The hospital gurney on which Valeriy is carried into the operating room is shaped like a cross. Cloth ties each arm loosely to the perpendicular extensions. The 52-year-old has been shot in the abdomen. Now it’s time to clean his wound.

“He is lucky in a way, the bullet missed his vital organs,” explains Dr Khassan El-Kafarna, a 27-year-old surgeon at the hospital in Kostiantynivka. “The problem is the wound was not clean when he arrived; he spent three days in Bakhmut managing it on his own.”

Across the roughly 600-mile frontline there are pockets of civilians living through the deadliest fighting in Europe since the Second World War.

Despite the often noble efforts of volunteer groups and the Ukrainian government to evacuate those caught in the crossfire, it is not uncommon for civilians to stay put even as the frontline overtakes their homes. Ukraine’s Donbas section of the front has consistently seen some of the heaviest fighting of the full-scale war, and it follows eight years of regional fighting between Russian-backed separatists and Ukrainian government forces. Civilians unable or unwilling to leave the area are often injured or killed.

In the midst of this is Kostiantynivka, a small industrial town ten kilometres from the frontline and 25 kilometres from the Russian-held city of Bakhmut, which has long been the focal point of the war. The town has become the primary stabilisation point for civilians injured along the front from Bakhmut to Niu-York, an old Ukrainian town somewhat puzzlingly named after the Big Apple and roughly 30 kilometres from Donetsk.

Situated between the strategic city of Kramatorsk and the front, Kostiantynivka is frequently hit by rocket, missile and artillery fire. Despite these dangers and the ever-present threat of the front moving closer, the staff at the hospital continue to provide life-saving care.

El-Kafarna, the surgeon treating Valeriy, says people in Kostiantynivka “have adapted to something they shouldn’t have to adapt to – the sound of explosions, the military moving around”. He adds: “People should not have to live in such conditions, but we will stay as long as we can".

Valeriy, who also lost most of his hearing during the incident, groans as nurses prepare his wound for cleaning. Bloodied gauze protrudes from two holes on the left and right of his stomach. Though the bullet passed through without damaging any organs, the holes are wide enough to take a bottle of water. Within minutes El-Kafarna and the team have removed the gauze packing, disinfected the wound and rewrapped Valeriy’s abdominal area, tasks that have become all too familiar to the doctor, who has been working in Kostiantynivka for nearly a year after spending the initial months of the war in Kyiv.

“After shellings we have mainly traumatic injuries, mostly to extremities, but we also see penetrating wounds to the abdomen and the thoracic cavity and so on,” El-Kafarna says after finishing with Valeriy.

The hospital has many cases like Valeriy’s. When the battle for Bakhmut reached its peak before Russia’s mercenary Wagner Group captured it in late May, wounded civilians streamed out of the destroyed city.

Valeriy explains: “I walked to a point where I knew I could get food from volunteers, ten minutes from my home. I heard sudden automatic gunfire and explosions, my arm went numb and I felt pain in my abdomen. I then felt blood and collapsed onto the ground. I stayed there for a few hours until volunteers could get me and bring me to shelter."

Throughout the battle for Bakhmut, church volunteers, non-governmental organisations and other informal groups worked with the Ukrainian army to bring food, water and other supplies into the city, while evacuating as many people as possible. The intensity of Russian shelling dictated each window of opportunity, and Valeriy stayed in the city for three days before being evacuated to Kostiantynivka. Living alone with no relatives, the former tractor driver still hopes to return to Bakhmut.

“I hate the Russians, but I do not want to lose my apartment,” he explains, seemingly indifferent to the likelihood his home would not survive the conflict.

In the hallway outside Valeriy’s room sits another man in a wheelchair. Vladimir, 40, was also wounded in Bakhmut, injured by a landmine as he crossed a street with three other men to board up the windows of a neighbour’s house.

“I know of probably 20 people who had left Bakhmut, ran out of money after two months or so and then came back,” he says. “Rent can be very expensive and some people accuse us of supporting Russia because we are from Bakhmut.”

Vladimir’s father also remained in Bakhmut, but as he lived near the Russian lines, he lost contact with him. “We thought everything would be okay, would get better, improve, so we didn’t leave. But now I want to warn people to leave, because it is hell there....it is hell,” he adds.

The need to care for elderly family members is often the reason people miss the opportunity to evacuate safely while they can.

Galina, a middle-aged businesswoman being treated for a shrapnel injury to her left arm and shoulder, says: “I stayed for my 92-year old-father who didn’t want to leave Bakhmut.

“At first we thought everything would be okay and it would be over very fast, but later there were no cars to evacuate us…we postponed too much”.

Galina was living in a basement with her son and father when a mortar round exploded, throwing her into a wall and leaving a gaping wound in her back. Her son, who is partially sighted, provided rudimentary first aid for 24 hours until a neighbour was able to drive the family to an evacuation point. From there, David, a volunteer from Britain, brought them to the hospital in Kostiantynivka.

“My father and my son were brought here and we were all allowed to stay together,” Galina explains. “I’m very grateful, they’ve provided great help to our family.”

The wounded are brought to the hospital for immediate care and then either moved to a larger hospital further from the front or allowed to recuperate here, depending on the severity of injury. Sharing a room with Galina is 59-year-old Kostiantynivka resident Rudakova Antonina Viktorivna, who suffered shrapnel injury to her legs from a bomb that detonated outside her home. Viktorivna and 12 others were injured.

“War is a very bad thing,” she says. “So many are suffering, and now I’m lying here and I am afraid because I can hear the explosions not far from here.”

That sound of explosions is a constant in Kostiantynivka, which has led the hospital to fortify ground floor windows with sandbags. A basement is also available to move patients when deemed necessary. When openDemocracy visited, it was caring for 50 injured civilians, 20 of them from Kostiantynivka.

Chief surgeon Yuri Mishasty says it is important for the outside world to know “Ukraine is dealing with a very bad and cruel enemy. A very disgusting enemy. A very bloody enemy”. In between treating patients, he adds: “Two weeks ago, weapons were used near our hospital. It’s difficult, but we do our jobs.”

Hospitals across Ukraine have not been spared by Russian attacks – a grim repeat of the tactics it used in Syria, where it bombed healthcare facilities for six years. Nearly one in every ten hospitals in Ukraine has been damaged by Russian attacks, with one recent strike killing two people and injuring 31 in the city of Dnipro.

The intensity of the war and attacks on healthcare infrastructure have taken their toll. The Kostiantynivka hospital has its own doctors, nurses and support staff, but also benefits from vital outside assistance as well as donations, which help them maintain a high level of care.

In recent weeks, Ukrainian forces have begun offensive operations in the vicinity of Bakhmut. On 14 June, Russian shelling killed three people and wounded three others in Kostiantynivka and Kramatorsk. A fortnight later, a Russian missile killed 13 people at a pizza restaurant in Kramatorsk.

“The war is a big disaster for everyone,” laments Galina from her hospital bed. “I have a great fear of the future.”

Anastasia Yaremchuk, the hospital’s director, says the staff are clear about their mission: “The frontline is so near, but life continues. It is stressful, but all of us who are here, choose to be here. We still have babies being born here and for us new life is probably the best thing that can happen.”