The bombed maternity hospital in Mariupol, Ukraine (Image: AP Photo/Evgeniy Maloletka)

Women and children have been trapped under rubble after Russian airstrikes hit a maternity hospital in the besieged south-eastern Ukrainian city of Mariupol. Ukrainian President Volodymyr Zelenskyy said it was a “direct strike,” asking: “How much longer will the world be an accomplice ignoring terror?”

Footage is heartbreaking. Ukrainian officials say at least 17 people were injured, including women in labour, with heavily pregnant women, post-partum women and babies carried out on stretchers.

Russia has continuously denied targeting civilians. 

So far it’s one of the most direct and blatant examples of a war crime across the 15-day war. The outrage from the international community is palpable. With such attacks on vulnerable citizens, could this be a turning point in the international response to the war? 

Push for ceasefire has been unsuccessful 

United Nations secretary-general António Guterres said the attacks were “horrific”, and called for an end to the bloodshed. UK Prime Minister Boris Johnson said they were “depraved” and said the UK “will hold Putin to account for his terrible crimes”. 

This is notable and may signal the UK’s support for Russia to be tried in the International Criminal Court (ICC) for war crimes.

It’s not the first time civilians have been targeted: four days into the invasion Kyiv’s Okhmadyt children’s cancer hospital was struck by artillery fire, forcing those who were well enough to evacuate and sick kids into the basement.

Medical Association for Prevention of War (Australia) president Dr Sue Wareham tells Crikey the attacks were absolutely forbidden in terms of war and constituted war crimes under the Geneva Convention.

“We would hope that this would be a turning point in ensuring that there are negotiations for a ceasefire … and we must advocate for intense negotiations for as long as it takes for a ceasefire to be reached,” Wareham said, adding Russia needed to feel its concerns had been adequately considered.

But negotiated humanitarian corridors have largely been unsuccessful; Ukraine accused Russia of not honouring a ceasefire and Russia accused Ukrainian nationalists of continued fighting. 

World leaders are calling for a ceasefire. Chinese President Xi Jinping said yesterday that only “maximum restraint” would prevent the war from “spinning out of control”. German Chancellor Olaf Scholz called attacks on civilian areas “inexcusable”, Canadian Prime Minister Justin Trudeau said the world needed a “strong coordinated response” to the invasion and US President Joe Biden has said by not responding to Putin’s assault “the cost to freedom and to the American people will be even greater tomorrow”.

Russia emboldened by UN’s hands-off approach 

The UN has specific definitions of war crimes, genocide, crimes against humanity and ethnic cleansing. When the definition is met, it is supposed to spur accountability, with perpetrators tried in the International Criminal Court. In reality, this rarely happens, Wareham says. 

“In recent wars, attacks on civilians or civilian infrastructure have almost become a part of modern warfare, and we’ve seen this in Syria, Afghanistan and Iraq,” she said. “A good precedent has not been set for accountability in attacks like this.”

In 2015 the US attacked the Kunduz trauma hospital in Afghanistan, killing 42 people despite Médecins Sans Frontières notifying the military it was attacking patients. The US called the attack an accident and has apologised but has not gone to trial in the ICC.

“There could well be a sense within Russia that they’ll get away with this because across genocide, multiple violations of the rules for international humanitarian law and other attacks on healthcare facilities, there hasn’t been accountability held,” Wareham said. 

“There’s a lot of grandstanding and bluster about how unacceptable this is, but when it comes down to actually holding all nations accountable by the same rules, then that’s missing.”

Other nations could commence war crimes prosecution 

Holding perpetrators to account in the ICC is no easy feat, Australian National University international law expert Don Rothwell tells Crikey. 

“The prosecutor at the ICC has now clear capacity to continue an investigation into war crimes in the conflict, so there’s no legal issue,” Rothwell said. 

“But each alleged crime raises new issues in terms of who will be held responsible — who ordered the military action and who holds responsibility?”

One key difference in Ukraine is that the crimes are not historical, and are being heavily documented by international media. Instead of waiting for the UN to take action, Rothwell says, independent nations could launch their own war crimes prosecution against Russia — which Australia did during the 1990s against former alleged Nazi war criminals.  

While this would “add an additional level of accountability for those who are responsible for these acts”, Rothwell says, it’s again difficult. The US has shown a degree of hostility towards the ICC, and with tensions between Europe and Russia so high it’s unlikely any country would begin proceedings. 

Even if they did, “the big issue is arresting and detaining the alleged perpetrators of these international crimes … and if these persons are Russians, Russia is not going to hand these persons over”, Rothwell said.

Countries like Australia can assist the ICC by collecting testimonies and information from those fleeing conflict to assist the UN when and if prosecutions are brought.