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Dozens of 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.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. We who were able to escape, did so.”

This horrifying event stands as a particularly egregious examples in the protracted internal conflict tearing the North African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 individuals receiving care and their families.

Rights organizations have called it “a crime beyond words,” and a stark illustration of the deteriorating protection for civilians living amidst warfare in several nations at war.

An Unprecedented Assault On Childbirth Services

Despite every significant nation have agreed to the Geneva conventions, which require them to safeguard civilians, the past year has seen a record number of attacks on healthcare systems. Mothers in labor are highly exposed due to their reliance on locally available medical care.

An investigation of records show an shocking trend: nearly 300 attacks on and disruptions to maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“This is not inevitable outcomes of conflict. They represent a deliberate strategy of violence against reproduction.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of expectant mothers are stranded.

Women have been killed, blocked from reaching help, or forced to give birth in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been killed, 15 kidnapped, and 101 detained—sometimes while assisting births.

The Global Crisis in Maternal Health

The numbers are probably a substantial underreporting, as they only include incidents reported in news outlets. In many war-torn areas, reporting is limited.

Last year, analysis showed that half of all women who perished while pregnant or giving birth lived amidst hostilities. This underscores a devastating pattern.

Beyond killing women and staff, these attacks are wrecking hospitals and wards, creating a grave danger to community survival.

Conditions within Gaza

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

Despite periods of calm, doctors report that women and children succumb from a lack of proper treatment, owing to severe deficits of medicine and equipment. UN officials have relayed women giving birth in rubble because hospitals could not be reached.

“Our facility has endured missile strikes fired at the wards, operating rooms, and maternity wards,” states the head of a major hospital’s gynecology department. A military spokesperson has denied deliberately targeting maternity care or trying to alter birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 childbirth centers have been damaged or destroyed 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,” asserts 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 faces the threat of assault,” notes a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris may hit a hospital.”

A Culture of Impunity

For the hundreds of millions of women living within range of fighting, there are minimal protections and even fewer war crimes prosecutions for those targeting maternity care.

This lack of accountability has led to a “culture of impunity,” says a human rights lawyer. “Violence targeting childbirth, like forced pregnancy or forced sterilisation, are potentially 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 increasing drastically, especially among children and pregnant women.

In the Democratic Republic of the Congo, information is restricted due to a inability to report from rebel-held areas. Nevertheless, shelling in Goma hit a neonatal ward, causing fatalities among patients and staff.

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

The majority of childbirth fatalities are averted with basic healthcare, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, resulting in risky home births without skilled assistance.

“The deliberate attack on maternity wards points toward a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” notes 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 ‘prejudicial to the opposing side’, which has often been cited as an excuse.”