DEBALTSEVE, Ukraine — It took nearly five months but Elena Koshikova finally convinced her ailing husband, Petr, to flee as fighting between Ukrainian forces and Russia-backed rebels intensified.

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"I'm very worried — he is all that I have now," Koshikova said of her husband, who has suffered a wheezing cough since the couple took shelter from near-constant artillery fire in the musty basement of Debaltseve’s railway station along with scores of others.

"I told him, 'This could be our last chance,'" she said, stroking the back of her husband’s neck as the couple waited for buses sent to evacuate the displaced.

But they missed one of the last buses out of the strategic rail junction, where thousands of Ukrainian soldiers are fighting to fend off a rebel offensive that has left the town nearly encircled. The buses arrived at the city's town hall instead of the railway station, sending some of the younger people darting down the street as missiles flew overhead to try and get a place on one of the buses before they sped off.

A boy runs to join others escaping the town of Debaltseve, eastern Ukraine on Sunday, Feb. 1, 2015.

Kiev has promised to evacuate civilians in the areas of eastern Ukraine where violence has erupted anew. But the government, with its limited resources, has only been able to evacuate a few hundred people every day, leaving thousands of other desperate residents caught in the crossfire.

In Debaltseve, where 12 civilians were killed on Saturday, according to Vyacheslav Abroskin, the regional police chief, those who manage to get a seat on a bus, must then worry about surviving the ride north to Artemivsk. The sole road in and out of the town is a precarious, cratered wreck where rockets rain down constantly.

One of two bridges along the route has been blown up twice but patched with metal beams so vehicles can still pass over.

In the rebel-stronghold of Donetsk about 45 miles to the south, the situation has become extremely dire over the last six months. In June, Kiev cut off support to public and social services, including pension payments, medical supplies and salaries for government workers.

Making matters worse, the banking system was shut down with local branches closing, ATM machines no longer working and credit card payments becoming blocked. Whatever money was left in peoples’ accounts became inaccessible, if not entirely lost.

A man waits with his dog and three children for a ride out of the besieged eastern Ukrainian town of Debaltseve on Sunday, Feb. 1, 2015.

For a while, residents could travel via a precarious corridor on the western edge of Donetsk to the other side of the front line to withdraw money or receive pensions. But that has become next to impossible following a stringent new measure that recently came into effect. Anyone going in or out of the rebel-controlled areas are now required to hold a special pass that must be obtained on the Kiev-controlled side of the front line after a 10-day wait.

A man assists a woman as residents prepare to evacuate the eastern Ukrainian town of Debaltseve on Sunday, Feb. 1, 2015.

Ongoing fighting has further exacerbated the situation, making it more complicated than ever to pass through checkpoints. Because of artillery fire, the roads in and out of Donetsk were closed in recent days and nobody was allowed to pass, not even trucks carrying humanitarian aid.

Loïc Jaeger, deputy head of mission for Doctors Without Border in Ukraine, said the new rules means that doctors and nurses working in front line hospitals are "now stretched to breaking point."

A woman and her dog prepare to flee the eastern Ukrainian town of Debaltseve amid intense fighting on Sunday, Feb. 1, 2015.

The government in Kiev is suspicious that those who have stayed in the rebel-controlled territories may have pledged allegiance to the self-proclaimed separatist republics. And a senior Ukrainian security official said the new rules are intended to restrict to the movement of people who have stayed in rebel-held areas.

"It is not a game," the official said. "This is a war."

"All the people that are left on the occupied territories have made their choice, and refused to leave," said Semyon Semenchenko, commander of the Ukraine's Donbass Battalion and a member of parliament, in a televised interview last month while explaining why the military had blocked humanitarian aid from the eastern regions under separatist control. "All this nonsense that old people and children are starving, it is not true and it is a manipulation of the facts."

A Ukrainian soldier assists Debaltseve residents in carrying a jug of water across town on Sunday, Feb. 1, 2015.

But nowhere is food and medicine needed more — and human suffering evident — than in the rural towns of eastern Ukraine.

In Komunar, a town of some 2,000 residents about 10 miles from the front line, people are living on a meager diet of grains, pasta and tea, without gas and electricity in subzero temperatures. There are no doctors left and the town's only pharmacy is closed. It's a dire situation in a place where most of those who have been left behind are elderly.

Huddled next to the warmth of her wood stove — her only means of heat — 96-year-old Vera Martinovskaya recalled the Second World War, saying it reminded her of what is happening now.

A Ukrainian soldier takes a smoke break atop his tank in Debaltseve, eastern Ukraine, Sunday, Feb. 1, 2015.

In the neighboring town of Verkhnya Krynka, where the only way in and out is a makeshift road over a field marked with deep craters and covered in a thick sheet of ice, the situation has grown particularly grim. The few hundred residents whose homes were bombarded by artillery shells last summer when it temporarily became the front line of this war, rely almost solely on shipments of humanitarian aid, which are few and far between.

There's a pervading desperation in the village. Valentina Mazur, a 55-year-old woman, recently hung herself inside her home after her husband and brother died and her daughter enlisted in the pro-Russian militia. Mazur's neighbor, Valentina Panchenko, 66, said she found the lifeless body two days before Christmas. "She had no money, no food, nothing," Panchenko told me.

A female Ukrainian soldier from the Donbass Battalion poses for a portrait in Debaltseve on Sunday, Feb. 1, 2015.

Renewed fighting has sent civilians fleeing but some worry that there is no longer anywhere to run.

Pensioner Viktor Pleshikov was among the scores of people still trapped inside the railway station in Debaltseve. He said he fears the conflict will go on for years and spread across the country.

"Will it ever end?" he asked.