In the space of 24 hours Russian forces have shelled a maternity hospital in the port city of Mariupol and two other medical facilities in Zhytomyr, northern Ukraine.
Pregnant women, children and doctors are reported to be among the dead and wounded.
The World Health Organisation estimates that at least 18 hospitals have been attacked by Russian forces since the invasion began on 24 February.
Here, Professor Michael Clarke, analyst and former director-general of military think tank RUSI, offers his take on the recent hospital attacks in Mariupol and Zhytomyr – and how they fit into Vladimir Putin’s strategy in Ukraine.
Putin has done this before.
The biggest example was in Idlib, Syria in 2019 where 24 hospital facilities were targeted first – before any other military action.
The International Red Cross and other members of the aid community had communicated the coordinates of the hospitals to make sure they would be left alone.
But instead the Russians used those very coordinates to bomb them. So after 2019 the aid community had to stop doing that.
There were also cases in Aleppo and Homs.
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Why has Russia done it?
It’s an attempt to create terror in the population and to break civilian morale.
In Mariupol, they just want the city to give in.
Usually they offer people a way out, but they aren’t offering any genuine escape routes in Mariupol – they just want them to surrender.
Essentially, it’s a medieval siege.
Flesh and blood can only do so much without food, water, electricity and hospitals.
They want to break the city down so they can walk in with their tanks and their armour and claim it as their own.
The Russians use the misery of a population as a weapon of war.
For us in the West, misery is an unfortunate side effect of war – we try to protect people from it and we beat ourselves up, quite rightly, when mistake do happen.
But the Russians don’t worry about it.
How will the Ukrainians react?
The evidence is that it makes people just as angry and determined to fight back as it makes others want to give up.
So the effect can be very double-edged.
It creates this sense of cold determination in many people, so in that respect, it’s not a particularly effective way of doing anything.
What could Russia’s excuse be?
Any deliberate targeting of civilian areas is a war crime, full stop.
And there’s nothing more civilian than a hospital, even a military one, because those in it are non-combatant.
What the Russians always say is that the hospitals are being used as bases for weapons by the opposition.
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That’s what ISIS and Al-Qaeda have been accused of doing in places like Afghanistan.
Ultimately they will try to say that the Ukrainians are terrorists – but there isn’t a shred of evidence for that.
Secondly, unlike in the West, only around 10% of Russian weapons are precision weapons.
So they are a lot more likely than us to say they hit the hospital buildings by accident.
But you have to look at the pattern.
If there’s a pattern of hospitals being hit every other day for a week, you can’t claim it’s an accident.
How does it fit in with Putin’s wider plan for Ukraine?
What this indicates is that Putin is doubling down on both his objectives and his methods.
His objective is to destroy Ukraine as an independent country.
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And his methods are to grind on with this offensive even though the cost – in terms of civilians and his reputation – is getting higher.
His military plan is to grind away and take the cities they’re currently surrounding. Because they’ve only successfully taken Kherson.
Read more: Are war crimes being committed and could Putin stand trial?
What are cluster and vacuum bombs and is Russia using them?
Chernihiv, Sumy, Kharkiv and Mariupol are all still resisting the Russians by fighting them in the suburbs.
But hitting hospitals drives people out.
If you get injured in the fighting, it’s very hard to get treated if there aren’t any hospitals, so people leave and go elsewhere.
It’s a deliberate policy of displacement – so they can empty parts of a city they want to occupy.
Will Russia ‘get away with it’ as some claim it has in Syria?
The difference between what’s happening in Ukraine and what happened in Syria is that nobody is looking the other way this time.
The world is watching and so is the International Criminal Court (ICC).
Russia cannot share the blame with anyone else this time – like it did in Syria.
What’s also different now compared with 10 years ago is our access to social media.
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Organisations like Bellingcat, Maxar and Oryx are collecting all the photos and footage they can get from social media.
They’ve also mobilised a whole community of people all over the world who are fascinated by the forensics of this and they have learned how to do it well.
What they’re doing is logging evidence for future ICC cases.
The ICC works very slowly, but it does work.
So this time, in terms of war crimes, the evidence will be there waiting.
