SLOVYANOSERBSK, Ukraine (Reuters) - Anna Tsvirinko takes her hand out of the jacket she is wearing over her nurse's uniform to keep warm and points at a dirty mattress in the unheated ward of the Ukrainian psychiatric hospital where she works.
"That's where a woman who died last night was lying," she says, estimating she was the 50th patient to die at the hospital since the conflict between pro-Russian separatists and Ukrainian government forces began in April.
"If there is no light when I'm on duty and a patient dies I go in with a candle or a torch. I'm the only nurse for six wards. I need to wash and dress others but there is no light and no water. What can I do?"
The Psycho-Neurological Hospital outside the village of Slovyanoserbsk is caught in the crossfire in separatist-held territory about 30 km (20 miles) northwest of the rebel stronghold of Luhansk and near the frontline.
There is a strong smell of urine in the ward of a dozen beds. Elderly women lie under blankets, wearing headscarves to keep warm.
Younger patients in their 30s and 40s walk along dark corridors or sit on the floor. Some seem unable to speak and one woman cries on a bench by the window.
"She wants to go home", Tsvirinko says.
Medical workers say the head of the hospital was killed by a shell in Luhansk and about half the 180 staff have fled. There were 400 patients when fighting began, they say.
When Reuters visited the hospital this week, it had no heating, no electricity, no running water and meals were being cooked outside on an open fire.
Artillery rounds could be heard a few kilometers (miles) away. Patients helped two women cooks to chop firewood.
"We wake up, wash and then go and help our cooks. It's cold to sleep at nights. We sleep in our clothes," said Vyacheslav Shavkin, one of the less seriously ill patients.
On good days, the hospital has electricity, the cooks say.
When temperatures dropped in November, the number of deaths in the hospital rose quickly. Medical records show 22 patients died in a month.
The latest, on the night of Nov. 30, were Olga Beletskaya, 57, who had infantile cerebral palsy, and Irina Taranskaya, 68, who suffered from encephalopathy, or disease of the brain.
"They died because it was cold and we had nothing to treat them with," Tsvirinko said.
Nurses said the hospital was running out of medicine. As a result, the patients were more aggressive than usual.
"They cry, they go crazy and you can't do anything for them," nurse Svetlana Nechvolod said.
Medical personnel and patients say they have not received their wages or pensions for more than six months.
At least one shell hit the backyard of the hospital a week ago. But the conflict is not what frightens them most.
"The most important thing is that everyone doesn't forget us," said Dmitry Shevshenko, a 33-year-old patient.
Editing by Timothy Heritage and Giles Elgood