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Dozens of women were seeking shelter in a maternity hospital in El Fasher, Sudan, when the massacre started. Among them were new mothers, while others were actively in labor.

Working that night, a 28-year-old lab technician, Abdo-Rabo Ahmed, managed to survive the ordeal. “There were cries of women and children,” he explains. “A massacre was taking place inside the hospital. Those who could run, fled.”

This brutal attack stands as a particularly egregious examples in the ongoing war tearing the African nation apart. Armed soldiers forced their way into the building, leaving dead more than 460 patients and their companions.

Rights organizations have called it “an act of unspeakable brutality,” and a stark illustration of the deteriorating protection 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 witnessed an unprecedented spike of violence targeting health services. Mothers in labor are highly exposed due to their dependence on locally available medical care.

An investigation of records reveal an alarming level of violence: nearly 300 violent acts against places and people associated with childbirth over the last three years, including at least 119 direct strikes on hospitals and delivery wards.

“These incidents do not represent standard wartime hazards. They constitute a pattern of reproductive violence.”

The majority of these incidents have happened in regions embroiled in intense conflict, where countless of expectant mothers are stranded.

Deaths have occurred, blocked from reaching help, 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 taken into custody—sometimes while assisting births.

A Worldwide Emergency in Maternal Health

These figures likely represent a grave undercount, as they are limited to incidents reported in news outlets. In many areas of fighting, communications are sparse.

Last year, it was reported that half of all women who died during pregnancy or childbirth lived amidst hostilities. This underscores a devastating pattern.

In addition to the loss of life, these attacks are wrecking maternal and neonatal care facilities, posing a long-term threat to societal repopulation and recovery.

The Situation in Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as a factor in genocide allegations.

Despite periods of calm, doctors report that women and children are still perishing from inadequate care, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were out of reach.

“Our facility has endured missile strikes targeting 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 seeking to affect birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 hospitals for mothers and babies have been damaged or destroyed in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to problems during delivery.

“The attacks on us are intentional,” says the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“The truth of the matter is, every facility is now a potential target,” comments a medical director in Sumy. “When defensive systems shoot down an aircraft, the falling debris can strike a hospital.”

A Culture of Impunity

For the more than 676 million women living close to deadly warfare, there are scarce guarantees and even fewer war crimes prosecutions for those targeting maternity care.

This void of justice has fostered a “atmosphere of lawlessness,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, may constitute 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 limited by a lack of access from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have suffered violence over the past two years of civil war.

The End of Safe Deliveries

Most maternal deaths are avoidable with standard medicine, but war destroys healthcare networks. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted points toward a larger and alarming strategy: the use of violence against hospitals as a tool for terror and to tear apart the social fabric,” notes a legal researcher.

“Safeguards are not guaranteed 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 now become a standard defence.”