This article was originally published on the Bill and Melinda Gates Foundation’s Impatient Optimists.

Every year Save the Children releases its annual State of the World’s Mothers report and each year a magnifying glass is held up to motherhood around the world and how mothers fare based solely on where they live. Now in its fifteenth year, Save the Children’s State of the World’s Mothers report puts into clear perspective the countries where motherhood is best and worst. This year Save the Children focuses its attention on motherhood in crisis.

Devastating crises have popped up across the globe, some of them ongoing and others that are fairly new, relatively speaking. No conflict, of course, is beneficial for the health and welfare of mothers and their children. In fact, women and children are precisely the ones who tend to suffer most during times of civil unrest, natural disasters, and all-out wars. Internal conflicts break families apart, cause families to flee to neighboring countries to then become refugees, or they become trapped inside of their home country and internally displaced. Basic services such as food assistance and health care then become scarce causing undue damage to the lives of children and the mothers who take care of them. The same is true for natural disasters that can irreparably ruin families’ lives and livelihoods.

This year over 60 million women and children are in need of humanitarian assistance according to the report and Save the Children has responded to nearly 120 humanitarian crises in 48 countries. Mothers and children, therefore, who are trapped in fragile countries are more susceptible to death and disease. We already know that 800 women die in childbirth and 18,000 children under the age of five die as a direct result of preventable disease every day. Did you know that half of these deaths for both women and children occur in countries that are fragile meaning there is a lack of good governance and political stability that leaves a country’s citizens open and vulnerable to a range of disasters whether man-made or natural.

During any crisis situation expectant mothers are in particular perilous situations. Obstetric services are often halted save for rudimentary services that many not be equipped to save a mother’s life in critical situations, that is if a pregnant woman is lucky. She may have to give birth alone in the bush or in the back of truck fleeing across the border to save her life and the life of her newborn.

The lives of newborns, of course, are also at increased risk when a mother gives birth in high-intensity, crises situations where mothers worry not only about giving birth to a healthy baby, but also simply staying alive.

As aforementioned, when countries experience crisis situations ordinary citizens suffer most. Health systems suffer. Frontline health workers – even the most dedicated of them – may have to flee along with citizens to save their own lives. And furthermore, hospitals and health centers can become targets of destruction in civil unrest in order to hurt those who need the services most.

Consider the conflict in the Central African Republic (CAR) where sectarian violence has left nearly 3000 dead and hundreds of thousands of people homeless and without access to the most basic needs such as food, clean water, and sanitation. And now that the rainy season is nearing the hardships in people’s lives will be greatly intensified. It is no wonder that the CAR ranks 173rd in the report rankings.

“Nothing will stop a mother from trying to keep her children safe and protected,” said Carolyn Miles, president and CEO of Save the Children, “But when disaster strikes, whether it’s a war in Syria, a tornado in Oklahoma or a typhoon in the Philippines, women and children are often at the greatest risk – up to 14 times more likely to die than men.  Fortunately, our evidence also shows we can save and dramatically improve the lives of mothers and children, even in the most challenging places to live, if we invest in the services they need.”

In Syria where the civil war has been raging on for four years 1.4 million children and nearly 700,000 women have fled the country, according to the report. There are now over 200,000 women and girls of reproductive age inside and outside of Syria according to the UNFPA meaning there will be an increased necessity for obstetric and newborn health care and family planning services. And, in the case of civil unrest, rape and torture of women and girls are often used as weapons of war exacerbating gender-based violence.

Even in the United States when a natural disaster such as Hurricane Sandy devastated the east coast, mothers and children with the least resources fared the worst amid the devastation and months of rebuilding. No matter the country or crises, women and children remain the most vulnerable communities to death, disease, abuse, and violence.

Through its report Save the Children is putting forth a reminder that in fragile countries the health of women and children remains a top priority and systems must be in placed to ensure they are not let down when they need help the most.

Read the full report at savethechildren.org.

Photo by Allessio Romenzi for Save the Children.