Haiti, a nation rocked by gang cruelty and plagued with political infighting, has — so far this year — had three prime ministers, seen at least 4,000 people killed and experienced brutality from armed groups so intense that it forced an extended closure of its international airport, twice.

But despite $600 million spent by Washington on an international police force to restore order, an explosion of violence last week underscored the enormity of a crisis so severe that the Federal Aviation Administration has barred U.S. aircraft from flying under 10,000 feet in Haitian airspace to avoid being shot at by gangs.

With another interim prime minister in place, but gangs gaining territory every day, Haitians are desperate for relief. Efforts to stabilize Haiti are floundering, and the country presents a dangerous and disastrous challenge as President-elect Donald J. Trump prepares to take office.

Few people seem to have answers.

“I am a complete loss,” said Susan D. Page, a University of Michigan Law professor and former United Nations official in Haiti. “Everyone is just kind of astounded.”

What’s going on?

Haiti has experienced a long-simmering crisis for about 15 years, a period marked by a devastating earthquake, squandered aid dollars, tarnished international interventions and flawed presidential elections.

In 2021, the president, Jovenel Moïse, was assassinated in his house. The United States played a hand in deciding who would become the next prime minister, but many Haitians opposed the choice, Ariel Henry. During his three-year tenure, killings and kidnappings by well-armed gangs surged.

The United States had little appetite for sending its own troops to take on the criminal groups. Instead, the Biden administration devised a plan for an international mission made up mostly of Kenyan police officers to help support the local police.

In February, while Mr. Henry was in Kenya finalizing the plan’s details, rival gangs in Haiti banded together, unleashed terror and forced him out.

For months, the main airport was closed, neighborhoods were burned and civilians were killed. To fill the power vacuum, the United States and Caribbean countries helped Haiti hatch a plan for a nine-member transitional presidential council to rule the country.

A former U.N. official, Garry Conille, was named interim prime minister. The Kenyans arrived in June and gangs appeared, at least briefly, to pull back.

What’s happening now?

The presidential council announced last week that it had fired Mr. Conille and replaced him.

In an apparent effort to sow mayhem and demonstrate that they still wield considerable power, gang leaders escalated their attacks. They shot at least three U.S. aircraft on Monday and took over more neighborhoods in Port-au-Prince, the capital.

Videos circulated on social media showed people running through streets, many lugging children and suitcases.

An already grim situation could get worse. Gangs have traditionally steered clear of upper-class neighborhoods where wealthy Haitians, diplomats and international humanitarian aid workers live. But experts fear that could soon change, leaving the entire capital in the hands of armed groups that some are now calling “paramilitaries.”

So what now?

The Kenyan-led mission the Biden administration created and funded is widely viewed as a disappointment. Few other countries contributed money, leaving the force with less than 400 police officers, far less than the 2,500 initially envisioned.

Mr. Trump has made disparaging comments about Haiti, and many people think he will make the Kenyans leave as soon as he takes office. (His team did not respond to a request for comment.)

The Biden administration is pushing hard for the Kenya police mission — known as the Multinational Security Support mission, or M.S.S. — to be converted into an official U.N. peace keeping force. That would solve several problems: a lack of personnel, equipment and money. A U.N. peace keeping force would obligate member nations to contribute financially and provide troops, taking the burden of finding money and officers out of Washington’s hands.

Even though the last U.N. peacekeeping force brought cholera to the country and was embroiled in sexual abuse scandals, the current situation is so desperate that the move would largely be welcomed.

But China and Russia, which have veto power, have made clear that they’re not interested in such a move. The U.N. Security Council is expected to discuss sending an assessment team to Haiti to explore the idea this week, said a senior U.S. official who was not authorized to publicly discuss Haiti policy.

The hope is that the two countries will abstain instead of vetoing the proposal, according to several officials familiar with the talks.

Still, even if a U.N. peacekeeping mission were approved, it would take months to create, the U.S. official said.

The current multinational force is expected to increase to 1,000 officers by the end of the year with the addition of air support from El Salvador and marine support from the Bahamas, the official said. Haiti will also soon get about 20 more armored vehicles.

The mission was hampered because countries in the Caribbean and Latin America with a direct interest in preventing a mass migration out of Haiti did not provide the help they should have, the official said.

President Biden discussed a U.N. peacekeeping force with President Xi Jinping of China during their meeting at the Asia-Pacific Economic Cooperation forum in Peru on Saturday, but the Chinese leader did not change his mind, national security advisor Jake Sullivan.

If the U.N. Security Council rejects the move, another option would be to beef up the multinational mission. But Congress has balked at spending more money for Haiti.

Pressed on whether the Biden administration’s strategy was failing, a second senior U.S. official said the administration had done what it could with the limited resources Congress made available, adding that lawmakers were not treating the crisis in Haiti with the same urgency as other emergencies across the globe, like Ukraine or the Middle East.

The official, who spoke on the condition of anonymity to discuss diplomatic plans, maintained that the United States has kept the Haitian government from collapsing.

Will negotiating with gangs be necessary?

Vanda Felbab-Brown, an expert on nonstate armed groups at the Brookings Institution, said that if the crisis persists, it will likely force the Haitian government to make an unpalatable, but perhaps necessary move.

“If desperation reaches epic proportions, I think a more likely scenario is to see the political system” negotiate with the gangs, she said, adding that “would give gangs more power than they have already.”

That’s easier said than done. There are up to 20 different gangs operating in Port-au-Prince, and many of them have committed horrific crimes. While gang leaders talk openly about wanting a “seat at the table,” they have not offered to lay down their weapons, and the Haitian government is determined not to negotiate from a position of weakness, several experts said.

Nobody is seriously discussing amnesty for gang leaders who have committed multiple homicides. But with gangs having an estimated 12,000 members — half of them minors — serious talks would eventually have to take place to figure out how to disarm, demobilize and reintegrate them into society, the first U.S. official said.

Many gang members are desperately poor teenagers who lack job opportunities. Analysts agree that the Haiti needs to implement significant job training and educational programs to lure children from the grips of armed groups that pay a regular salary.

Talks are unlikely to start until the M.S.S. and the Haitian National Police succeed in capturing or killing top leaders, a goal that they have yet to achieve.

Stemming the flow of guns

Several Haiti experts stressed that the United States needs to do more to end the flow of guns from its shores to Haiti. Whether the solution is a full arms embargo or tougher sanctions on people known to finance and control gangs, experts agreed that the crisis will not end until high-powered weapons are off the streets.

“This is what Haitians have been consistently saying: ‘We do not produce guns,’” said Nathalie Frédéric Pierre, a Haiti expert at Howard University. “This is what is choking our society.”

Several Haitians interviewed expressed disappointment that the United States had spent so much money on the international force rather spending more on the Haitian National Police, which is vastly understaffed and ill-equipped.

“We wasted a lot of time money and energy that could have been invested in to our own Haitian solution,” said Vélina Élysée Charlier, a human-rights activist in Port-au-Prince.

Leslie Voltaire, who is currently president of the transitional presidential council — a position that rotates every few months — said he hopes to see the police accomplish a few victories against the gangs, even if it’s against “low-hanging fruit.”

“We are seeing that the international community is helping, but in a very slow way,” he said.

He hopes to see the Kenya mission reinforced with a better flow of supplies.

He said he is working on an action plan to submit to the international community that includes constitutional reform and planning for presidential elections next November.

“This is our road map, but it is very bumpy,” he said.

He does not know whether Mr. Trump will end the Kenya-led mission.

“I sent a tweet to him saying congratulations,” Mr. Voltaire said. “I know he loves tweets.”

He hasn’t heard back.

Zolan Kanno-Youngs, David C. Adams and André Paultre contributed reporting.

An Israeli airstrike hit the Lebanese capital on Sunday, a rare attack inside the city that comes as Israel’s military has been pounding areas outside it where Hezbollah holds sway.

Israel’s intensified push on the battlefield appears aimed at pressuring the Lebanese government and Hezbollah to accede to terms for a cease-fire for Lebanon worked out between Israeli and American officials, in what Israeli analysts describe as a strategy of “negotiations under fire.”

Lebanon’s Health Ministry said one person was killed in the strike on the capital, Beirut — the first to hit the city in weeks. The infrequent attacks inside the capital have tended to target individuals belonging to Hezbollah, and the attack on Sunday appeared to be no exception.

Mohammed Afif, the head of Hezbollah’s media office was “coincidentally present” when the building was struck, according to Lebanon’s state-run news agency.

As the de facto spokesman of Hezbollah, Mr. Afif was one of the group’s few remaining figures with a public profile. His role had gained newfound prominence in recent weeks after Israel killed Hezbollah’s leader, Hassan Nasrallah, in September along with much of the group’s top command and leadership.

The strike in Beirut on Sunday destroyed a seven-story building in the neighborhood of Ras al-Naba, Lebanon’s state-run news agency reported. It said that search teams were working to rescue a number of people trapped under the rubble.

The building housed the Lebanese headquarters of the Arab Socialist Baath party, a small political faction aligned with Hezbollah. In a statement, the party said that its leader, Ali Hijazi, was not in the building at the time of the strike.

Mr. Hijazi appeared to confirm Mr. Afif’s death on social media. He posted a photograph of himself sitting alongside Mr. Afif and wrote: “May God have mercy on you, dear brother, beloved fighter… You knew you would join the ranks of martyrs.”

The explosion set off panic and confusion in the city. People rushed out into the street, some screaming, others trying to reach people by phone. Smoke and dust filled the air and gunfire rang out as multiple ambulances rushed to the scene, where a crowd had gathered.

Um Ahmad, who gave only her first name, stood across from the building, her three young daughters huddled behind her. She said that she, her husband and their six children were staying in a nearby apartment along with dozens of others displaced by the war. The moment they heard the blast, they rushed out of their building in fear.

“We heard a loud boom and left immediately,” she said.

There was no immediate comment from Israel’s military about the strike in Beirut. Earlier Sunday, the Israeli military said it had conducted “intelligence-based strikes” against Hezbollah on the Dahiya, an area just south of Beirut where the militant group holds sway. A spokesman for the Israeli military, Avichay Adraee, said on Sunday that Israel had struck 50 targets in the area over the past week.

Abu Hussein had fled the Dahiya and taken a job as a security guard at a building in Beirut a few weeks ago. The building where he works was the one that was hit on Sunday.

After the strike, Mr. Hussein stood nearby in a daze. His head bandaged, and streaks of blood ran down his neck.

“The building was nearly empty” when the strike hit, Mr. Hussein said, as medics tended to his wounds.

Mr. Afif had appeared in public in recent weeks to speak to reporters at news conferences in the Dahiya. During one news conference last month, Israeli warnings of an imminent strike sent journalists scrambling to gather their equipment and leave as Mr. Afif told them, “The bombardments don’t scare us, so how should the threats scare us?”

Mr. Afif said at a news conference a week ago that Hezbollah had not yet received any official proposal for a cease-fire deal — though he noted that there had been “contacts between Washington, Moscow, Tehran and other capitals” on the issue since the election of former President Donald J. Trump.

Hezbollah, he cautioned, remained “ready for a long war.”

About 20 rockets were fired into Israel on Sunday, setting off alert sirens in the area around Haifa, Israel’s main northern port city, and other places, the Israeli military said. Some of the rockets were intercepted by Israel’s air defenses, and others fell in open areas. There were no immediate reports of casualties.

Hwaida Saad, Christina Goldbaum and Gabby Sobelman contributed reporting.

Russia renewed its campaign to destroy Ukraine’s battered power grid on Sunday, targeting facilities across the country with missiles and long-range drones in one of the largest and most complex bombardments of the war, Ukrainian officials said.

The attack lasted several hours and featured around 120 missiles and 90 drones, President Volodymyr Zelensky said in a statement. Air-defense teams destroyed 144 targets, but at least nine civilians were killed, officials said. Mr. Zelensky said F-16 pilots had shot down 10 targets.

“The enemy’s target was our energy infrastructure throughout Ukraine,” Mr. Zelensky said. “Unfortunately, there is damage to objects from hits and falling debris.”

Interceptor missiles could be seen streaking across blue skies over the capital, before exploding in thunderous claps. Similar scenes played out across Ukraine, Ukrainian officials said.

Russia used a combination of cruise and ballistic missiles fired from bombers, warships and land-based systems as well as swarms of drones from multiple directions. Ukraine had long expected a renewed attempt to collapse its energy grid, and it has come just as winter begins to bite.

Ukrainian officials said the attack was the latest demonstration that President Vladimir V. Putin of Russia remained bent not on a settlement but on the destruction of the Ukrainian state.

Ukraine’s foreign minister, Andrii Sybiha, said in a statement that the attack represented Mr. Putin’s “true response” to calls for peace. The minister added: “We need peace through strength, not appeasement.”

Precautionary emergency blackouts were announced across the country. With explosions in nearly every region, the extent of the damage was not immediately clear.

Even when air defense does its job, the margin between life and death can be a matter of inches as debris rains down. Serhii Melnykov said he was walking near his home in Kyiv when he heard a powerful explosion, followed by an urgent call from his wife.

“She was trapped under the debris,” he said. “I immediately called the ambulance and rescuers, but by the time I got home, my wife, Anya, had already gotten out from under the rubble.”

She suffered a concussion and was in shock, he said, but was out of danger.

Rescue workers told him that they pulled a 600-pound fragment of a 3M22 Zircon hypersonic cruise missile from his apartment, he said.

Russian authorities have claimed that the Zircon can reach eight times the speed of sound, which would make it one of the fastest missiles in the world.

In both its size and variety, Ukrainian officials said the attack ranked as one of the most complex of the war. They also warned that Russia has been stockpiling missiles for months and would likely be able to carry out similar attacks in coming weeks.

Oleksandr Musiienko, head of the Center for Military Law Research, said that in addition to undermining the Ukrainian economy and causing pain, the attacks served a political goal for the Kremlin: demonstrating to President-elect Donald J. Trump “that there is no alternative but to force Ukraine to make concessions.”

He expected the attacks to continue as Mr. Putin tried “create a picture” that Ukraine was doomed.

The bombardment followed months of nightly attacks by long-range drones, an effort to wear down Ukrainian air defenses and terrorize civilians.

Before Sunday’s attacks, the United Nations warned that Russian strikes on Ukraine’s energy infrastructure could result in further mass displacement and deepen suffering for millions.

“If they were to target the energy sector again, this could be a tipping point,” Matthias Schmale, the U.N. humanitarian coordinator in Ukraine, said on Friday.

Years of relentless attacks have destroyed around 65 percent of Ukraine’s energy infrastructure, leaving Ukraine even more vulnerable this winter. Because Ukrainian cities have centralized systems for water, sewage and heating, power cuts put all those services at risk.

The renewed assault also comes as Ukrainian forces struggle to slow Russian advances in eastern Ukraine.

Mr. Zelensky acknowledged the difficult situation in a radio interview broadcast on Saturday with the Ukrainian public broadcaster Suspilne.

“There is slow, but nonetheless ongoing pressure and Russian advancement.” he said. “For various reasons: filling our brigades with trained personnel, equipping and supplying brigades with weapons — these processes have been quite slow.”

He said the war “will end faster with the policy” of a Trump administration but cautioned that Ukraine needed to strengthen its position on the battlefield to have a chance of negotiating a just and lasting peace.

Mr. Trump has vowed to bring the war to a quick end without saying how. On the campaign trail, he and some of his supporters cast doubt on his commitment to supporting Ukraine, leading to speculation that he might try to pressure Ukraine by withholding military aid.

Mr. Zelensky has said he has yet to hear anything of the sort from Mr. Trump, and has also repeatedly said that he sees no indication that Russia would be willing to negotiate in good faith.

“I don’t think Putin wants peace at all,” he told Suspilne.

With the Trump administration considering appointing a special envoy to mediate talks between Russia and Ukraine, Mr. Zelensky said it was important that America continue to recognize Russia as the aggressor.

“You can’t speak abstractly, ‘I’m a mediator, so I cannot choose one side or the other,’” he said. “This cannot happen when it’s about cases where international law was violated.”

Yurii Shyvala contributed reporting and Nataliia Novosolova contributed research.

The strawberry ice cream for sale by the ticket booth seemed out of place at the museum to the My Lai massacre, one of America’s most ghastly crimes of war. The parking lot held a single car. Only a wide sign near the entrance explained the significance of the location.

It showed a map of the area as it looked on the morning of March 16, 1968, when a company of American soldiers showed up and killed more than 500 women, children and older men, raping girls, mutilating bodies and burning homes with families still inside.

One of the massacre’s survivors, Nguyen Hong Mang, would tell me later that he had met the soldiers with a smile, shouting, “Welcome, Americans!” He was 14.

Minutes later, he and his family and neighbors were being lined up and shot, crumpling into a pile of the dead and nearly dead.

Retelling such horrors, to visiting strangers and with a museum right where you live, takes a special kind of courage. Most war memorials in Vietnam focus on revolutionary heroes. My Lai is pure tragedy. And the way the affected hamlets deal with one of the war’s worst atrocities says a lot about how to honor trauma without becoming defined by its scars.

Over two days in Son My, the village 95 miles south of Danang that includes My Lai and other rural hamlets, I was often struck by efforts to treat hatred like a virus, to suppress its power, to avoid passing it on or letting it grow.

Five decades ago, weary American soldiers angry about recently killed colleagues took out their murderous frustration on helpless villagers. This year, the most bloodthirsty platoon commander, William L. Calley Jr., who was convicted of killing at least 22 people, died, spurring obituaries and bouts of reflection in the United States.

Yet survivors in the village mostly did not even know he was dead; instead, they spoke of those who did not kill, or who tried to stop the slaughter.

My experience of such generosity began with a museum video offering only a brief mention of Lieutenant Calley. It noted that while 25 soldiers were charged with murder, only he was found guilty, with a sentence that amounted to house arrest for a little more than three years.

The video mostly featured the museum’s director, Pham Thanh Cong, another survivor, meeting an American soldier involved in the massacre, and staying calm.

A second video, in Vietnamese, was even more magnanimous. A narrator highlighted a handful of humane soldiers: one who intentionally shot himself in the leg to avoid taking part in the violence, a helicopter crew that eventually intervened to stop the killing.

On the way out, I flipped through a book of visitors’ comments.

“That Calley is free, that no one paid, is all wrong,” wrote an American from Seattle in 2003.

A few pages later, a Vietnamese official, Nguyen Dang Vang, described the village’s resilience as “an inspiration for future generations,” barely mentioning the United States.

It was the sign of a resilient nation — Vietnam often tops Gallup’s ranking of the most optimistic countries — eager to seek prosperity with past enemies.

“One of the first things that many Americans notice when they go to Vietnam is that Americans are not just welcomed, not just tolerated — there is genuine enthusiasm,” said Edward Miller, a historian of modern Vietnam at Dartmouth.

In part, he noted, that is because the war’s atrocities have been countered by time. More than half of Vietnam’s population was born after the conflict ended. Many Vietnamese also hold fast to an idealized version of the United States, shaped by relatives who moved there.

But Americans tend to oversimplify Vietnamese good will. In the streets around the museum, forgetting was impossible, forgiveness earned.

At a one-story house just beyond the museum’s outer walls, two graying women were chatting outside. Pham Thi Tuong, 64, was just a young girl when the Americans landed. She and her family had hid near where she was sitting, in an underground shelter, shaking with fear at the sound of helicopters, screams and bone-shattering gunfire.

“When I finally got out of the shelter around noon, there were so many dead bodies,” Ms. Tuong said. “I was so small I didn’t know what to think.”

Her friend, Truong Thi Son, 67, said her husband’s family was killed.

“I carried a lot of hatred for a long time,” she said.

And now?

“So many people go to the U.S. to study, and so many Americans come here,” Ms. Son said. “If we feel hatred now, what’s the use? There’s no use for hatred.”

Upon hearing that Lieutenant Calley had died, Ms. Son felt neither relief nor anything else: He did not deserve a second of her attention. Ms. Tuong longed for accountability.

“It was so brutal,” she said. “They destroyed everything. They burned the houses, the banana trees, the animals.”

She suggested we keep going, past the rice fields, to see Mr. Mang, the one who had shouted, “Welcome, Americans!” He was 71 now, a farmer who raised cows and coconuts.

He guided us into his kitchen, where new tiles with white flowers brightened the walls.

“I don’t like to talk too often about what happened because it touches old wounds and the hatred that we once had,” he said.

Deep wrinkles encircled his eyes.

“I survived because the Americans shooting everyone ran out of bullets,” he said.

For nearly an hour, he recounted a day that seemed to never end as he hid under bodies seeping blood, so much blood, he said, “it was like pouring water from a bottle.”

At one point, I tried to shift the conversation, to give him an off-ramp. He insisted on continuing. His voice rose — “they killed pregnant women, small children, I will not forget” — as if wanting the world to hear.

By the end, as his tears dried, he landed where the museum tried to guide people: to a place where remembering was vital but rage was not.

He and his neighbors, like Tran Thi Diep, 67, who smiled as she greeted her grandson returning from school to a new home with white marble floors, had worked tirelessly to break the cycle of darkness, to put children through universities.

“I sold pigs and rice,” she said.

Her son was now an electrical engineer at a nearby factory. She envisioned a time when My Lai would mean more than horror.

“I want everyone to remember the pain, the brutality, the blood and bone — the losses,” she said. “But I also want this village to be known for transformation, for moving from hardship to prosperity.”

The museum has also evolved. It started out with grisly photographs. A more recent design features a diorama of armed Americans looming over villagers — still frightening, but less graphic.

The longtime director, Mr. Cong, 67, the only survivor in his family after an American soldier threw a grenade where they were hiding, said the museum existed to remind people what happened “and to cherish and protect peace.” He approved the cooler of ice cream.

He said he had been touched by what he had witnessed over the years, especially when a few remorseful American soldiers returned and spent hours on their knees, repenting.

Lieutenant Calley was not among them.

“I always kept the door open, welcoming him to return,” Mr. Cong said. “Now he is gone. I am not angry.”

In the museum’s gardens, mud footpaths between rows of reconstructed thatched-roof huts have been turned into concrete showing bike tracks, footprints and the distinctive marks of American military boots.

It made me think of young Vietnamese fleeing young Americans. Much of Vietnam now wants to imagine them walking together.

Israeli airstrikes pummeled two areas in central Gaza and a town in the north of the enclave on Sunday morning, killing more than 30 people and wounding several others, according to local rescue and emergency services.

In central Gaza on Sunday morning, a strike on a home in Nuseirat killed four people, the Palestinian Civil Defense said in a statement. Strikes in nearby Al Bureij killed 13 people, according to Mahmoud Basal, a spokesman for the Civil Defense, an emergency rescue group. He said that several others were wounded and that rescuers were still searching for people under the rubble.

The Israeli military did not immediately respond to a request for comment on the strikes in central Gaza, which came as it is waging a renewed offensive in the northern part of the enclave. In an effort to stamp out what the military has called a Hamas resurgence, Israeli troops, tanks and armed drones have bombarded northern Gaza almost daily.

On Sunday, the town of Beit Lahia again came under attack. Mr. Basal said, an Israel strike on a house there killed 15 people. Another strike hit a residential building where dozens of people were sheltering, Mr. Basal said, adding that information on casualties was not immediately available since rescue teams were unable to reach the area.

Gaza’s Civil Defense said it was forced to cease rescue operations in the north late last month because of attacks by the Israeli military on its members and destruction of its equipment.

Gabby Sobelman contributed reporting from Rehovot, Israel.

The missile wreckage fell from the sky on a Monday afternoon, a clumsy dagger that buried itself in the top floor of the Adonis clinic in central Kyiv. It caused an explosion that sent up a large plume of black smoke, blew out the windows in the back, ripped holes through the walls like tissue and arbitrarily spared items like a piggy bank and a carton of cream.

Within minutes, the news had spread among staff members.

“Is everybody alive?” one worker who was off that day asked on the staff Telegram chat.

No one answered. Another plea came 13 minutes later. “When you can, write to us how it’s going.” Then another, more distressed. “It’s horrible. Write that everything’s OK.”

Nine minutes passed.

“Not everybody,” came the reply.

This past summer was the deadliest three-month stretch for civilians in Ukraine since the initial onslaught of Russia’s full-scale invasion in 2022, according to the United Nations. Many of the victims in these attacks can seem almost invisible, just numbers added to a civilian death toll that is likely much higher than the official U.N. tally of about 12,000.

One of the deadliest days was July 8, when Russian missiles rained down across Ukraine, killing at least 41 people and injuring scores. Much of the world’s attention focused on the devastation at Ohmatdyt, Ukraine’s largest children’s hospital. A Russian missile slipped through Kyiv’s air-defense system, killing two adults and sending bloodied children running in terror.

Largely overshadowed was a strike several hours later at Adonis, a clinic five miles to the east that specialized in maternity care.

This is the story of that clinic and its workers, pieced together through interviews with more than a dozen survivors and family members, text messages, cellphone photos and security-camera videos. Adonis is one of more than 1,900 medical facilities damaged or destroyed since Russia’s full-scale invasion. In August, the World Health Organization said it had logged more attacks on the practice of health care in Ukraine than in any humanitarian emergency to date.

Though not all facilities are intentionally targeted, experts say Russia has historically attacked clinics and hospitals in conflicts to sow terror and push people to pressure their governments to surrender.

On this summer day, it was a grim lottery who was at Adonis. Some workers went to a staff member’s birthday party at another of the clinic’s buildings. The medical director took the day off to help her mother, who had broken her hand. An engineer had driven to the children’s hospital to see if he could help dig people from the rubble.

Svitlana Poplavska, a gynecologist and obstetrician, had recently come back from her own maternity leave and was working part-time. Monday was one of her days.

Oksana Korzh, the clinic’s matron, who took care of things like getting clean sheets or new chairs, wanted to spend the day with her grandchildren. Her daughter had given birth to twins 11 days earlier. But she had to work.

“Bye bye, babies,” Ms. Korzh said that morning, kissing them on their heads. “Your grandmother will come in the evening.”

‘A Circle of Help’

Dr. Olha Hyrina opened her first clinic in Kyiv in 1997 in three rented rooms. At the time, with the Soviet Union a recent memory, private clinics and hospitals were largely unheard-of in Ukraine.

Her husband came up with the name, Adonis, inspired by the red flower that in Greek myth sprang from the blood of a young mortal and the tears of the goddess Aphrodite, his lover. The flower, an anemone, can symbolize the loss of a loved one. But it also, Dr. Hyrina liked to tell people, has healing powers.

Eventually, Adonis expanded to 20 rooms, with ultrasounds and interns. It opened new clinics. In 2012, the company launched a flagship maternity hospital on a hill about 20 miles west of Kyiv, the capital, that could see 300 patients a day. It started to accept private medical insurance.

International patients visited, drawn by less expensive rates for in vitro fertilization and cosmetic procedures. A laboratory worked with stem cells. Adonis also offered surrogacy to hopeful parents from outside Ukraine.

By early 2022, Adonis had 11 clinics in the Kyiv area. Dr. Hyrina, who kept her purplish black hair neatly styled and favored blouses with paisleys and beads, often described her mission as creating “a circle of help for women.”

In the days after Russian troops invaded that February, pushing toward Kyiv, the flagship hospital came under attack. A local soccer team arranged for buses to evacuate people. But some patients could not leave, including the women who were about to give birth. Staff members moved them to the basement, where they delivered babies in the darkness as shelling rang out above.

That clinic was eventually destroyed, with no fatalities.

Because of the war, most international patients stopped coming. Many pregnant women left the country to deliver their babies. Financial strains forced three more Adonis clinics to close.

But the original clinic, in a four-story building on the east bank of the Dnipro River, stayed open.

A Kind of Family

At a birthday party for the clinic’s medical director, the chief nurse, Tetiana Sharova, made the main toast, near a long narrow table laden with sliced meats and vegetables.

“We wish you success, mutual understanding, prosperity,” Ms. Sharova said, holding up a plastic glass with juice inside.

Every staff member at Adonis seemed to have a specific connection to the clinic, a role to play. Ms. Korzh, the matron, was the den mother, anticipating everyone’s needs. Ms. Sharova was the social leader, quick with a toast and a joke.

Indeed, the clinic had become a kind of family, celebrating holidays and special occasions. Doctors cared for the families of fellow employees, including Ms. Korzh’s daughter and her twins. In May, workers dressed in vyshyvankas — traditional embroidered outfits, once thought to ward off harm and bring good luck — to mark a national holiday.

Several staff members had bonded after escaping the eastern Donetsk region, where fighting against Russian-backed separatists had simmered since 2014. This gave them all something to talk about — the homes that they had been forced to leave, their family members who had lost everything, even their lives.

Ms. Sharova, for instance, had fled the same clinic in Makiivka, 10 miles from Donetsk, as Viktor Brahutsa, an ultrasound diagnostics doctor at Adonis who delighted in being the first person to tell a woman she was pregnant.

She and her husband, Ihor, moved into a studio apartment in a Soviet-style building in Kyiv that they joked reminded them of their first apartment in the east — boiling in the summer, freezing in the winter.

Ihor Sharov often drove his wife to Adonis. When the power was off because of blackouts, she carried her hair dryer and used the clinic’s electricity to dry her hair. She liked to dress smartly, despite having to change into blue scrubs at work.

On the first weekend of July, she listened to songs on her earbuds and danced around her apartment in a short red and blue caftan. She teased her husband for not being able to move like her.

Ms. Sharova and her husband had wanted to take a few days’ vacation to visit their son and his wife, southwest of Kyiv.

But Ms. Sharova could not find anyone to fill her shift. So on that Monday, with the electricity working, she dried her hair at home, put on a new red dress and left for work.

The Explosion

The air-raid sirens started about 10 a.m. Women climbed out of their examination stirrups. Patients got dressed. Everyone ran downstairs to the parking garage, which doubled as a bomb shelter.

As they huddled, they learned about the attack on the children’s hospital. Staff members called and texted family members, making sure everyone was OK. When the sirens stopped, employees and patients headed back to the clinic, but the mood was somber.

About 12:45 p.m., Dr. Hyrina’s son and daughter stopped by and asked her to come with them to the bank. She did not want to leave — she was already so far behind with work — but they insisted.

“We were in a hurry,” Dr. Hyrina recalled later. “I wanted to get back.”

At 12:57 p.m., the air-raid sirens went off again.

No one moved quickly. What were the odds of another attack? Ms. Korzh rested her elbows on a countertop, video footage shows. Ms. Sharova leaned against the wall, her glasses in her right hand, her phone in her left.

At 1:02 p.m., a large piece of missile debris fell from the sky, hitting just outside Dr. Hyrina’s office, blowing out the glass walls of some offices and setting off an explosion. All of the security cameras went dark. Dr. Kateryna Bondar, a dermatologist, was tossed onto the stairwell.

It’s not clear exactly what happened. Adonis does not appear to have been deliberately targeted, but instead was collateral damage from a missile intercepted far above, officials said.

After the dust cleared, after those who were conscious checked themselves for injuries, they stumbled to find the injured. One of those they found was Dr. Brahutsa, the ultrasound specialist. Two doctors started cardiopulmonary resuscitation on him, but he had lost both his legs.

Dr. Bondar picked herself up. She did not realize what had happened. Maybe a missile hit a taller building nearby, she thought. She ran down to the shelter and waited, maybe 15 minutes.

Then Dr. Bondar walked outside and saw that her workplace had been hit.

Another siren went off. More people were pulled from the clinic. Dr. Bondar was asked to help the assistant cashier, who had been sitting near Ms. Korzh and Ms. Sharova. A tourniquet had been tied above each of her elbows, to stanch the bleeding in her lower arms, and her clothes were the muddy color of gray dust mixed with blood. She asked for water. Her lip was cut. Dr. Bondar started wiping her face and realized the jaw was shattered.

“I think I’m dying,” the assistant cashier said.

“You’re not dying, don’t die!” Dr. Bondar told her. “Don’t you dare.”

The Aftermath

Seven people died at Adonis that day. Two patients. Dr. Brahutsa, 52, the ultrasound doctor. Dr. Poplavska, 38, the gynecologist who had recently given birth. Viktoriia Bondarenko, 51, the head cashier.

Ms. Korzh, 44, the new grandmother, did not make it either. Her husband identified her by her manicure: pink nails with white polka dots.

And then there was Ms. Sharova, 52. Her limp body, covered in blood, was placed on a small white trolley next to an ambulance, her hands hanging off the sides.

The five staff funerals were all on the same morning, three days after the explosion. Clinic employees went from one to the next. Dr. Brahutsa’s was first. At 8 a.m., his coffin was brought to the hospital and placed just outside the front doors before being buried at a family plot hours away.

The other funerals followed, a procession of grief. Ms. Korzh was laid to rest in her favorite vyshyvanka: blue and yellow, the colors of the flag.

Mr. Sharov gave much of his wife’s jewelry to their daughter, but traces of her remained everywhere. There was her Alive perfume on the dresser top, near his Eternity cologne. Her shoes from that day, and her bloodstained beige purse. He put those in his car trunk because he did not know what else to do.

Dzvinka Pinchuk and Evelina Riabenko contributed reporting from Kyiv.