had just delivered their newborns, while others were actively in labor.

Working that night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, managed to survive the ordeal. “The sounds of screaming reached me of women and children,” he states. “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 two-year civil war tearing the African nation apart. Armed soldiers forced their way into the building, reportedly killing more than 460 patients and their companions.

Rights organizations have called it “a crime beyond words,” and a prime example of the vanishing safeguards for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

A Record of Violence On Childbirth Services

While all major 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. Mothers in labor are particularly at risk due to their dependence on locally available medical care.

Data analysis and investigations show an alarming level of violence: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These incidents do not represent standard wartime hazards. They form a pattern of reproductive violence.”

The majority of these incidents have happened in regions embroiled in intense conflict, where a vast number of expectant mothers are stranded.

Mothers have lost their lives, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 arrested—sometimes during medical procedures.

The Global Crisis in Maternal Health

The numbers are probably a grave undercount, as they only include incidents reported in news outlets. In many areas of fighting, communications are sparse.

Last year, it was reported that half of all women who lost their lives in maternal circumstances were in a conflict area. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are wrecking maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the ruinous consequences on reproductive health rights 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 continue to die from medical shortages, owing to severe deficits of medicine and equipment. Agencies have reported women having children by the roadside because hospitals could not be reached.

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

The Crisis in Ukraine

Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Accounts from embattled medical centers describe births forced underground and extreme psychological pressure leading to birth complications.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed 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 may hit a hospital.”

Accountability Evaporates

For the over half a billion females living near active conflicts, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.

This lack of accountability has created a “atmosphere of lawlessness,” explains a human rights lawyer. “Violence targeting childbirth, 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 limited by a lack of access from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, killing mothers, babies, and nurses.

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 Collapse of Safe Childbirth

A large proportion of mother deaths are avoidable with standard medicine, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births lacking professional help.

“When childbirth centers become intentional targets indicates a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to destroy community bonds,” notes 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 ‘prejudicial to the opposing side’, which has often been cited as an excuse.”