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Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Some had just delivered their newborns, while others were experiencing childbirth.

On duty during that fateful night, a 28-year-old lab technician, Abdo-Rabo Ahmed, became one of the few known survivors. “There were cries of women and children,” he recounts. “They executed everybody inside the hospital. Those who could run, fled.”

This brutal attack stands as among the worst examples in the ongoing war tearing the African nation apart. Armed soldiers raided the hospital, leaving dead more than 460 patients and their companions.

Rights organizations have described it as “an act of unspeakable brutality,” and a clear case of the collapse in safety 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

Despite every significant nation are signatories to 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 reliance on locally available medical care.

Research and compiled data reveal 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 direct strikes on hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They represent a deliberate strategy of violence against reproduction.”

The majority of these attacks have taken place in Ukraine, Gaza, and Sudan, where countless of expectant mothers are stranded.

Deaths have occurred, denied medical attention, or forced to give birth 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 while assisting births.

A Worldwide Emergency for Mothers and Newborns

These figures likely represent a significant underestimate, as they capture solely incidents documented publicly. In many conflict zones, communications are sparse.

Last year, analysis showed that 50% of women who died during pregnancy or childbirth lived amidst hostilities. This underscores a catastrophic reality.

Beyond killing women and staff, these attacks are destroying maternal and neonatal care facilities, posing a long-term threat to demographic stability.

The Situation in Gaza

In Gaza, the catastrophic impact on reproductive health rights has been cited by a UN commission as a factor in declaring certain actions a genocide.

Despite periods of calm, doctors report that women and children continue to die from a lack of proper treatment, owing to desperate lacks of medicine and equipment. Agencies have reported women having children by the roadside because hospitals were inaccessible.

“We’ve had rockets targeting the wards, operating rooms, and maternity wards,” explains 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 attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births occurring in shelters and extreme psychological pressure leading to birth complications.

“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.

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

Accountability Evaporates

For the hundreds of millions of women living close to deadly warfare, there are few safeguards and even fewer war crimes prosecutions for those attacking childbirth services.

This lack of accountability has led to a “environment where anything goes,” explains a human rights lawyer. “Assaults against maternal services, like coerced birth or involuntary sterilization, can be understood as acts of genocide by destroying a group's future.”

Other Conflict Zones

In El Fasher, the area lacked access to humanitarian aid long before the hospital attack, with malnutrition rising sharply, especially among children and pregnant women.

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

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 Collapse of Safe Childbirth

Most maternal deaths are preventable with routine care, but war destroys healthcare networks. Rights groups note that anxiety is forcing women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.

“If maternity hospitals are being deliberately targeted indicates a larger and alarming strategy: the use of violence against hospitals as a weapon to spread fear and to tear apart the social fabric,” observes 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 increasingly been used as a justification.”