MUKACHEVO, Ukraine — A Russian airstrike hit a Ukrainian maternity hospital in the besieged coastal city of Mariupol on Wednesday, injuring at least 17 staff members and patients as leaders warned of the fast-rising civilian toll of the two-week-old conflict, officials said.

The blast tore the front off one of the buildings in the hospital complex and damaged several others. One pregnant woman was evacuated on a stretcher; a long bleeding gash on her left hip was visible in images from the scene. Another pregnant woman, bleeding from her forehead, walked down a staircase, a faded rose-print blanket draped over her shoulders, her possessions in a purple plastic bag. A flaming car sat on a square that was punctuated with gnarled, burned trees.

“What kind of country is this, Russia, which is afraid of hospitals and maternity hospitals and destroys them?” Ukrainian President Volodymyr Zelensky said in a late-night video, appearing close to tears. “Were pregnant women going to fire at [the Russian city of] Rostov? Did someone in the maternity hospital abuse Russian-speakers? What was that? Was it the de-Nazification of the hospital?”

The bombing punctuated another devastating day in Ukraine, where leaders made increasingly desperate calls for more Western help, while U.S. officials warned that Russia seemed to be launching more indiscriminate attacks and making small but strategic gains on key cities. U.S. officials also warned that Russian rhetoric about chemical weapons could mean they were plotting a “false-flag” attack.

Officials feared that the coming days could be particularly grim for refugees and Ukrainians who have camped out in basements and subway stations to try to avoid Russian bombing. The United Nations said Wednesday it had recorded 516 civilian deaths, including 37 children, in the fighting so far, but it said in a statement that “the real figures are considerably higher.”

Evgeniy Maloletka/AP Ukrainian servicemen work inside of the damaged maternity hospital in Mariupol.

The governor of the region that includes Mariupol, Pavlo Kyrylenko, said in a video posted on Telegram that the 17 injured people in the Mariupol attack were mostly staff members and that no children were hurt. It was not immediately clear how full the hospital was when it was hit, with Mariupol encircled by Russian forces and city life largely having come to a halt. Patients appeared to have been using at least a portion of the aboveground maternity wards.

The attack drew immediate global condemnation, along with promises of more support for the embattled country.

“There are few things more depraved than targeting the vulnerable and defenceless,” British Prime Minister Boris Johnson wrote on Twitter.

The World Health Organization said earlier Wednesday it had so far verified 18 attacks on health facilities in Ukraine. The attacks inflicted 10 deaths and 16 injuries, the organization said.

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“These attacks deprive whole communities of health care,” said WHO Director General Tedros Adhanom Ghebreyesus.

The Russian military appears to be throwing inexperienced soldiers into combat, acknowledging Wednesday that at least some conscripted soldiers had been sent into battle despite Russian President Vladimir Putin’s orders to leave the fighting to professionals. Putin on Wednesday ordered military prosecutors to investigate who was responsible for disobeying the order, Kremlin spokesman Dmitry Peskov said.

Adding to worries about an escalation, White House press secretary Jen Psaki warned that Russia may be planning a “false-flag” chemical weapons attack, after Russian officials claimed to have evidence that the United States had supported a bioweapons program in Ukraine, and that “Ukrainian nationalists” were readying a chemical weapons “provocation” close to the Russian border near Kharkiv. U.S. officials dismissed the accusation.

“Now that Russia has made these false claims,” Psaki said on Twitter, “we should all be on the lookout for Russia to possibly use chemical or biological weapons in Ukraine, or to create a false flag operation using them.”

There were fears that the scale of the human suffering could grow even more if Ukraine’s nuclear facilities failed as a result of the fighting. Ukraine’s power grid operator, Ukrenergo, warned Wednesday that the closed Chernobyl nuclear power plant had been disconnected from the grid and that there were just 48 hours of fuel left for the diesel backup generators that keep the cooling and ventilation systems at the plant operational.

Ukrainian Foreign Minister Dmytro Kuleba demanded a cease-fire with Russia so repairs could be made, warning that after reserve diesel generators run out of fuel, “cooling systems of the storage facility for spent nuclear fuel will stop, making radiation leaks imminent.” The International Atomic Energy Agency was slightly less urgent, saying Wednesday on Twitter that the power loss “violates [a] key safety pillar on ensuring uninterrupted power supply” but adding that “in this case IAEA sees no critical impact on safety.”

Both Russia and Ukraine announced routes to allow people to leave hard-hit cities. But after accusing Putin’s forces of shelling the escape routes four days in a row, Ukrainian officials remained skeptical about the temporary cease-fire announcements.

Officials in Izyum, one of the cities set to be evacuated, alleged Wednesday that efforts to get civilians out were compromised by shelling from Russian forces. Other evacuations appeared to be proceeding. Local officials in the northeastern Sumy region, from which 5,000 people were able to evacuate a day earlier, said people were leaving in private cars and that they planned to load 22 buses, prioritizing pregnant women, women with children, older people and people with disabilities.

Evgeniy Maloletka/AP An injured pregnant woman walks downstairs in the damaged maternity hospital in Mariupol

By Friday morning, much of Ukraine could be hovering around 14 degrees Fahrenheit, with gusty winds from the east that make the air feel even more bitter. And parts of northeastern Ukraine could get up to four inches of snow through Friday. The bitter temperatures are expected to make the situation in the country more difficult — for soldiers and civilians alike.

A senior U.S. defense official, speaking on the condition of anonymity under rules set by the Pentagon, said Wednesday that Russia’s military campaign appears to be growing more indiscriminate as its troops make small but strategic gains on key cities.

There are “indications” the Russians are dropping “dumb munitions,” the official said, but added that it was “not totally clear whether that is by design” or because precision-guided munitions were somehow damaged.

“While we can’t prove a certain dumb bomb is hitting a certain target … what we see manifested is increasing damage to civilian infrastructure and civilian casualties,” the official said. Avoiding such casualties, the official added, “cannot be aided by the use of dumb bombs.”

The Biden administration has been adamant that it will not involve U.S. troops in the war and thus far has dismissed calls from Zelensky and others to impose a no-fly zone over Ukraine, saying enforcement could risk putting U.S. and NATO military personnel in direct conflict with Russian forces. But as the advance on major cities continues, the humanitarian situation is becoming more dire — particularly in places like Mariupol, which, according to the defense official, is now “isolated.”

Russia has launched more than 710 missiles, about half of which were fired from locations within Ukraine, according to the defense official. In the last 24 hours, Russian troops also made gains in their assault on Kharkiv, Ukraine’s second-largest population center, moving 20 kilometers closer to the center of the city in the country’s northeast. Russian forces also have moved about 15 kilometers to the north of Mykolaiv in southern Ukraine, according to a U.S. assessment, representing another territorial gain.

If the southern city falls, it could become a staging ground for a Russian assault on the large port city of Odessa, the defense official said.

The Pentagon believes Ukraine still has the bulk of its fixed-wing aircraft “available to them and operational,” the official said, but the Russians have surface-to-air missile systems that “virtually cover the whole country.”

“One has to assume they’re taking that into effect before they decide to fly manned aircraft,” the U.S. defense official said.

Evgeniy Maloletka/AP Ukrainian emergency personnel work at the side of the shell-damaged maternity hospital in Mariupol on March 9.

That posture appears to have been driving some skepticism in the United States about the logic of sending Ukraine more attack aircraft, as Poland has been pressing to do. On Tuesday night, the United States rejected a Polish proposal to move MiG-29 warplanes to a U.S. base in Germany so they could be deployed to aid Ukraine at the United States’ direction.

Psaki reiterated Wednesday that there “obvious concerns” with such a plan.

“It doesn’t require a military expert to understand why having planes fly from a U.S. air base into … a country where there is a war is not in our interests and not in NATO’s interests,” she said.

Psaki also cited problems with alternative suggestions for transporting those planes from Poland into Ukraine. “Carting them down the street,” she said, was not as easy as people might think.

“They have to be taken apart and put back together,” Psaki said. “You have to have people who are able to put those planes back together. You have to ensure that they can be safely moved through the course of a contested country.”

But U.S. officials also acknowledged that Ukrainian leaders may feel the need to press for whatever assistance they can get.

“If I were in President Zelensky’s position, I’m sure I would be asking for everything possible … to help the Ukrainian people,” Secretary of State Antony Blinken said at a news conference with visiting British Foreign Secretary Liz Truss.

Truss was more direct in her skepticism.

“The best way to defend” Ukraine, she said, is “with antitank weapons and anti-air weapons.”

Birnbaum, Demirjian and Firozi reported from Washington. Karly Domb Sadof, Elyse Samuels, Amy B Wang and Karen DeYoung in Washington and Karla Adam, Annabelle Timsit and Adela Suliman in London contributed to this report.

Washington Post