“Ukrainian air defences have historically had high shoot-down rates for certain types of cruise missiles, particularly the older Kh-101 variety,” the Institute for the Study of War wrote in its latest daily report on the conflict in Ukraine.

“But Ihnat’s suggestion of Russian forces launching cruise missile strikes at such low altitudes indicates that Russian forces may have innovated their tactics and/or technology somewhat to inflict maximum damage on Ukrainian infrastructure by giving Ukrainian air defence practically no time to respond until the missile is already within close range of the ground.”

Ukraine has deployed similar tactics, with its air force launching British Storm Shadow missiles to fly low to the terrain to make them harder to intercept.

Kyiv’s pilots often fly at low altitude to use the terrain below to cover their approach from Russian radars on the ground.

An assessment by the United Nations monitoring mission in Ukraine said that evidence from the scene had indicated a “high likelihood” of a direct hit from the Russian cruise missile.

Some 670 children and 1,000 staff members were at the hospital at the time of the attack.