Russia's invasion of Ukraine has devastated hundreds of hospitals and other medical institutions and left doctors without drugs to tackle cancer or the ability to perform surgery, President Volodymyr Zelenskiy said.
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Zelenskiy said many places lacked even basic antibiotics in eastern and southern Ukraine, the main battlefields.
"As of today Russian troops have destroyed or damaged nearly 400 healthcare institutions: hospitals, maternity wards, outpatient clinics," Zelenskiy said on Thursday.
In areas occupied by Russian forces the situation was catastrophic, he said.
"This amounts to a complete lack of medication for cancer patients. It means extreme difficulties or a complete lack of insulin for diabetes. It is impossible to carry out surgery. It even means, quite simply, a lack of antibiotics."
The Kremlin says it targets only military or strategic sites and not civilians. Ukraine daily reports civilian casualties from Russian shelling and fighting, and accuses Russia of war crimes. Russia denies the allegations.
Pavlo Kyrylenko, governor of Donetsk region, said 25 people had been injured in intense shelling in the town of Kramatorsk, site of a railway station bombing last month in which more than 50 died.
Russia calls its actions in Ukraine a "special operation" to disarm Ukraine and protect it from fascists.
Ukraine and the West say the fascist allegation is baseless and that the war is an unprovoked act of aggression.
Russia has turned its heaviest firepower on Ukraine's east and south, after failing to take the capital Kyiv. The new front is aimed at limiting Ukraine's access to the Black Sea, vital for its grain and metal exports, and linking Russian-controlled territory in the east to Crimea.
In Mariupol about 200 civilians, along with Ukrainian resistance fighters, are trapped undergound in the Azovstal steel plant with little food or water.
The steel works was rocked by heavy explosions on Thursday as Russian forces fought for control of Ukraine's last stronghold and the UN rushed to evacuate civilians.
President Vladimir Putin said Russia was prepared to provide safe passage for the civilians but reiterated calls for Ukrainian forces inside to disarm.
Ukraine's stubborn defence of Azovstal has underlined Russia's failure to take major cities in a 10-week-old war that has united Western powers in arming Kyiv and punishing Moscow with sanctions.
Clinging on desperately, Ukrainian fighters have reported fierce battles with Russian troops in Azovstal.
A Ukrainian fighter holed up in Azovstal accused Russian forces of breaching the plant's defences for a third day despite an earlier pledge by Moscow to pause military activity to permit civilian evacuations.
"Heavy, bloody fighting is going on," said Captain Sviatoslav Palamar of Ukraine's Azov Regiment. "Yet again, the Russians have not kept the promise of a ceasefire."
The Kremlin denies Ukrainian allegations that Russian troops stormed the plant in recent days.
Aerial footage of the plant, released Thursday by Ukraine's Azov Regiment, showed three explosions striking different parts of the vast complex, which was engulfed in heavy, dark smoke.
Russia's military promised to pause its activity for the next two days to allow civilians to leave. The Kremlin said humanitarian corridors from the plant were in place.
Ukrainian Deputy Prime Minister Iryna Vereshchuk said on Thursday that people would be evacuated from Mariupol on Friday.
Sweeping sanctions from the US and European allies have hobbled Russia's $US1.8 ($A2.5) trillion economy, while billions of dollars worth of military aid has helped Ukraine frustrate the invasion.
Australian Associated Press
