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Thirty women were huddled for safety in a maternity hospital in El Fasher, Sudan, when the massacre started. Several had recently given birth, while others were experiencing childbirth.

On duty during that fateful night, a 28-year-old lab technician, a technician named Abdo-Rabo Ahmed, lived to tell the tale. “I heard the screams of women and children,” he recounts. “They were killing everyone inside the hospital. Survival meant running for your life.”

This horrifying event stands as one of the most shocking examples in the ongoing war tearing the North African nation apart. Armed soldiers raided the hospital, reportedly killing more than 460 patients and their companions.

Rights organizations have described it as “an unspeakable atrocity,” and a stark illustration of the vanishing safeguards for civilians trapped in war-torn areas in several nations at war.

A Record of Violence Against Maternal Care

While all major powers have agreed to the international laws of war, which require them to safeguard civilians, the past year has seen a record number of assaults against medical infrastructure. Women undergoing childbirth are particularly at risk due to their need for locally available medical care.

An investigation of records show an alarming level of violence: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 targeted attacks against hospitals and delivery wards.

“This is not natural consequences of war. They represent a systematic assault on childbirth.”

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

Deaths have occurred, denied medical attention, or forced to give birth in deplorable situations. The data also indicates that at least 68 maternal health workers have been murdered, 15 abducted, and 101 arrested—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 areas of fighting, reporting is limited.

Last year, analysis showed that 50% of women who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.

Apart from fatalities, these attacks are destroying hospitals and wards, jeopardizing the future to demographic stability.

Conditions within Gaza

In Gaza, the devastating effect on the right to maternal care has been cited by a UN commission as part of the basis for genocide allegations.

Even after ceasefires, doctors report that women and children succumb from medical shortages, owing to critical shortages of medicine and equipment. UN officials have relayed women having children by the roadside because hospitals were out of reach.

“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.

Ukraine's Ordeal

Since early 2022, at least 80 maternity and neonatal facilities have been attacked and rendered unusable in Ukraine. Reports from frontline hospitals describe births taking place in basements and extreme psychological pressure leading to problems during delivery.

“The attacks on us are intentional,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Officials from Russia have rejected deliberately targeting civilians.

“In fact, every facility faces the threat of assault,” comments a medical director in Sumy. “If a drone is destroyed, the falling debris may hit a hospital.”

A Culture of Impunity

For the over half a billion females living close to deadly warfare, there are minimal protections and rare trials for atrocities for those attacking childbirth services.

This void of justice has led to a “culture of impunity,” argues a human rights lawyer. “Assaults against maternal services, like forced pregnancy or forced sterilisation, can be understood as 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 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, causing fatalities among patients and staff.

In Myanmar, hospitals have come under fire and dozens of midwives and patients have faced detention, death, or harm over the past two years of civil war.

The End of Safe Deliveries

The majority of childbirth fatalities are preventable with routine care, but war collapses medical infrastructure. Rights groups note that fear is now driving women away from facilities once considered safe, pushing them toward risky home births without skilled assistance.

“When childbirth centers become intentional targets indicates a wider and more disturbing trend: the use of attacks on medical facilities as a means of intimidation and to tear apart the social fabric,” notes a legal researcher.

“There is no absolute protection 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 often been cited as an excuse.”