Russia’s deadly strikes on Ukraine just days before the NATO summit, including an attack on a children’s hospital, have blown up in its face, stirring outrage in Ukraine, gaining international media attention, and fueling support from partner nations at a time when war fatigue threatens Kyiv’s fight.

Monday’s attack was one of the worst against Ukraine in months. It destroyed part of the Ohmatdyt Children’s Hospital in Kyiv, the capital, where children get cancer treatment and organ transplants, and sites in other cities. Ukraine said the attack killed at least 41 people and injured 166 more.

The attack aggressively highlighted Ukraine’s critical need for air defenses, something for which it has been begging Western partners.

Russia’s attack was met with more attention than most recent developments in Ukraine, and viral images spread of injured and bloodied children and searches in the rubble.

“Russia’s missile strikes that today killed dozens of Ukrainian civilians and caused damage and casualties at Kyiv’s largest children’s hospital are a horrific reminder of Russia’s brutality,” US President Joe Biden said afterward.

Biden said at the NATO summit Tuesday that a number of alliance members will send Ukraine dozens of air defense systems, including at least four more Patriot systems, in the coming months.

While such an announcement would have been long in the works, the timing of Russia’s attack one day before NATO’s biggest event massively highlighted Ukraine’s need at a key time when the alliance will be weighing next steps, potentially solidifying its convictions.

Air defense priorities

The annual NATO summit kicked off in Washington, DC, on Tuesday with leaders of the 75-year-old Western military alliance gathering to discuss its priorities, including Ukraine.

Ukraine’s primary aim for this summit was to secure more air defenses. The missile attacks the day before underscored that need, just before NATO’s biggest gathering of the year, where Ukraine and its partners can meet, negotiate, and strike deals.

The deadly Russian missile attack saw child cancer patients evacuated and moved with medical tubes still in their bodies. Rescue workers and volunteers were seen digging through the post-strike debris. Ukraine’s presidential office shared an image of a child, awake in a woman’s arms, with a head injury of some kind and covered in blood and dust.

Rajan Menon, a senior research scholar at Columbia University’s Saltzman Institute of War and Peace Studies, said Russia’s strikes had “backfired” by highlighting how badly Ukraine needs more air defenses.

He said that because one of the sites struck was a children’s hospital, it drew far more attention to Russia’s attacks and Ukraine’s needs. Ukraine’s cities have long been bombarded, but this particular tragedy triggered new outrage. “The nature of the site and the nature of the occupants made a very big difference,” Menon said.

Ukraine has issued a challenge to its international partners in the wake of the attack, demanding more than just air defenses.

Ukrainian presidential advisor Mykhailo Podolyak said that the Russian missile attack and its timing were meant to show that even with children being killed, the alliance will not do everything necessary to help Ukraine. Ukrainian officials say allies need to drop restrictions on hitting military targets inside Russia, where many attacks originate, and give Ukraine additional support.

Highlighting Ukraine’s needs

One of Russia’s more brutal tactics in its invasion has been to fire barrages of drones and missiles at Ukrainian cities far from the front lines in the country’s east. Those attacks have killed civilians and destroyed power infrastructure and residential and medical buildings.

Ukraine has been asking for more help from allies throughout Russia’s invasion and has received many systems from the West. But Ukraine has repeatedly said it needs more, though those requests rarely make international headlines anymore.

Now, more than two years into the war, many of Russia’s missile attacks no longer draw huge international reactions. But this week’s attack was different. World leaders, including the EU’s foreign policy chief and the head of the UN, publicly condemned the attacks.

Menon said that this attack had “without question” drawn more public attention from world leaders than other recent events in Ukraine.

He said that “when you hit not just a hospital or a children’s hospital —and not just a children’s hospital, but a children’s hospital in which there are children were being treated for cancer — it doesn’t get much worse than that in terms of brutality.”

France’s foreign minister called the strikes “barbaric” and “war crimes” and promptly called for Ukraine’s allies to strengthen their support.

New UK prime minister Keir Starmer condemned “attacking innocent children” as the “most depraved of actions.”

Biden called the strikes “horrific” and said “I will be meeting with President Zelensky to make clear our support for Ukraine is unshakeable.”

The Russian missile attacks were also a notable talking point at the NATO summit. The head of Ukraine’s parliament started his address by holding up photos of its aftermath and described it as Russian President Vladimir Putin laughing at the red lines the West has set. He added that it showed how the remaining restrictions need to be lifted.

US Secretary of State Antony Blinken and Ukrainian Foreign Minister Dmytro Kuleba also spoke at the start of the summit. Blinken acknowledged the hospital attack and said that it “underscores” how Russian aggression continues.

A devastating hit

The children’s hospital appeared to have been struck by a Russian Kh-101 missile, something the UK MOD previously described as being among Russia’s “most valuable weaponry,” but it is unclear if the hospital was Russia’s intended target.

War analysts looking at videos of the strike said there were no signs of damage or distress on the missile that would suggest it went off course. Russia has, however, long struggled with intelligence reliability and targeting for its devastating barrages.

A UN investigation found the children’s hospital likely took a direct hit from a Russian missile, likely a Kh-101. Ukraine also said it found Kh-101 remnants at the site.

Moscow has denied hitting the hospital, arguing instead that a Ukrainian anti-aircraft missile was responsible. Russia, throughout its invasion, has repeatedly made claims that have been disproven by evidence. War analysts said available visual evidence disputes Russia’s claims.

Russia has hit multiple hospitals, medical sites, and civilian sites throughout its war.

Menon said “it doesn’t in the end matter whether Russia did it deliberately or it was an errant missile or some commander screwed up. The fact is it was done, and it’s a war crime in a legal sense.”

Multiple Ukrainian officials have also called the missile attack a war crime, and a UN official said that “intentionally directing attacks against a protected hospital is a war crime and perpetrators must be held to account.”

Ukraine’s new air defense systems will bolster the country’s ability to prevent strikes like this, but they likely won’t fully meet its defense needs. Ukrainian President Volodymyr Zelenskyy said in April that Ukraine needs 25 Patriot systems with between six and eight batteries each to fully protect the country.

That’s a tall order as is, but Ukraine wants its international partners to go further still. It wants a clear path into NATO, as well as the lifting of the remaining restrictions on attacking legitimate targets in Russia. It remains unclear if the ongoing NATO summit will produce these results.

Senior defense reporter Jake Epstein contributed to this reporting from the NATO summit.

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