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Thirty women had taken refuge in a childbirth facility in El Fasher, Sudan, at the onset of the horrific violence. Several had recently given birth, while others were in the midst of labor.

Working that 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. “A massacre was taking place inside the hospital. Survival meant running for your life.”

This appalling incident stands as one of the most shocking examples in the two-year civil war tearing the North African nation apart. Combatants forced their way into the building, leaving dead more than 460 individuals receiving care and their families.

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

A Record of Violence On Childbirth Services

Although world powers are signatories to the Geneva conventions, which require them to safeguard civilians, the past year has witnessed an unprecedented spike of assaults against medical infrastructure. Women undergoing childbirth are highly exposed due to their need for locally available medical care.

Data analysis and investigations uncover 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 direct strikes on hospitals and delivery wards.

“These incidents do not represent natural consequences of war. They represent a pattern of reproductive violence.”

The majority of these assaults have occurred in regions embroiled in intense conflict, where a vast number of women bearing children are confined.

Mothers have lost their lives, blocked from reaching help, or compelled to deliver in perilous and unsafe environments. The data also indicates that at least 68 maternal health workers have been slain, 15 abducted, and 101 arrested—sometimes during medical procedures.

The Global Crisis for Mothers and Newborns

The numbers are probably a grave undercount, as they only include incidents reported in news outlets. In many conflict zones, reporting is limited.

Last year, findings indicated that one in two mothers who perished while pregnant or giving birth were in a conflict area. This underscores a horrifying trend.

Beyond killing women and staff, these attacks are obliterating maternal and neonatal care facilities, creating a grave danger to community survival.

Conditions within Gaza

In Gaza, the devastating effect 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 desperate lacks of medicine and equipment. Agencies have reported women delivering babies amidst ruins because hospitals could not be reached.

“We’ve had rockets 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.

Ukraine's Ordeal

Since early 2022, at least 80 childbirth centers have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births forced underground and skyrocketing stress leading to birth complications.

“We are being singled out,” claims the head of obstetrics at a repeatedly damaged hospital in Kherson. The government has disputed deliberately targeting civilians.

“The reality is, every facility is now a potential target,” states a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

A Culture of Impunity

For the hundreds of millions of women living near active conflicts, there are few safeguards and a stark lack of legal accountability for those targeting maternity care.

This absence of consequences has created 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.”

Additional Hotspots

In El Fasher, the area had been cut off from 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 struck a baby care unit, killing mothers, babies, and nurses.

In Myanmar, medical facilities have been bombed 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

The majority of childbirth fatalities are avoidable with standard medicine, but war shatters health systems. 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 means of intimidation and to tear apart the social fabric,” says a legal researcher.

“Safeguards are not guaranteed for hospitals in war. Under the Geneva conventions, medical facilities are not inviolable if used for acts deemed ‘harmful to the enemy’, which has often been cited as an excuse.”