DNIPRO, Ukraine (AP) — The horrors of war arrive through the night at a hospital in eastern Ukraine, a procession of stretchers bearing limp bodies whisked from the front line.

The soldiers come with bandaged limbs soaked in blood, faces blackened with shrapnel fragments and stunned eyes fixed on the ceiling, frozen in shock. Lately, they’ve been coming with ever-greater frequency.

“Pain!” shrieks a serviceman with a gaping thigh wound as medical workers move him to a surgical gurney.

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Evacuated from trenches in the east, forests in the north and the open fields of the south, wounded soldiers begin showing up at the Mechnikov Hospital in late afternoon, and dozens more in desperate need of surgery are wheeled in before the sun rises the next day.

The surge of wounded soldiers coincides with the major counteroffensive Ukraine launched in June to try to recapture its land, nearly one-fifth of which is now under Russian control. Surgeons at Mechnikov are busier now than perhaps at any other time since Russia began its full-scale invasion 17 months ago, according to doctors at the hospital, who declined to be more specific.

In a war where casualty counts are treated as state secrets, the hospital — one of Ukraine’s biggest — serves as a measurement of distant battles. When they intensify, so does the doctors’ workload, which these days consists of 50 to 100 surgeries per night.

“Here, we see the worst of the front line,” Dr. Serhii Ryzhenko, the hospital’s 59-year-old chief doctor, says with a weary smile. “We have 50 operating rooms, and it’s not enough.”

The Associated Press was given rare access last week to the hospital, a 12-hour visit to witness doctors and nurses care for soldiers rushed from the battlefield to the operating room.

During the day, Mechnikov functions as a normal hospital, treating patients with cancer and other chronic diseases. But every night ushers in the same macabre routine: Wounded soldiers arrive — many unconscious — and surgeons operate. The soldiers are then sent off to recover elsewhere to create space for the next nightly deluge.

“We hold our own front line here, we understand that we must do this, we must hold on,” said Dr. Tetyana Teshyna, a soft-spoken anesthesiologist wearing pink scrubs.

“It’s very hard,” said Teshyna, who remains calm amid the bustle in this clean, orderly hospital. She wants to say more but is summoned by a nurse. Another urgent surgery is about to start.

Ukrainian soldiers are fighting in multiple combat zones along the 1,500-kilometer (932-mile) front line, but the counteroffensive — focused in the Russian-occupied east and south of the country — has been slow going. Small units are being deployed to probe a Russian army that is deeply dug in, and minefields must be cleared before Ukrainian soldiers can attempt to root them out.

Any initial momentum from the opening phase of the counteroffensive has given way to sluggish advances. Territorial gains have been minimal, despite highly publicized Western donations of military hardware that heightened expectations of a quick Ukrainian breakthrough.

For its part, Russia has stepped up operations in the north of Ukraine, near Lyman, in the forests of Kreminna, in a possible attempt to corner Ukrainian troops there.

Ukrainian soldiers fighting along the front say the ferocity of Moscow’s artillery barrages has surprised them the most, especially in the southern Zaporizhzhia region, where mine-clearing operations leave them badly exposed to enemy fire.

Oleh Halah, 22, was hit by artillery from a Russian tank near Lyman this month, injuring his stomach and legs. Straining to speak in the hospital’s intensive care unit, Halah said his platoon saw the tank coming, but the artillery hit them before they could reach their grenade launcher.

“Twenty-four hours a day, constant shooting, all the time … if not (Russian) infantry, then artillery,” he said. “It doesn’t stop.”

Other soldiers being cared for by Mechnikov’s doctors were injured while clearing mines from Russian trenches. A Belarusian fighting alongside Ukrainian soldiers who uses the call sign “Gold” was injured this way. He had been walking slowly with his unit, 5 meters (yards) per minute, when he was ambushed by a Russian soldier hiding behind a dugout.

As evening comes, the pace of activity in the trauma room picks up, with new soldiers arriving nearly every 15 minutes.

Discordant voices of doctors and other hospital staff echo in the halls, describing blood loss and case histories. Diagnoses are called out: shrapnel in the brain, a burned respiratory tract, shrapnel in the legs, a bullet in the arm; and, again, shrapnel in the brain.

Shrapnel accounts for the majority of injuries treated at Mechnikov, doctors said. Bullet wounds, less so. Wounded soldiers are typically cared for in hospitals closer to the front line and then, once stabilized, they are brought to Mechnikov, a journey that can sometimes take half a day.

Dr. Simon Sechen brings in a soldier with a wide gash in his shin. A tourniquet was applied for roughly half a day, he explained, because the soldier was trapped in a faraway trench, and it took hours to evacuate him. Sechen had tried to encourage blood flow, but it may be too late. “We did all we could to fight for his leg,” he says.

The soldier is taken to the operating room, where Dr. Yakov Albayuk takes one look and determines that the leg must be amputated to save the soldier’s life. “After 12 hours without blood circulation, the limb will die,” Albayuk said, explaining that a tourniquet must be taken off after two hours and, if necessary, reapplied. “Because of tiny mistakes we’re losing people’s limbs.”

For Albayuk, every wound inspected on the operating table is a raw and unvarnished account of the brutality of the fight Ukrainian soldiers face in combat: constant bombardment, hidden mines, and cunning snipers.

In this soldier’s case, his wounds tell a story of bravery; he was advancing toward fire, not running away.

The amputation takes 20 minutes. Albayuk uses a surgical saw to cut through the bone. A nurse wraps up the severed limb, and it is taken away.

Nearby, a soldier lying on a stretcher in the hallway calls out for his girlfriend, Anna. He has been brought to Mechnikov so that doctors can treat complications from a leg that was amputated a few days ago at a hospital closer to the front line.

Anna rushes to his side and tells him to be strong. When he’s gone, she collapses into tears.

Later, a soldier named Maksym, who was injured while fighting in the Donetsk region, awakens in the intensive care unit to the sight of his wife, and then a relieved kiss from her. She traveled with his sister when they learned Maksym had been admitted for surgery.

“I am so happy I got to see them one more time,” Maksym said.

Like Ukraine itself, the Mechnikov Hospital — which is more than 200 years old — has been transformed by war over the past decade.

The hospital did not begin treating wounded soldiers until Russia’s invasion in 2014, when it was not prepared for the task, said Ryzhenko. Soldiers would be admitted with guts spilling out and massive amounts of blood loss. Back then, Ryzhenko saw cases he had only read about in textbooks. Today, Mechnikov is lauded for its state-of-the-art facilities and expertise — roughly 400 doctors spread across six buildings.

On Dr. Mykyta Lombrozov’s operating table is a soldier who sustained a shrapnel injury on the left part of the brain. The 28-year-old neurosurgeon’s elegant hands work methodically. Crushed skull pieces are removed, one by one, until he can extract the small metal fragments lodged in the soldier’s brain.

It’s a complicated surgery that would normally take up to four hours. The war has taught Lombrozov to finish it in 55 minutes. He does it every day, he says, sometimes up to eight times in a single 24-hour shift.

“It is very important to me, that’s why I am here. That’s why we all work here,” Lombrozov said as he looked down at the soldier. “He is our hero.”

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Follow AP’s coverage of the war in Ukraine at https://apnews.com/hub/russia-ukraine