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Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, as the slaughter began. Some had just delivered their newborns, while others were actively in 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 states. “They executed everybody inside the hospital. We who were able to escape, did so.”

This brutal attack stands as among the worst examples in the protracted internal conflict tearing the North African nation apart. Militiamen forced their way into the building, reportedly killing more than 460 individuals receiving care and their families.

Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the collapse in safety for civilians caught in conflict zones in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

Although world powers have signed the Geneva conventions, which commit them to defending civilians, the past year has seen a record number of attacks on healthcare systems. Expectant mothers are exceptionally vulnerable due to their need for locally available medical care.

Research and compiled data show an unprecedented scale of attacks: nearly 300 incidents targeting or hindering maternity care facilities, staff, and pregnant women over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“This is not standard wartime hazards. 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 women bearing children are confined.

Deaths have occurred, denied medical attention, or made to have their babies in deplorable situations. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 kidnapped, and 101 taken into custody—sometimes during medical procedures.

The Global Crisis for Mothers and Newborns

The numbers are probably a significant underestimate, as they capture solely incidents documented publicly. In many war-torn areas, 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.

In addition to the loss of life, these attacks are destroying hospitals and wards, creating a grave danger to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the devastating effect on reproductive health rights has been cited by a UN commission as a factor in accusations of genocidal acts.

Even after ceasefires, doctors report that women and children succumb from inadequate care, owing to critical shortages of medicine and equipment. Accounts describe women delivering babies amidst ruins because hospitals could not be reached.

“We’ve had rockets 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.

The Crisis in Ukraine

Since early 2022, at least 80 maternity and neonatal facilities have been damaged or destroyed in Ukraine. Journalism from conflict zones describe births occurring in shelters and skyrocketing stress leading to maternal health issues.

“We are being singled out,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

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

A Culture of Impunity

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

This void of justice has created a “culture of impunity,” says a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”

Other Conflict Zones

In El Fasher, the area lacked access to 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 lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, killing mothers, babies, and nurses.

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

The End of Safe Deliveries

A large proportion of mother deaths are preventable with routine care, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births lacking professional help.

“The deliberate attack on maternity wards points toward a larger and alarming strategy: the use of violence against hospitals as a tool for terror and to break societal cohesion,” observes a legal researcher.

“There is no absolute protection for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘prejudicial to the opposing side’, which has now become a standard defence.”