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Thirty women were huddled for safety in a childbirth facility in El Fasher, Sudan, as the slaughter began. Among them were new mothers, while others were actively in labor.

Present at the hospital after dark, a 28-year-old lab technician, Abdo-Rabo Ahmed, lived to tell the tale. “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 among the worst examples in the two-year civil war tearing the African nation apart. Combatants forced their way into the building, allegedly slaughtering more than 460 patients and their companions.

Rights organizations have called it “an unspeakable atrocity,” and a stark illustration of the vanishing safeguards for civilians living amidst warfare in Ukraine, Gaza, Myanmar, the Democratic Republic of the Congo, and Sudan.

An Unprecedented Assault Against Maternal Care

While all major powers are signatories to the Geneva conventions, which obligate them to protect civilians, the past year has experienced a historic high of attacks on healthcare systems. Expectant mothers are highly exposed due to their reliance on locally available medical care.

An investigation of records reveal an unprecedented scale of attacks: nearly 300 violent acts against maternity care facilities, staff, and pregnant women over the last three years, including at least 119 bombardments of hospitals and delivery wards.

“These are not inevitable outcomes of conflict. They represent a systematic assault on childbirth.”

The majority of these incidents have happened in regions embroiled in intense conflict, where hundreds of thousands of women bearing children are confined.

Deaths have occurred, denied medical attention, or forced to give birth in dangerous and unsanitary conditions. The data also indicates that at least 68 midwives, obstetricians, and gynaecologists have been slain, 15 abducted, and 101 arrested—sometimes during medical procedures.

The Global Crisis for Mothers and Newborns

Statistics are thought to be a significant underestimate, as they capture solely incidents reported in news outlets. In many conflict zones, reporting is limited.

Last year, findings indicated that half of all women who perished while pregnant or giving birth were in a conflict area. This underscores a catastrophic reality.

Apart from fatalities, these attacks are wrecking critical infrastructure for mothers and babies, jeopardizing the future to community survival.

Conditions within Gaza

In Gaza, the catastrophic impact on the right to maternal care has been cited by a UN commission as one reason behind declaring certain actions a genocide.

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 giving birth in rubble because hospitals were inaccessible.

“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 contested deliberately targeting maternity care or trying to alter birthrates.

The Crisis in Ukraine

Since early 2022, at least 80 maternity and neonatal facilities have been struck and ruined in Ukraine. Journalism from conflict zones describe births taking place in basements and extreme psychological pressure leading to birth complications.

“Russia is targeting us deliberately,” asserts the head of obstetrics at a repeatedly damaged hospital in Kherson. Russian authorities have denied deliberately targeting civilians.

“The truth of the matter is, every facility can be under attack now,” states a medical director in Sumy. “If a drone is destroyed, the falling debris could impact a hospital.”

A Culture of Impunity

For the more than 676 million women living within range of fighting, there are few safeguards and rare trials for atrocities for those attacking childbirth services.

This lack of accountability has fostered a “culture of impunity,” argues a human rights lawyer. “Violence targeting childbirth, like coerced birth or involuntary sterilization, are potentially acts of genocide by hindering reproduction.”

Additional Hotspots

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 communication blackout from rebel-held areas. Nevertheless, shelling in Goma damaged a maternity hospital, resulting in tragic loss of life.

In Myanmar, clinics have been attacked 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

A large proportion of mother deaths are averted with basic healthcare, but war shatters health systems. Rights groups note that anxiety is forcing women away from facilities once considered safe, resulting in risky home births devoid of emergency care.

“If maternity hospitals are being deliberately targeted points toward a broader and more sinister pattern: the use of attacks on medical facilities as a weapon to spread fear and to destroy community bonds,” notes 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 now become a standard defence.”