He has lived in fear of heavy shelling for months, but it was only on Thursday that 73-year-old Vladislav Victorovych first considered fleeing his home near Ukraine's front line.

Before dawn, a Russian missile crashed through the apartment block next to where he lives with his wife and son. Had it landed just 50 metres (160 feet) north, it would have been their home reduced to a heap of rubble and broken glass.

"After today's incoming, we began to seriously think that we need to leave," Victorovych told AFP as residents of the wrecked building ventured inside to salvage what they could.

"The wife said, 'It's time to get ready.'"

By midday, however, Victorovych had thought it over and recommitted to staying, overwhelmed by the prospect of relocating his wife, who suffers from a heart condition and other ailments.

Like many towns across eastern Ukraine's hard-hit Donetsk region, Chasiv Yar has seen a steep population decline in recent weeks. Those left behind are mainly "older people and people with limited mobility", according to the United Nations.

Those who stay cite various reasons for doing so: from simple defiance to the need to care for sick relatives -- or just a lack of better options.

But the situation is growing increasingly desperate, given the intense fighting and worsening winter conditions. The temperatures here are forecast to plunge well below zero at the weekend.

"We are now experiencing extreme stress, and this leads to illness," Victorovych said.

"A person has a limit... A person who lives in normal conditions cannot understand this."

'All the young people left' 

Across the street, 88-year-old Yulia Tuskova, wearing a down coat and pink beanie hat, waited in line to receive sheets of clear plastic tarp handed out by city authorities -- a temporary fix for shattered windows.

As she tried to walk home with the aid of a cane, she broke down in tears when asked who would install the tarp for her.

"We have no men, only grannies," said Tuskova, who lives alone. "All the young people left and only the old people remain.

"There is no one to nail the polyethylene, all the windows are broken, there is no one to help."

Olena, 64, told AFP she had no choice but to stay and care for her mother and three dogs.

"My mother, who is 85, is sick," said Olena.

"She walks around the garden at night, and we are afraid that she will be shot."

In the industrial city of Kostiantynivka, roughly 20 kilometres (12 miles) west of the heaviest fighting in Bakhmut, an 89-year-old woman named Praskoviya told AFP that while conditions were rough, she was determined to ride them out.

"I was 10 years old when there was the Second World War, and now there is another war in my old age," she said.

"Back then we had both hunger and cold -- we faced everything. We survived back then, and we will survive now."

Battling loneliness 

Yet even elderly Ukrainians like Praskoviya, while less immediately threatened by the fighting, face their share of challenges, notably loneliness.

In the town of Lyman, recaptured from the Russians in September, 60-year-old Anatoly Gysenko once welcomed as many as 30 people into the basement shelter he has filled with mattress pads and flimsy wooden chairs.

But as temperatures started to drop and Lyman's population dwindled, the basement, heated with a woodstove Gysenko built himself from bricks and mud, began receiving fewer and fewer visitors.

Eventually he was left alone with his three dogs.

He recently invited his friend Sergiy Tarasenko, who was living alone in a different part of town, to move in so at least they would have each other.

"It's more fun staying together," Tarasenko, 58, told AFP this week as the temperature hovered near zero.

"Maybe more people will come if it gets a little colder."

He especially hopes a woman will arrive to take over the cooking so they can focus on tasks like chopping wood.

They are currently living off a bland repertoire of pasta, porridge and mushrooms picked from the mine-strewn forest behind their building.

"Now, while we are alone, we have to do both men's and women's work," he said.