Aid organisations say an airtight blockade, ongoing violence, and a rapidly declining humanitarian situation are putting the lives of more than 6,000 Palestinian refugees at risk in Syria's Yarmouk camp.
The UK-based Action Group for Palestinians in Syria warned that Yarmouk's "humanitarian situation is going from bad to worse" in a statement published on Tuesday.
Yarmouk was once home to nearly 200,000 Palestinian refugees and Syrians, and most of its former residents have been displaced to other parts of Syria or outside the country.
Stuck between a brutal blockade and armed clashes, a mere 6,250 civilians are believed to be in Yarmouk, according to UNRWA, the United Nations agency for Palestinian refugees.
"Health facilities are limited and the humanitarian situation can change rapidly given levels of vulnerability," spokesman Chris Gunness told Al Jazeera.
Gunness added that UNRWA has been unable to access the refugees from the camp since its last aid convoy went in May 2016.
'Siege within a siege'
Syrian government forces and militias loyal to President Bashar al-Assad have imposed a blockade on the camp since December 2012, restricting the flow of food, medicine and other humanitarian goods to civilians.
The Islamic State of Iraq and the Levant (ISIL, also known as ISIS) invaded Yarmouk in March 2015.
ISIL controls of most of the camp's territory, while a handful of neighbourhoods are still held by Jabhat Fateh al-Sham (formerly al-Nusra Front) and other fighters.
READ MORE: ISIL and Nusra put Yarmouk civilians in line of fire
Wesam Sabaaneh, director of the Jafra Foundation, a humanitarian group that works in Syria's Palestinian camps, said Yarmouk is often rocked by "sporadic clashes" between government forces and armed groups, as well as clashes between ISIL and Jabhat Fateh al-Sham.
"The situation for civilians is very bad," Sabaaneh told Al Jazeera, describing life in the camp as "a siege within a siege" for the remaining residents.
"ISIL is imposing strict laws, such as requiring niqab [a full face veil], as well as taking over the schools. It has also carried out executions of civilians in the streets," he added.
"There are water shortages and no electricity, and it's getting worse now that winter is setting in. There's no clean water or medicine, so there's a lot of fear that illnesses will spread very fast in the camp," Sabaaneh said, explaining that medical care is available only in a few makeshift clinics.
On Friday, the Action Group reported that Hussein al-Misri, a 70-year-old refugee, died "due to the lack of medical care and the acute shortage [of] life-saving medicines" in Yarmouk.
Misri is among more than 3,411 Palestinian refugees - at least 1,277 from Yarmouk - who have died as a result of Syria's more than five-year civil war.
Among the deaths documented by the Action Group were 188 people who died as a direct result of the blockade. Another 477 were killed by shelling and 160 died during torture. Others were killed by gunfire, car bombs, field executions and along the treacherous refugee trail to Europe.
At least 1,135 Palestinians remain behind bars in the government's prisons, while 300 are missing, the group estimates.
Q&A: Beyond Yarmouk, Palestinians in Syria need aid
Although Syria's conflict started as largely unarmed protests against Assad's rule in March 2011, it quickly turned into a full-scale civil war that has killed hundreds of thousands. More than half the country's pre-war population has been displaced.
Salim Salamah, director of the Palestinian League for Human Rights - Syria, explained that Palestinian refugees are particularly vulnerable because they are already stateless.
"To be brutally honest, this is just a reflection of the larger Syrian trajectory," he told Al Jazeera.
"For Palestinians, what is more worrisome is what is after this forced displacement. The reality of statelessness has re-emerged."
Follow Patrick Strickland on Twitter: @P_Strickland_
Source: Al Jazeera News