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Thirty women were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. 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, a technician named Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “A massacre was taking place inside the hospital. Survival meant running for your life.”

This brutal attack stands as among the worst examples in the protracted internal conflict tearing the African nation apart. Combatants stormed the facility, allegedly slaughtering more than 460 individuals receiving care and their families.

Rights organizations have labeled it “a crime beyond words,” and a stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in multiple global hotspots.

A Record of Violence On Childbirth Services

While all major powers are signatories to the international laws of war, which commit them to defending civilians, the past year has seen a record number of assaults against medical infrastructure. Expectant mothers are particularly at risk due to their reliance on locally available medical care.

Research and compiled data show an alarming level of violence: 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.

“These incidents do not represent inevitable outcomes of conflict. They form a pattern of reproductive violence.”

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

Women have been killed, prevented from accessing care, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 childbirth professionals and specialists have been killed, 15 taken hostage, and 101 arrested—sometimes while assisting births.

The Global Crisis in Maternal Health

The numbers are probably a substantial underreporting, as they are limited to incidents reported in news outlets. 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 resided in a war zone. This underscores a devastating pattern.

In addition to the loss of life, these attacks are obliterating hospitals and wards, jeopardizing the future to societal repopulation and recovery.

Conditions within Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as one reason behind accusations of genocidal acts.

Even after ceasefires, doctors report that women and children succumb from medical shortages, owing to severe deficits of medicine and equipment. UN officials have relayed women delivering babies amidst ruins because hospitals were inaccessible.

“Direct shelling targeting 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 damaged or destroyed in Ukraine. Journalism from conflict zones describe births taking place in basements and skyrocketing stress 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.

“In fact, every facility can be under attack now,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris can strike a hospital.”

Accountability Evaporates

For the more than 676 million women living within range of fighting, there are minimal protections and a stark lack of legal accountability for those attacking childbirth services.

This void of justice has fostered a “atmosphere of lawlessness,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by destroying a group's future.”

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 scarce because of a communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, clinics have been attacked and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.

The Collapse of Safe Childbirth

Most maternal deaths are preventable with routine care, but war collapses medical infrastructure. Rights groups note that terror is compelling women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.

“When childbirth centers become intentional targets points toward a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” observes a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities can lose their protected status if used for acts deemed ‘harmful to the enemy’, which has now become a standard defence.”