The World Health Organization assembly passed a motion on Wednesday condemning Russia's aggression against Ukraine, including attacks on healthcare facilities.
The motion passed by 80 votes to 9, with 52 abstentions and 36 countries absent.
The Western-led motion, put forward at the U.N. agency's annual meeting, also called for an assessment of the impact of Russia's aggression on the health sector.
Russia had submitted a counter-proposal recognising the health emergency in Ukraine, but making no mention of its own role in the war.
That motion was rejected by the assembly immediately after the first, by 62 votes to 13, with 61 abstentions and 41 countries absent.
After the votes, the Russian representative told the assembly it was not against the work of the WHO in Ukraine, but it was against the "politicization" of the body.
Ukraine's representative said the vote was a "sign of hope" for its citizens in need of health assistance, and a milestone in the continuation of the WHO's work in the country.
Tensions had been running high in the run up to the twin votes. During speeches that were critical of Russia, Moscow's envoy interrupted with points of order.
Britain's ambassador Simon Manley also accused Russia of spreading "disinformation" at the assembly and a Russian official confirmed it had distributed pamphlets accusing Ukrainian forces of attacking medical facilities in parts of the country it controls.
Moscow has consistently denied targeting civilians during what it calls its "special military operation" in Ukraine.
The votes echo last year's assembly, when two sets of motions were also presented, with the Western-led resolution passing with 88 votes for and 12 against. Abstentions and absence levels were high, as in this year's vote.
(Reporting by Emma Farge in Geneva and Jennifer Rigby in London; Editing by Toby Chopra and Alex Richardson)
