A tense peace summit in Minsk between the leaders of Ukraine, Russia, Germany and France dragged on into today as they tussled over a plan to end 10 months of fighting in Ukraine.

A grim-looking Ukrainian President Petro Poroshenko shook hands with Russian leader Vladimir Putin at the start of the marathon talks as the two arch-foes came face-to-face for the first time since October.

The crunch four-way meeting with German Chancellor Angela Merkel and French President Francois Hollande in the Belarussian capital was the climax of a frantic European diplomatic drive aimed at stopping the worst East-West crisis since the end of the Cold War from escalating.

Underscoring the urgency, rebels said that one civilian was killed when a hospital in their bastion Donetsk was shelled as the leaders met, bringing the number of those reported killed in the hours before the make-or-break talks to nearly 50.

“Today the peace process for Ukraine is all about Minsk and I hope that the meeting will fulfil our best expectations,” Poroshenko told host Belarussian leader Alexander Lukashenko ahead of the talks.

By 3 a.m. local time the tortuous negotiations had entered their eight hour and the four leaders remained shut in an ornate meeting room in Minsk’s opulent presidential palace without their advisors.

Earlier, a senior Ukrainian diplomatic source told AFP that the talks were making “progress” but also proving “very hard“.

Another source close to the discussions had said the leaders hoped to sign a joint statement calling for the fulfilment of an earlier failed peace plan signed by Kiev and the rebels in September.

Separatist negotiators meanwhile met elsewhere in Minsk to agree how to implement previous truce deals with representatives from Kiev, Moscow and mediators from the Organisation for Security and Co-operation in Europe.

The most pressing element is the need to agree an immediate ceasefire between the two sides that would see an end to the surging fighting that has killed hundreds of civilians in recent weeks.

A key sticking point is whether a new deal will extend rebel control over 500 square kilometres (200 square miles) of territory seized over the past month.

Western diplomats warn that the sides also remain deadlocked over other key issues including how Ukraine can shore up a rebel-controlled 400 kilometres (250 miles) stretch of its border with Russia, across which it accuses Moscow of pouring arms and fighters.

Moscow is also pushing for the separatist-held territories to be granted a large degree of autonomy, but Kiev only says that it is willing to decentralise some powers.

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