SELYDOVE, Ukraine — “The NATO hospitals in Afghanistan are five star compared to Ukraine,“ says Kyrylo Kravchenko, who saw them when he served with his country’s contingent as part of the coalition there. Now, near the front lines in the war with Russian-backed rebels around Donetsk, he dreams of those NATO facilities more than a little wistfully.

Kravchenko is a Ukrainian army doctor from Kiev, tall, slender, with gray hair, dark eyebrows and an air of deep seriousness. He volunteered to come east as the fighting intensified.

Over the past few weeks the rebels have taken Donetsk airport and are now pounding the town of Debaltseve. The sound of shelling is relentless as you travel throughout the Anti-Terror Operation (ATO) zone in eastern Ukraine. The various ceasefires agreed between Russia and Ukraine, and being talked about again this week, are widely regarded as a joke by those on the ground. Kravchenko felt he had no choice but come to the front.

Selydove hospital where he works brings the Ukraine war’s realities into vivid relief. The hospital is around 20 kilometers (12.5 miles) from the city of Donetsk and is the first port of call for Ukrainian soldiers and civilians injured in the fighting. It is essentially serving as MASH unit coping with shock and trauma, where the doctors’ priority is to stop bleeding and save limbs or, in more serious cases, to operate. Once the patients are stabilized they are sent on to larger hospitals in the Ukrainian-held eastern cities of Kramatorsk, Kharkiv and Dnipropetrovsk.

Most of the injuries Kravchenko sees are shrapnel wounds from shelling. He sees few bullet wounds. The fighting rarely gets that close up. Most of the wounded are soldiers, although there is a steady stream of noncombatants, too. The most recent arrivals were four civilians with head and body injuries from artillery.

Kravchenko says, loyally, that even if the facilities are not up to NATO’s standards, they are adequate. But as one wanders the hospital’s dank, meandering corridors and badly lit examination rooms the impression is very grim indeed. One “ward” consists of five old low wooden beds squashed together across the centre of the room and a single bed, lying lengthways, behind them. There is no space to walk between any of the beds.

The casualties come in waves. From January 11 to 24, while the army and rebels battled for Donetsk airport, the hospital was almost overwhelmed and Kravchenko often worked for 24 hours at a time, snatching sleep whenever he could. It was a traumatic time generally. Five of his colleagues—paramedics, he said— were burned alive in an armored car at the airport.

The doctors receive a lot of support from Ukrainian volunteers who raise money on social media, crowd-sourcing the funds to supply the hospital with badly needed medical supplies when government help falls short, as it often does. “Some problems can only be solved by volunteers,” said Kravchenko. “They save a lot of wounded because they can organize quickly as they don’t have to go through the same bureaucracy that government officials do when we request things.”

Kravchenko sleeps, when he is off duty, in a small, bare rectangular box of a room, which he shares with another doctor. There is a tiny kitchenette. In the bathroom the tiles are chipped, the toilet has no seat, and the grimy bathtub is filled with a rust-colored liquid. He keeps a bulletproof vest on his bed and, underneath it, boxes of medical supplies.

There is a story behind those boxes that tells you something about this war in microcosm. The divisions in the society afflict the hospitals, too.

Selydove was a stronghold of the former president Viktor Yanukovych before his overthrow almost a year ago. It is close to both Donetsk and Sloviansk, a city under rebel control until the summer of last year, and sympathies for the separatist cause still linger among a certain part of the population. When the volunteers first started delivering supplies they gave them to the hospital’s head doctor but soon discovered that she was giving some away to the rebels. Being a local, she likely had relatives in Donetsk or, possibly, in Russia. Either way, the pro-Kiev volunteers decided she couldn’t be trusted.

They’ve continued to work with the hospital; their help was needed and they hoped to show the administrator that, contrary to Russian propaganda, Ukrainians were decent people. But now they make sure to deliver a certain amount of supplies directly to Kravchenko and his roommate, who comes from the pro-Ukrainian heartland of Lviv in Western Ukraine: people who have volunteered to come themselves and whose patriotism they do not doubt. They use different boxes for their official deliveries and for the supplies that go directly to Kravchenko, which he stashes under his bed.

Kravchenko remains upbeat but he is under no illusion about the difficulties that hospitals across the east are facing. “I have spoken to colleagues who worked [as doctors] during the Soviet invasion of Afghanistan and they tell me the injuries are much worse here,” he said. “The weaponry is more modern now, and more destructive.”

At every hospital across the ATO zone supplies are needed. At Dymytriv city hospital, Dr. Anna Golubeva has treated so many wounded that she can no longer even estimate the numbers. Some stuck in her mind, though, like the nine-year old boy who recently came in with extensive shrapnel wounds. Whenver there is a bout of intense fighting the hospital falls short. The main problem in Golubeva’s, she says, is that it lacks an intensive care unit, so she could only stabilize patients before sending them on to better-equipped hospitals. A lot, she explained, fell on the shoulders of volunteers. The hospital has even taken to posting its needs on its website to allow people to donate.

Among its primary requests is a new type of metal splint used to treat fractures because shrapnel tends to shatter bones. But generally the most needed supplies across the east are blood-clotting agents and hemoglobin. Anything involving blood and the immediate treatment of wounds is welcomed. Supplies of anesthetics also are scarce.

Golubeva’s boss, Dr. Roxana Khokhlova, a fierce looking lady with short black hair and an impatient demeanour, was in no doubt as to who was to blame for the problems the doctors faced: “We get no support from the government, it’s all from volunteers,” she said. “The Ministry of Defense should pay for doctors and the Ministry of Health should pay for supplies, but they don’t.”

This lack of official support remains the most serious problem in the east. Hospitals lack even enough ambulances and many come in a variety of shapes and sizes because they have been converted from vans or minibuses provided by public-spirited civilians.

“I dream of NATO-standard sutures,” said Kravchenko, with a faraway look in his eyes shortly before he returned to work. It was a look that spoke volumes of the wider trials faced by Ukraine’s doctors and nurses, casualties in their own way of the ongoing war in the east.