It is 2 a.m. and the sounds of heavy gunfire cut sharply into the early morning calm. Nurse Lidia Ivanovna, a friendly, rounded woman in her 50s, is unflustered by the activity. Almost mechanically, she reaches out one hand to close an open window, before using the other to turn her black portable radio up a few notches. The growling melodies of Soviet civil war songs substitute the crackle of fighting outside. “Enter into the last deadly fight,” instructs a chorus, “march, Red Army, march.”

Lidia Ivanovna laughs nervously. “I’ve always felt things will tun out OK,” she says. “But I sometimes have to argue with Valentina Vasilyevna… she thinks we’re all going to die.”

Valentina Vasilevna, a cautious woman dressed in a pink scrubs, is in charge of hospital admissions. She logs the names of everyone who enters, everyone who leaves, and those who don’t make it out as well. Working exhausting 24-hour shifts, sometimes as often as every other day, Vasilevna has seen the horror of Ukraine’s hybrid war first hand. Before the war, Gorlovka was the butt of all kinds of jokes about its three prisons and lack of paved roads, but its current reputation for death and amputation is no laughing matter.

Over the dark winter months, when Gorlovka became an apocalyptic firing range, the staff of Hospital Number 2 became its lifeline. “Some days, we’d have people in the corridor, with fifty or so serious cases throughout the night,” Vasilevna says. Like others, she risked her life coming into work. “You had to dodge missiles falling as you ran from your home, but what else could you do?”

The reality, following the collapse of an always-shaky ceasefire, has eased pressure on hospital admissions; the number of daily cases is rarely half that of the winter months. But ongoing fighting continues to put pressure on intensive care spaces at the hospital. And there is worrying evidence of military escalation in the area too.

Last week, one local publication suggested hospital doctors had been given instructions by separatist authorities to clear beds ahead of an anticipated military advance. Who in fact issued the instructions is a moot point, but one senior doctor, Nikolai Tishenko, confirmed there was an ongoing program to clear intensive care spaces in the hospital. “We need to send some people to normal wards as we may very well see new deliveries in the next few days,” he said. “We’re in a waiting mode; we know it may get worse.”

A steady stream of military casualties pass through Valentina’s desk. Despite the unmistakable sounds of artillery and mortars, however, tonight’s injuries are mostly of a comical variety. Early on, doctors treat a 27 year-old soldier, Aleksei Kaluzhskikh, who presents with shrapnel stuck into his rear end. The doctor’s diagnosis of an injury to the “top third of the leg” is considerably kinder than the reaction of the young soldier’s friends.

An hour later, a tank driver called Andrei calls in with a bloodied and severely bruised face. It wasn’t exactly a combat injury: he had been struck off his tank by a stray tree branch. The last time he’d be joyriding in the forest at night…

The nurses say they are well disposed to separatist soldiers, whom they describe as their “defenders.” “How my heart bleeds when some of the young boys come in without arms or legs,” says Lidia Ivanovna. Very occasionally, they have treated Ukrainian soldiers too. What ended up of them? “I can’t say. You must understand it’s difficult for us to give all the details”, she says.

Beirak Karimovich, the sparky, 25 year-old doctor on duty, is keen to avoid politics. On one level, the young doctor has been served a hand by the unusual situation in the town: how else would he have got his break? But he was also tortured by “criminal” cases, where, he said, it is best to know the minimum information.

“But what do you suggest I do about it, doctor,” insists Evgeny, a local man who had been brought to the hospital with a broken nose received courtesy of the military police. He had been walking home drunk and after the curfew, and the police had asked why he wasn’t fighting for the new republic. The answer they received was unsatisfactory, it seems. “I’m scared, doctor, I have three children and all that, but I can’t let them get away with it,” says the defiant Evgeny.

Beirak Karimovich looks to the floor. “My role is clear,” he says. “If I see injury, I treat it, I don’t see injury, I don’t treat it. That’s it.” He suggests that the father of three should consider himself lucky after coming away from the altercation with a jaw intact. “I had a guy with a broken one just the other day. It took hours to fix,” he says. “Was it a car crash?” “No, fists.” “So he was fucked right over.” “You might put it like that.”

Evgeny is keen to get home, and the medical staff confer whether it is safe to dispatch their patient back into nighttime Gorlovka. Lidia Ivanovna thinks it might be OK to let him walk home. “The worst thing that will happen is the police will pick him up,” she says. “That’s my primary concern,” replies the young doctor.

The following night the hospital was back to a normal regime. Mass shelling of the most frontline regions of town had resulted in several serious injuries, with a civilian woman dying soon after being delivered to the hospital.

Lidia Ivanovna reported that staff had been asked to come in at the weekend to help convert the hospital’s basement to living quarters. She was unsure what to make of it, but said she’d be staying put in Gorlovka whatever happens. She knew no one in Ukraine, and she’d heard Ukrainians were putting people they didn’t like into basements. The family she did have in Russia, but was sure they wouldn’t welcome impoverished refugees.

“No one wants us, we’ve worked this out already,” she says.