Dmitry took a drag from his cigarette and pulled a box of pills from his pocket.

"My sedatives," he said, tapping the white and blue packaging.

"When it's calm like now then it's ok. But when the bombardments start, my heart starts beating fast, I panic and I don't know what to do."

A resident of the rebel-held city of Donetsk, the forty-year-old market vendor lives in constant fear of the deadly exchanges of missiles and shells that fly between government forces and pro-Russian rebel fighters close to his neighbourhood.

In mid-September, the market where he worked selling sausages was pulverised by a salvo of mortar fire—a clearly traumatising experience for Dmitry.

"I couldn't sleep, I was too anxious," he said.

Now every small noise makes him nervy, as a possible prelude to the frenzied dash for cover. Only work and his medication help.

"You need to talk, to interact, otherwise you lose your mind," he said.

At Donetsk's main psychiatric hospital, Dr Mikhail Bero has seen hundreds of patients check in as the seven months of fighting that has cost over 4,300 lives takes its toll.

"We receive people who have been profoundly affected, sometimes they are paralysed and can't move their arms or legs," said the aging psychiatrist wearing a white coat.

Other patients have attempted suicide or had , he said.

"This is a natural result of post-traumatic stress."

'Children are ammunition experts'

A broom in one hand and a dustpan in the other, Larisa Zinkovskaya battles with the wind as she sweeps up leaves outside a rickety building on the edge of Donetsk.

For the past 11 days she's been sweeping up here despite the boom of artillery from the frontline not far away.

"I'm afraid of the bombardments but I've got used to them," says the cleaner, 41, her face ruddy with cold.

In July, she said, she lived through the worst experience of her life: half an hour under direct shelling.

"I was here, in this area," she reminisced. "To begin with I couldn't move, I was petrified and then someone yelled to run."

"I hid in in the entrance of a building until it got quieter and my husband came to find me."

She left for work the following day, her "legs trembling" and her husband by her side.

"At the first sound, we ran to hide," she said.

Little by little though she managed to get used to the bombardments.

"When it's calm you should begin to worry," she says.

Residents in this once-peaceful city have now managed to distinguish between the different noises and can tell how far and from where the shots are coming.

"Even our children are ammunition experts. Do you find that normal?" said a rebel fighter known as Groz, who spends his days on one of the most dangerous checkpoints in the city.

"You'd have to be an idiot not to get frightened. Psychologically it is a big pressure, huge pressure," he admit, a hand resting on his rifle.

The former miner says he is not a professional fighter or a "terrorist", as the authorities in Kiev call the Kremlin-backed fighters.

When a shell falls he does not panic but he makes sure to get to cover as quickly as possible.

"It's not worth playing the hero," he said.

And in any case, he said, if a shell is headed straight for you, you probably will not realise it.

"If it does have your name on it, you won't even hear it coming."

© 2014 AFP