Deadly fighting between the Islamic State of Iraq and the Levant (ISIL) and the al-Nusra Front has put civilians, mostly Palestinian refugees, in danger yet again in the Yarmouk refugee camp in southern Damascus.
Issam, a 54-year-old resident of Yarmouk, said that civilians have called for a temporary humanitarian ceasefire from the armed groups but have yet to receive a response.
"There is not a piece of bread left in this camp," he told Al Jazeera by telephone while the sound of gunfire rang out behind him. "There isn't medicine or water for drinking."
Issam estimated that 5,000 civilians are stuck in the areas where clashes are ongoing. "The people who stayed in the camp [since the outbreak of the Syrian uprising] are the ones who will never leave until they can return to Palestine."
The Sons of Yarmouk Movement, a recently formed Palestinian armed group, is also battling ISIL (also known as ISIS), he added.
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Home to both Palestinian refugees and Syrians, Yarmouk is situated in southern Damascus and was the largest Palestinian camp in Syria, with some 200,000 residents. The Jafra Foundation, a Yarmouk-based humanitarian group, estimates that a mere 5,000 to 8,000 residents remain.
The people who stayed in the camp [since the outbreak of the Syrian uprising] are the ones who will never leave until they can return to Palestine.
Describing the camp, Issam said that bodies of killed fighters were in the streets and snipers were posted up on rooftops as civilians hid in their homes, while plumes of smoke dotted the skyline.
"People are scared to leave their homes. They are hiding there because there is killing in the middle of the streets, and ISIL has burned down homes and cut off the roads," he said. "Everyone here is just trying to survive."
Wesam Sabaaneh, a coordinator at the Jafra Foundation, explained that 20 homes were set ablaze during the fighting on Wednesday.
"The humanitarian situation in the camp is very difficult," Sabaaneh told Al Jazeera by telephone.
With medical access already limited, ISIL set the Basel Hospital on fire, leaving only one medical facility still standing in the camp, the Palestine Hospital.
Since the clashes erupted on April 7, more than 50 ISIL fighters and another dozen from al-Nusra have been killed, said Sabaaneh.
Four civilians were killed, two of whom were beheaded by ISIL.
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Sabaaneh said ISIL has taken over most of the camp's territory, but that Palestinian factions, some of which are aligned with the Syrian government, and al-Nusra continue to control the key areas, checkpoints and entrances.
"Geographically, ISIL controls most of the territory now," Sabaaneh added. "But the Palestinian factions and al-Nusra control the areas key to security. The clashes are very heavy."
On Wednesday, camp residents issued a joint statement calling for a six-hour ceasefire to allow for access to humanitarian aid. They noted that there is an immediate need for drinkable water as most supplies in the camp have been contaminated as a result of the ongoing battles.
In April 2015, ISIL invaded the camp in coordination with al-Nusra and took control of an estimated 90 percent of its territory. However, ISIL subsequently pulled out most of its fighters and stationed them in nearby neighbourhoods in southern Damascus.
As allegiances shift on the battlefield, al-Nusra and ISIL have now turned their guns on one another in Yarmouk and surrounding areas.
Since 2013, government forces and armed groups loyal to President Bashar al-Assad have imposed a harsh siege on Yarmouk, restricting the flow of food, medicine and other humanitarian goods into the camp.
In July 2015, the United Nations removed Yarmouk from a list of besieged communities in Syria. In February, the camp was added to the list again. "Camp residents have suffered a serious deterioration in health due to the siege," Jafra said in a statement on Wednesday. "Urgent medicine and medical equipment are not allowed to enter the area."
Mere kilometres from the heart of the Syrian capital, controlling Yarmouk is a strategic goal for many armed groups in the Syrian civil war.
The Palestinian League for Human Rights - Syria's Salim Salamah argued that the ongoing fighting demonstrates "the desire of multiple parties to put the final nail in the coffin" of Yarmouk.
"The surprising thing about the new round of infighting is that food has run out, but bullets and weapons have not," he told Al Jazeera, adding that al-Assad forces have merely paid lip service to de-escalating the violence. "This is a battle for a single faction monopoly in the camp. Up until this moment, it seems that ISIL has the upper hand and no lack of weapons and manpower."
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For many, Yarmouk is a microcosm of the broader situation Palestinian refugees face across the map of Syria. Among the camps hit particularly hard are the Sbeineh camp in Damascus and the Deraa camp in southern Syria, which are respectively 80 percent and 60 percent destroyed.
Salamah decried the UN's inaction and the Palestine Liberation Organisation's silence over the plight of Palestinians in Yarmouk as conditions plunge yet again.
"Palestinian refugees, as the backbone of the Palestinian cause, deserve at least a word of consolation from those who are supposed to be their representatives," he said.
"The most important responsibility lies with UNRWA - to highlight and ease the dark plight of Palestinian refugees. Palestinians are looking for protection and not food packages."
Starting as an unarmed uprising against Assad in March 2011, the Syrian conflict morphed into a full-on civil war that has left upwards of 260,000 people dead, according to UN statistics. Of the more than 500,000 Palestinian refugees who lived in the country before the uprising, more than 50,000 have fled and another 3,200 have been killed, estimates the UK-based Action Group for Palestinians in Syria.
The Action Group has also documented at least 163 Palestinian refugees from Yarmouk who were tortured to death by the Syrian government since the beginning of the conflict.
The latest bout of violence has also interrupted aid deliveries by UNRWA, the UN Agency for Palestinian refugees, to displaced Yarmouk residents in the adjacent neighbourhoods of Yalda, Beit Saham and Babila.
"It is distressing to see yet another episode of extreme trauma and suffering imposed on civilians in Yarmouk," Chris Gunness, UNRWA spokesman, told Al Jazeera. "To help reverse the years of deprivation endured by civilians in Yarmouk, this minimal level of humanitarian assistance must be sustained."
UNRWA has been unable to access Yarmouk's interior since ISIL's April 2015 invasion of the camp. ·
"The Agency calls on the concerned parties to cease hostilities and to comply with their obligations under international humanitarian law to respect and to protect the lives of civilians in Yarmouk," Gunness added.
Back in Yarmouk, resident Issam appealed to the international community, the UN and the Palestinian factions for protection. "No one cares about the people of Yarmouk," he lamented. "No one is ready to protect us."
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