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Dozens of women were huddled for safety in a maternity hospital in El Fasher, Sudan, at the onset of the horrific violence. 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, became one of the few known survivors. “I heard the screams of women and children,” he recounts. “A massacre was taking place inside the hospital. Survival meant running for your life.”

This appalling incident stands as a particularly egregious examples in the two-year civil war tearing the North African nation apart. Militiamen stormed the facility, leaving dead more than 460 innocent people inside.

Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the deteriorating protection for civilians trapped in war-torn areas in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

While all major powers have agreed to the international laws of war, which commit them to defending civilians, the past year has experienced a historic high of assaults against medical infrastructure. Women undergoing childbirth are highly exposed due to their dependence on locally available medical care.

An investigation of records reveal 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.

“These are not inevitable outcomes of conflict. They represent a pattern of reproductive violence.”

The majority of these attacks have taken place in regions embroiled in intense conflict, where countless of pregnant women are trapped.

Women have been killed, prevented from accessing care, or compelled to deliver in dangerous and unsanitary conditions. The data also indicates that at least 68 maternal health workers have been slain, 15 taken hostage, and 101 taken into custody—sometimes in the act of delivering babies.

A Worldwide Emergency for Mothers and Newborns

The numbers are probably a significant underestimate, as they only include incidents covered by the media. In many war-torn areas, information is scarce.

Last year, it was reported that 50% of women who perished while pregnant or giving birth were in a conflict area. This underscores a devastating pattern.

In addition to the loss of life, these attacks are destroying critical infrastructure for mothers and babies, creating a grave danger 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 declaring certain actions a genocide.

Following truces, doctors report that women and children are still perishing from inadequate care, owing to desperate lacks of medicine and equipment. Accounts describe women giving birth in rubble because hospitals were out of reach.

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

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been struck and ruined in Ukraine. Reports from frontline hospitals describe births occurring in shelters and skyrocketing stress leading to birth complications.

“Russia is targeting us deliberately,” claims 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,” states a medical director in Sumy. “Even if air defence intercepts a drone, the falling debris may hit a hospital.”

Accountability Evaporates

For the more than 676 million women living close to deadly warfare, there are minimal protections and a stark lack of legal accountability for those targeting maternity care.

This lack of accountability has fostered a “culture of impunity,” explains a human rights lawyer. “Attacks on reproductive healthcare, like coerced birth or involuntary sterilization, are potentially acts of genocide by preventing births.”

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 inability to report from rebel-held areas. Nevertheless, shelling in Goma struck a baby care unit, causing fatalities among patients and staff.

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

Most maternal deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that terror is compelling women away from facilities once considered safe, leading them to risky home births devoid of emergency care.

“The deliberate attack on maternity wards indicates a wider and more disturbing trend: the use of attacks on medical facilities as a weapon to spread fear and to break societal cohesion,” 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 ‘militarily advantageous’, which has increasingly been used as a justification.”