BEIRUT – In Syria's eastern city of Deir el-Zour, supplies are running so short that desperate residents are selling their gold, valuables and even their homes for food or an exit permit allowing them to escape a siege by both government troops and Islamic State militants.
The extremists have blockaded government-held areas of the city for over a year, and some of its 200,000 residents are slowly starving — while troops and militias supporting President Bashar Assad exploit their suffering.
While international attention was focused recently on Madaya — a rebel-held town surrounded by pro-Assad troops near the capital of Damascus — the United Nations and aid agencies say another catastrophe is unfolding in Deir el-Zour.
The civil war has transformed a once oil-rich city into a place where even something as simple as making tea is a struggle, according to residents who have fled, because of severe shortages of food, water and fuel.
Many people live on bread and water — and there are long waits for both. Taps are shut off for days at a time, and the water that flows out for only a few hours is brackish. The city hasn't had electricity for over 10 months, with little fuel available for generators and water pumps.
The U.N. warned last week that living conditions have deteriorated significantly in Deir el-Zour. Students are frequently absent from school because of malnutrition. The only remaining civilian hospital needs drugs and other supplies, as well as staff.
Unverified reports cited up to 20 malnutrition deaths, the U.N. said in its report. But Ali al-Rahbi, spokesman for the Justice for Life Observatory for Deir el-Zour, said his group documented 27 deaths.
The Islamic State group surrounds Deir el-Zour and won't let people and supplies in by land; the Syrian government, which controls part of the city and its airport, won't allow supplies to be brought in by air or let its people out.
The city, about 450 kilometers (280 miles) northeast of Damascus, is divided roughly along the Euphrates River, with the Islamic State group on the eastern side and the Syrian government on the western side, although IS controls some territory on the western bank as well.
Deir el-Zour is the largest of about 15 besieged communities in Syria, cutting off about 400,000 people from aid. U.N. Secretary-General Ban Ki-moon said both the Syrian government and the rebels are committing war crimes by deliberately starving civilians. Reports of starvation in Madaya prompted an international outcry, and two aid convoys last week delivered humanitarian aid to civilians there.
So far, no such aid is forthcoming to Deir el-Zour.
The city recently has been the focus of renewed efforts by Islamic State militants to retake it. An offensive over the weekend captured new areas from government forces, killing over 250 troops and civilians, and capturing hundreds.
The offensive "is putting thousands of people in the line of fire," said U.N. deputy spokesman Farhan Haq.
How the city came to be under such a punishing siege from both sides only makes sense in the perverse circumstances of Syria's civil war, now in its fifth year.
Deir el-Zour lies near the Iraqi border, deep in Islamic State territory, but the government has been able to defend its military airport on the outskirts, allowing it to maintain its city's fortifications. It also controls four large neighborhoods that are home to many internally displaced people, including women and children.
Because the airport is so close to the front line, only helicopters have been able to land there since September, the U.N.'s Haq said.
The government troops in the city are regularly reinforced and supported by Russian and Syrian air power. Rather than fight them, the IS militants imposed a blockade in January 2015. Residents say the siege grew worse in March when the government stopped anyone from leaving Deir el-Zour without permission.
IS has prevented people from entering government-held areas, but a few months ago, it began allowing people to leave for other IS-held areas, although it subjected them to interrogation and harassment — and in some cases, it confiscated their documents.
The extremists then closed that window, banning anyone from leaving.
Residents say the government has its own reasons for maintaining the siege-within-a-siege and carefully controlling the flow of goods and people through the military airport: The residents have effectively become human shields against an IS attack. In addition, the government can extract money from them by raising the price of food or taking huge bribes in return for permits to leave.
Many residents wonder if an IS takeover would bring much-needed supplies of food.
"My father told me exactly, 'My beard is long now, and my stomach is empty. Let them (the militants) in if it is going to let food into the city,'" said Karam Alhamad, a Deir el-Zour native who escaped in September but left his parents behind. It took him six months to find someone who could arrange his exit permit.
But Haq said that following the IS attacks on Sunday, the U.N. has received credible reports of the "execution and abduction/detention of civilians," including those believed to have been smuggling in food.
International organizations have been able to fly in only a limited amount of aid through the military airport, where it passed through government hands before reaching the population, if at all.
Any aid typically goes to army officers and their allies, who resell it on the black market, al-Rahbi said by phone from Turkey.
"The regime is operating a war economy and allows its officers to control humanitarian aid to the city," he added.
Last week, Russia dropped 22 metric tons of relief supplies into Deir el-Zour, but activists said government-affiliated vehicles immediately moved in. Alhamad said security forces collected all the supplies to sell them at the market for the prices they wanted.
A resident who identified himself as Bahaa said he lost more than 14 kilograms (33 pounds) during 11 months in the city and escaped in November to Gazientep in southern Turkey weighing only 55 kilograms (121 pounds).
"My health now is much better than it was, but I'm still suffering psychologically. A lot," he said by phone.
The man, who did not give his real name because he feared for reprisals against relatives left behind, said he paid 250,000 Syrian pounds (over $600) in bribes to receive permission to fly out. It was too expensive to bring his whole family.
"We sold our gold" to raise the money for the bribes, he said. "Other families have sold their homes."
Bahaa's house is on the IS-held side of the city. When the militants took over, the family fled to the government-held side, where they rented an apartment.
"We don't know what has happened to our home," he said.
A resident named Mustafa, who also spoke on condition his full name not be revealed for fear of reprisals, said he managed to flee in October to the Islamic State group's de facto capital of Raqqa, then made it to Turkey. From there, he took the perilous sea route to Europe and has resettled in Austria.
"I thank God every day that I was able to get out," Mustafa said, adding that his three children fell ill and one began refusing food and drink. "I couldn't bear it any longer. There was no one to help. No doctors, no medicine, no nothing."
Mustafa said he sold his apartment "and bribed so many people, I forgot how many."
Associated Press writer Edith M. Lederer at the United Nations contributed to this report.