In Pokrovsk, a transport hub and a key prize for invading Russian forces where the hospital is situated, the bombardments are becoming louder and nearer.

"We had 10 attacks last night. Can you believe it?" Ivan Tsyganok, the 58-year-old head of the medical facility said, striding through the corridors of his hospital.

The towering obstetrician issued orders left and right as he pushed through doors on his rounds.

"They aren't getting enough sleep. They're malnourished. They're stressed," he told AFP, describing the general state of his patients.

Pokrovsk, which once had a population of around 60,000 people, lies just 20 kilometres (12 miles) from looming Russian troops.

Moscow is also seeking to seize a major highway nearby that links Pokrovsk to Kramatorsk, the largest town in the industrial Donetsk region under Ukrainian control.

The maternity unit there has been destroyed.

The region has been partially controlled by Russian separatist forces since 2014, and has suffered several fatal attacks on maternity wards.

That includes during the brutal siege of Mariupol at the beginning of the war and recently in the nearby town of Selydove.

The World Health Organisation says it has documented at least 1,770 attacks on Ukrainian medical facilities that have killed at least 136 workers and patients.

Work by phone light

"With the road closed, we're finding it hard to refer patients to our centre," Tsyganok said.

Women living near the front must now make a long detour to avoid a route that comes under frequent artillery and drone attack, he said.

President Volodymyr Zelensky urged residents to flee Donetsk two years ago and authorities have been implementing forced evacuations in some frontline towns and villages.

The doctors are determined to stay as long as they can

"We understand the risks," Tsyganok said, "but as long as there are patients here, we can't stop our work."

Passing through an operating room, he gestured to sandbags piled against windows to protect the patients and doctors from glass shards.

Electricity is another problem. Russian strikes on Ukrainian power plants have halved the country's generation capacity compared to a year ago. Blackouts are routine in frontline areas.

"We had a power cut in the middle of a delicate caesarean section and we had to finish up by the light of our telephones because of a problem with the generator," Tsyganok said.

Staff shortages are a growing problem, too. "Some of our nurses live on the front line. Many have left," Tsyganok explained. "The town is regularly bombed. The situation affects employees and patients," he added.

Tsyganok said premature births had "doubled" in the Donetsk region since Russia invaded in February 2022.

Not if, but when

"Women about to give birth need to be in a protective, medical environment. What kind of protective environment can there be living in Avdiivka?" he said.

Russia captured the ruins of the industrial town of around 30,000 people in February and has advanced towards Pokrovsk since.

In one ward, Tetiana Pychuk, with dark circles under her eyes, gazed down at her two-day old son Timofey.

The 31-year-old was from Selydove, where Russian shelling killed a pregnant woman and her child at a maternity ward in February.

She had been up all night sheltering in the relative safety of a hospital corridor amid the threat of a Russian missile attack.

"There was bombing throughout my pregnancy," Pychuk said.

She said her daughter was born 12 years ago and has grown up with the sounds of fighting between the Ukrainian army and Kremlin-backed rebels.

When asked why she decided to leave Selydove, tears streamed down her face.

"When the cluster missiles fell in front of the house," she answered.

She fears for the future.

"Honestly, I don't know what will happen in a week, in a fortnight's time," she said.

The closure of the maternity hospital would be "tragic" for Donetsk residents, Tsyganok said.

The hospital would have to relocate equipment and patients to Dnipro, around 200 kilometres (125 miles) away. The town is also under sporadic attack and it is a precarious journey for a woman in labour.

"We're going to evacuate. But I don't know when yet," Tsyganok told AFP.

"If the soldiers are fighting, it's so that their companions can give birth here."

AFP