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Thirty women had taken refuge in a maternity hospital in El Fasher, Sudan, as the slaughter began. 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, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “The sounds of screaming reached me of women and children,” he recounts. “They were killing everyone inside the hospital. Survival meant running for your life.”

This appalling incident stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Armed soldiers raided the hospital, allegedly slaughtering more than 460 innocent people inside.

Rights organizations have called it “a crime beyond words,” and a stark illustration of the collapse in safety for civilians living amidst warfare in multiple global hotspots.

A Record of Violence On Childbirth Services

Although world powers have agreed to the international laws of war, which obligate them to protect civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are exceptionally vulnerable due to their need for locally available medical care.

Data analysis and investigations show an alarming level of violence: nearly 300 incidents targeting or hindering places and people associated with childbirth over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“These incidents do not represent standard wartime hazards. They form a deliberate strategy of violence against reproduction.”

The majority of these assaults have occurred in Ukraine, Gaza, and Sudan, where hundreds of thousands of expectant mothers are stranded.

Mothers have lost their lives, blocked from reaching help, or made to have their babies in deplorable situations. The data also indicates that at least 68 childbirth professionals and specialists have been murdered, 15 abducted, and 101 arrested—sometimes while assisting births.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a grave undercount, as they capture solely incidents covered by the media. In many war-torn areas, reporting is limited.

Last year, analysis showed that half of all women who perished while pregnant or giving birth resided in a war zone. This underscores a horrifying trend.

Apart from fatalities, these attacks are destroying hospitals and wards, posing a long-term threat to community survival.

The Situation in Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as part of the basis for genocide allegations.

Following truces, doctors report that women and children are still perishing from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals could not be reached.

“Our facility has endured missile strikes hitting the wards, operating rooms, and maternity wards,” says the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or aiming to influence birthrates.

The Crisis in Ukraine

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 maternal health issues.

“Russia is targeting us deliberately,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“The reality is, every facility is now a potential target,” notes a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

Accountability Evaporates

For the over half a billion females living within range of fighting, there are minimal protections and a stark lack of legal accountability for those assaulting reproductive health.

This lack of accountability has fostered 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 preventing births.”

Other Conflict Zones

In El Fasher, the area had been cut off 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 limited by a inability to report 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 been arrested, killed, or injured 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 collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted indicates a wider and more disturbing trend: the use of violence against hospitals as a means of intimidation and to break societal cohesion,” notes a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘militarily advantageous’, which has increasingly been used as a justification.”