YEREVAN, Armenia (AP) — Rockets hit a hospital and residential areas Wednesday amid deadly fighting between Armenian and Azerbaijani forces over the separatist region of Nagorno-Karabakh that has raged for more than a month despite a U.S.-brokered cease-fire.

In Nagorno-Karabakh, an Azerbaijani rocket hit a maternity hospital but inflicted no casualties. Azerbaijani authorities denied responsibility and in turn accused Armenia of launching a rocket strike on the town of Barda that killed more than 20 civilians and wounded over 70. Armenia rejected the accusations.

Nagorno-Karabakh officials said Azerbaijani forces hit Stepanakert, the region's capital, and the nearby town of Shushi with Smerch long-range multiple rocket systems, a devastating Soviet-designed weapon intended to ravage wide areas with explosives and cluster munitions. One civilian was killed in Shushi and two more were wounded, officials said.

There were no patients or medical personnel in the maternity hospital in Stepanakert at the moment of the strike, which also damaged adjacent premises of a sprawling medical center filled with patients.

Mger Musailyan, the center's chief doctor, denounced the attack as “inhumane,” noting that the medical center is treating COVID-19 patients among others. The region has seen a spike in infections amid the fighting that has diverted scarce medical resources to treat the wounded.

"This is absurd to attack a hospital. It’s prohibited in the whole world,” Musailyan said.

Inna Gasparyan, the chief nurse, said the coronavirus patients are helpless. “Those patients who are here, they are all on breathing machines, they are very sick and they cannot be evacuated to the basement,” she said.

The Azerbaijani Defense Ministry denied hitting the maternity hospital and targeting other civilian areas and in turn accused Armenian forces of using the Smerch multiple rocket system to fire at the Azerbaijani towns of Terter and Barda. The strike on Barda killed at least 21 civilians, including children, and wounded more than 70, Azerbaijani officials said.

Armenian Defense Ministry spokeswoman Shushan Stepanian called accusations of striking Barda “groundless and false.”

The U.N. children’s agency UNICEF said a dozen children aged between 10 months and 16 years are known to have been killed during one month of fighting in and beyond Nagorno-Karabakh. It said that over 130,000 people have been displaced, 76 schools and kindergartens have been damaged and a maternity hospital has been shelled.

“Countless children are being scarred by the psychological impact of daily exposure to rocket and missile attacks in civilian areas,” UNICEF said, urging an immediate cease-fire.

U.N. Secretary-General Antonio Guterres reiterated his appeal to Armenia and Azerbaijan to immediately implement the humanitarian cease-fire both sides committed to, saying “the ongoing hostilities are unacceptable and must stop immediately,” U.N. spokesman Stephane Dujarric said.

Azerbaijani President Ilham Aliyev promised on Twitter a “befitting response” for the strike.

Nagorno-Karabakh lies within Azerbaijan but has been under the control of ethnic Armenian forces backed by Armenia since a war there ended in 1994. By then, Armenian forces not only held Nagorno-Karabakh itself but also captured substantial areas outside the territory’s borders.

The latest fighting, which began Sept. 27, has involved heavy artillery, rockets and drones, in the largest escalation of hostilities over the separatist region in the quarter-century since the war ended. Hundreds, and possibly thousands of people, have been killed in the latest fighting.

The hostilities have raged for over a month despite international calls for peace and three attempts at establishing a cease-fire. The latest U.S.-brokered truce frayed immediately after it took effect Monday, just like two previous cease-fires negotiated by Russia. The warring sides blamed each other for violations.

According to Nagorno-Karabakh officials, 1,068 of their troops and 39 civilians have been killed in the clashes so far, while 122 civilians have been wounded. Azerbaijani authorities haven’t disclosed their military losses, but say the fighting has killed 69 civilians and wounded 322.

Russian President Vladimir Putin said last week that, according to Moscow’s information, the death toll from the fighting was nearing 5,000, significantly higher than what both sides report.

Azerbaijan's leader claimed in an interview published Wednesday that about 5,000 Armenian soldiers have been killed — a claim rejected by the Armenian military.

Russia, the United States and France have co-chaired the so-called Minsk Group set up by the Organization for Security and Cooperation in Europe to mediate the conflict, but they have failed to score any progress.

Aliyev has repeatedly criticized the Minsk Group for failing to achieve any results in three decades and insisted that Azerbaijan has the right to reclaim its territory by force since international mediation has failed.

The Minsk Group’s co-chairs are set to meet with the foreign ministers of Azerbaijan and Armenia in Geneva on Thursday, but prospects for progress appear dim.

Turkey, which has thrown its weight behind Azerbaijan in the conflict, has sought to take a more prominent role in the peace talks — something Armenia has vehemently opposed.

Turkish President Recep Tayyip Erdogan told his ruling party’s legislators Wednesday that during a phone conversation with Putin the day before, he proposed that Ankara and Moscow work together to resolve the conflict by using their influence on the Azerbaijani and Armenian leaders.

“If you want, we can solve this issue together,” Erdogan said, recounting his conversation with Putin. “You hold talks with (Armenian Prime Minister Nikol) Pashinian, and let me hold discussions with my brother Ilham (Aliyev). Let’s bring this issue to a sweet end."

Asked about Russia's view of Turkey's push for a bigger role in the Nagorno-Karabakh talks, Kremlin spokesman Dmitry Peskov said that it's up to the warring parties to invite mediators.

Russia, which has a military base in Armenia and a security agreement to protect its ally, has been involved in a delicate diplomatic game while trying to also maintain good ties with Azerbaijan and avoid a showdown with Turkey.

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Associated Press writers Daria Litvinova and Vladimir Isachenkov in Moscow, Aida Sultanova in London, Edith M. Lederer at the United Nations and Suzan Fraser in Ankara, Turkey contributed to this report.