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Aleksandr Ishko helps his supervisor Alexey Undarov into an ambulance after standing in a food line for more than an hour Kharkiv, Ukraine, on Sept. 20, 2022.Anton Skyba/The Globe and Mail

Alexey Undarov had been standing in a food line for more than an hour when the pressure of scrambling to repair Ukraine’s infrastructure, under constant attack from Russian forces, finally caught up with him.

Mr. Undarov, who looks much older than his 45 years, collapsed as he was waiting to receive parcels of humanitarian aid delivered to central Kharkiv on Tuesday. After helping him into an ambulance, his colleague Aleksandr Ishko said Mr. Undarov was simply exhausted. He had been trying to keep the city’s Soviet-era centralized heating system operating as the nights are getting colder and Russia escalates a shelling campaign that seems intended to punish Ukrainian civilians for their army’s recent military successes.

“We don’t have any time off these days. Our brothers are keeping us busy all the time,” Mr. Ishko said bitterly, referring to Russian propaganda that claims Ukrainians are a “brotherly” nation in need of liberation. “Since the 24th of February [when Russia invaded], we have just been running in circles around the city, under shelling, under fire. The stress caught up with him.”

Ukrainian family mourns death of 11-year-old daughter after a Russian missile destroys home

This month’s surprise Ukrainian counteroffensive in the Kharkiv region forced the Russian military to stage a chaotic retreat from thousands of square kilometres of territory it had occupied since early March. In revenge, Russia has increased its attacks on facilities that provide essential services to the people who live here.

“What’s happening is terrorism of the population. You can see it on the ground right now,” said Valentyn Lebedynskiy, who was co-ordinating the distribution of food aid Tuesday for the charity Caritas, which delivers 1,400 to 2,000 packages of pasta, sauce and canned meat every day to different neighbourhoods of Kharkiv. “An incoming rocket can land here any second.”

Russian President Vladimir Putin said last week during a visit to Uzbekistan that the attacks on “sensitive targets” were merely “warning strikes,” a response to the counteroffensive. “If the situation develops further in this direction, our response will be more serious.”

On Wednesday, Mr. Putin warned of even more severe escalations – calling up hundreds of thousands of reservist soldiers and threatening to use nuclear weapons in Ukraine, if he deemed it necessary.

The mood in and around this half-deserted city, which had a prewar population of 1.4 million, remains fearful. Air raid sirens and loud explosions are still features of daily life here, despite the Ukrainian military’s gains.

Over the past 10 days, Russian missiles have struck the thermal power plants in Kharkiv and in Slovyansk, a city in the neighbouring Donbas region, causing brief blackouts before engineers could restore electricity. Two nuclear power plants in Zaporizhzhia and Mykolaiv, in the south, have also sustained damage.

In the city of Chuguiv, about an hour’s drive from Kharkiv, two S-300 missiles were fired at an oil refinery on Saturday. One missed and slammed into a nearby house, killing 11-year-old Anastasiya Hrytsenko. The S-300 is an anti-aircraft missile, not designed to target buildings, but has been Russia’s weapon of choice in the assault on Ukraine’s infrastructure.

“The use of S-300s in this role amounts to nothing less than the indiscriminate bombing of a civilian population. Its military utility, in a strict sense, is non-existent. But they obviously remind Ukrainians that they are at war and can die at any time,” said Konrad Muzyka, the founder of Rochan Consulting, a Polish firm that provides analysis of the war in Ukraine.

Ukrainians hide out in Kharkiv’s basements and subway stations, still wary even after being liberated from Russian control

Russia has also repeatedly fired missiles over the past week at the Karachun dam in the southern city of Kryvyi Rih, the hometown of Ukrainian President Volodymyr Zelensky. Several streets in the city flooded before workers were able to repair the dam. One worker died during the repairs.

Mr. Zelensky responded to the attacks with an angry speech last week, warning the Russians firing the missiles that historians would see them as villains. “You are weaklings, waging a war against civilians. Scoundrels who, having fled the battlefield, are trying to do harm from somewhere far away. You will just be terrorists whom their own grandchildren will be ashamed of.”

Medical facilities have also been targeted. The hospital in Chuguiv was damaged on Sept. 9 by a missile that landed in the parking lot, blowing out windows and doors of the main building. “They hit the hospital intentionally,” director Vyacheslav Grushka said.

On Sunday, four medics were killed and two patients were injured in the recently liberated village of Strilecha, along the border with Russia, when Russian forces shelled a psychiatric hospital while the Ukrainians were trying to evacuate its 600 patients.

In Kharkiv, a city with uncounted but rising numbers of patients with psychological, heart and neurological conditions, as well as chronic illnesses and often-unmentioned COVID-19 symptoms, the medical system is buckling.

“With COVID and the shooting, to be honest, I’m afraid to go to the hospital. Most of the time I stay at home with my daughter,” said Maria Anatolevna, a 40-year-old nurse who was also waiting for food aid Tuesday. She said the apartment where she lives with her 16-year-old daughter had been without hot water for three months and often had no electricity for several hours a day.

“The situation is critical. No one is paying attention to medical issues in this country. The pressure is rising and rising,” said Dr. Lebedynskiy, the Caritas employee. He is a neurologist but had to close his clinic and said it was still impossible to reopen it. He worried about all the people who were going untreated in the badly damaged northern suburbs of the city.

“There are a lot of children in Saltivka and around the Kharkiv tractor factory who need help, and we can’t get it to them. No one knows how the next generation will grow up.”

Dr. Lebedynskiy said the situation will only get worse if Russia continues hitting Ukraine’s electricity and heating systems as winter draws near. “It will cause stress, stress, stress.”