Mosul, Iraq: In the last square mile of Islamic State territory in this city, terrified families trapped in their basements are bracing for a final ferocious showdown.
As many as 150,000 residents are crammed into Mosul's Old City, as Islamic State fighters fortify their positions in the warren of narrow streets and alleyways.
With no safe drinking water, sickness and disease are spreading as food and medicine run dangerously low. Mortars fired by security forces trying to dislodge the militants "rain down," while airstrikes tear down buildings in the packed neighborhood, one resident said by phone from the besieged area.
But attempting to escape is just as dangerous, with militants determined to keep civilians as human shields and gunning down hundreds who have tried to flee in recent weeks - men, women and children.
"I think the chance of us dying on our way out of the city is higher than the chance of us dying in our houses," the resident said, speaking on the condition of anonymity for fear of Islamic State reprisals. "We are living in a state of horror and siege."
The punishing eight-month battle for the city has taken place in heavily populated neighborhoods, leaving entire streets in ruins. Islamic State militants are now nearly entirely contained in the Old City, where more hardened foreign fighters have arrived in recent weeks as their territory shrinks, residents say.
In the middle of the historic city center lies the Great Mosque of al-Nuri with its iconic leaning minaret, where Islamic State leader Abu Bakr al-Baghdadi declared a caliphate three years ago. The fighters have hunkered down in surrounding alleys - nine or 10 in each, according to another resident who recently fled - and zip around on motorcycles.
Lt. Gen. Stephen Townsend, commander of the U.S.-led coalition backing Iraq's fight with airstrikes and military advisers, recently described Mosul as the toughest urban warfare he has witnessed, or even read about, during his 34 years of service. But Iraqi and U.S. military officials expect the final push into the Old City to be more brutal still as the militants make a last stand.
Massacres of civilians attempting to leave have deterred many from trying. In the worst incident, more than 100 people were gunned down near the city's Pepsi factory this month. The militants also confiscate identity cards; some men are scared to leave without them because security forces might suspect they are Islamic State fighters.
The Old City resident said his extended family of 20 recently ran out of the three months of food they had stored, but managed to purchase about 22 pounds of flour for $170. They eat a single meal every day at sunset.
Residents risk mortar fire to wait in line for muddy well water that is causing diarrhea and hepatitis A, he said. If they can find wood to burn, they boil the water before drinking it, he said.
Around 10 to 15 civilians die each day in bombings, he said. Militants demand that the doors of homes are kept open so that they can access rooftops to fight, bringing terror to residents inside who fear they could be accidentally killed in airstrikes by the U.S.-led coalition or Iraqi forces. The buildings are old and unstable, and several can be torn down in a single strike, he said.
"We pray that there is no strike near us, not just on our house, but near us, because the result will be the same," he said. "There are lots of families trapped under the rubble."
Col. Ryan Dillon, a coalition spokesman in Baghdad, said the integrity and density of buildings are taken into account before airstrikes are conducted, as are Islamic State tactics of gathering people in houses used for fighting positions.
Those who do escape gather at designated locations for screening by security forces and evacuation. Many are dehydrated, malnourished and injured when they arrive, according to medics. All are traumatized.
"It's death, death, death, red death," said 22-year-old Ahmed Haitham. "We haven't seen the sun for the past month." Eighteen people were killed in an airstrike in the house next to his a day earlier, he said. His family still had food, but others said hunger had forced them to leave.
The provincial council sent a request to the federal government and the U.S.-led coalition for an airdrop of essential food supplies two months ago but has not received a response, said Hussam al-Abar, one of its members. Dillon said the coalition has not received such a request.
Estimates of the number of people trapped in the Old City range widely. Abar put the number at 45,000, while Lise Grande, the United Nations humanitarian coordinator for Iraq said between 120,000 and 150,000 are inside. "The major concern is water," she said. "Food is short, the electricity is off most of the time, and there are severe shortages of medicine."
Ahmed Mohammed, 32, fled the Maidan neighborhood of the Old City two weeks ago with his wife and two children, ages 4 and 2. Having run out of milk for the children, they had little choice, he said.
It took him two days to get from his house to the security forces, despite it being a distance of only a few miles. The family traveled from house to house to evade the militants, who stop people in the street they suspect are trying to flee.
"We started at 2 a.m. and went to houses recommended by friends, or friends of friends," he said. "Now I'm talking to relatives inside, they say they won't try to leave after Zanjili," he added, referring to the mass killings at the Pepsi factory.
Before he left the city, Islamic State militants were reinforcing around the Grand Mosque of al-Nuri, with more fighters from the Caucasus arriving in the area recently, he said.
Maj. Gen. Najim al-Jabouri, the head of Nineveh Operations Command, said the Islamic State fighters in the city include about 300 to 400 foreigners and about the same number of locals.
Federal police forces reached the outskirts of the Old City months ago but stalled as they hit the dense neighborhoods and have suffered persistent counterattacks. With the offensive from the south stuttering, Iraqi troops repositioned to begin a new attack from the north in May, moving in to choke off the Old City.
"They are the hammer, and we are the anvil - be a strong anvil," Lt. Col. John Hawbaker, who heads the advise and assist mission for federal police forces, told U.S. paratroopers on lookout at a base less than two miles from the mosque, as forces began their new offensive to surround the Old City.
But the anvil was shaken this week when dozens of Islamic State fighters penetrated police lines in a well-planned counterattack, briefly taking ground.
Still, the final push for Mosul's Old City is expected soon, Iraqi commanders say. A small area around the Jumhuiya hospital is the only territory outside of the Old City still to be recaptured.
"Tell the security forces to reach us quickly," the Old City resident pleaded. "If this lasts until the end of the month, many people will die."
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