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Dozens of women were seeking shelter in a childbirth facility in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were in the midst of labor.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”

This horrifying event stands as among the worst examples in the ongoing war tearing the North African nation apart. Combatants forced their way into the building, reportedly killing more than 460 innocent people inside.

Rights organizations have called it “an unspeakable atrocity,” and a prime example of the collapse in safety for civilians caught in conflict zones in several nations at war.

An Unprecedented Assault Against Maternal Care

While all major powers have signed the international laws of war, which obligate them to protect civilians, the past year has experienced a historic high of violence targeting health services. Expectant mothers are highly exposed due to their reliance 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 bombardments of hospitals and delivery wards.

“This is not natural consequences of war. They constitute a systematic assault on childbirth.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where countless of pregnant women are trapped.

Deaths have occurred, denied medical attention, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been killed, 15 abducted, and 101 arrested—sometimes in the act of delivering babies.

A Worldwide Emergency in Maternal Health

The numbers are probably a significant underestimate, as they capture solely incidents covered by the media. In many conflict zones, information is scarce.

Last year, findings indicated that half of all women who died during pregnancy or childbirth resided in a war zone. This underscores a catastrophic reality.

Apart from fatalities, these attacks are destroying hospitals and wards, jeopardizing the future to demographic stability.

Conditions within Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as a factor in genocide allegations.

Even after ceasefires, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. Agencies have reported women giving birth in rubble because hospitals were inaccessible.

“Direct shelling fired at the wards, operating rooms, and maternity wards,” states 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 childbirth centers have been struck and ruined in Ukraine. Journalism from conflict zones describe births occurring in shelters and extreme psychological pressure leading to birth complications.

“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris can strike a hospital.”

Accountability Evaporates

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

This lack of accountability has led to a “atmosphere of lawlessness,” argues a human rights lawyer. “Attacks on reproductive healthcare, like forced pregnancy or forced sterilisation, are potentially acts of genocide by hindering reproduction.”

Other Conflict Zones

In El Fasher, the area had been cut off 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 scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.

In Myanmar, hospitals have come under fire 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 preventable with routine care, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.

“The deliberate attack on maternity wards indicates a larger and alarming strategy: the use of attacks on medical facilities as a tool for terror and to destroy community bonds,” 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 now become a standard defence.”