DONETSK Ukraine (Reuters) - Maria, a nine-year-old girl suffering from cerebral palsy, was able to stand and walk unsteadily on her own before the outbreak of armed conflict between Ukrainian forces and pro-Russian separatists in eastern Ukraine.
Now, after five months of shelling in and around her hometown of Yasynuvata, a strategic rail hub that has changed hands several times during the conflict, her condition has deteriorated as stress has stiffened her muscles and crippled her posture. She can no longer stand unsupported.
"Kids like Maria are much more afraid than others," said Maria's grandmother Tamara, who brought the girl through fighting and roadblocks for treatment in Donetsk, the region's largest city and now the separatists' main stronghold.
"All this bombing has pushed her recovery back by about a year and a half," she said, cradling Maria in her arms.
Maria is among about 30 young patients undergoing treatment in the half-full Donetsk clinic which specializes in children's neurological disorders. It is now awaiting the arrival of a boy who needs to learn how to walk again after sustaining shrapnel wounds that damaged his spine.
He is one of the more than 8,700 people to have been wounded in the conflict which erupted in east Ukraine in April and which has so far killed more than 3,660 people, according to the United Nations.
Many schools, hospitals and other public institutions are closed after being hit by shelling or because of nearby fighting that has meant it is too dangerous to continue operating.
The clinic also suffers from an acute shortage of money in rebel-held territory, where many public-sector workers no longer receive salaries from Kiev and the separatists' self-proclaimed "Donetsk People's Republic" (DNR) has virtually no resources to make up for the shortfall.
"I treat children and that requires money, whether they come from Ukraine yesterday or the DNR tomorrow. We just need to keep going," said the clinic's director, Oleg Yevtushenko.
"And I don't ask my staff who they are backing (in the conflict). We need to work for the children and that's it."
On his desk lies a pile of papers prepared for when he is required to register his clinic and staff under the DNR rather than Ukraine.
"For now, the DNR has nowhere to take money from, they first need to start collecting taxes. I am ready to register as required but I need to know there will be money for us," said Yevtushenko.
He said the Ukrainian authorities were still covering the clinic's utility bills and, after a break, had paid his staff's salaries for July, August and half of September.
But the future remains very uncertain, despite a fragile ceasefire - marred by sporadic shelling - which has broadly held across the region now for more than a month.
The crisis in east Ukraine, which has affected the lives of many civilians, has dragged ties between Russia and the West to new lows. The West has imposed economic sanctions on Russia for what it sees as Moscow's role in fanning the separatist unrest and supporting the rebels with arms and troops.
Moscow accuses Kiev of mistreating the mainly Russian-speaking region of east Ukraine but denies playing a role in the conflict, despite evidence to the contrary cited by human rights campaigners and groups representing Russian soldiers' families.
In Yasynuvata, the fighting often left Maria and her grandmother without electricity, enough food or medicines. Maria has grown to fear the sound of shelling and men wearing military camouflage, widely used by both sides in the conflict.
Even in the clinic she has not been able to forget the war. One day, she got a shock when a rebel fighter wearing dark-green camouflage uniform walked in.
It turned out he was visiting his wife and their heavily disabled baby daughter, who was being treated next to Maria.
"When Stephanya was born, she was unresponsive, everyone told us she would die," said her mother Viktoria, holding her daughter wrapped in a white shawl.
"But she is with us and we are treating her here. From the tone of her voice I can now tell what she needs from me."
The family lives in the town of Yenakievo where, before the conflict, Viktoria ran a shop and her husband was a miner.
Born prematurely, Stephanya is very small for her one year and three months of age. Her mother has tears in her eyes when she talks of her husband fighting, but she hopes it may allow them to get better treatment for Stephanya in Moscow.
"He sometimes comes home to wash his uniform. But since he joined the ranks of DNR fighters, that makes me a DNR supporter as well, I guess," she said.
"Yes, I hope we will live better than under Kiev and I hope we will be an independent state but, honestly, most of all I hope my daughter gets better."
Editing by Alexander Winning and Gareth Jones