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In Iraq, a major offensive is underway by Iranian-bolstered Iraqi forces against the IS-held city of Fallujah.

But reports of indiscriminate shelling by advancing forces and mounting civilian casualties have prompted the United Nations to issue warnings of "dire conditions" for residents of the city.

Both the purported sectarian motives and the previous battle record of some of the pro-government militias taking part in the battle for Fallujah are also a source of concern. 

Only 800 people have been able to flee Fallujah since Iraqi forces launched a major offensive to retake the city, the United Nations said in a statement quoted by AFP on Thursday.

Lise Grande, the UN's humanitarian coordinator for Iraq, said that those who managed to leave the city occupied by the IS group reported dire living conditions inside.

"We are receiving distressing reports of civilians trapped inside Fallujah who are desperate to escape to safety, but can't," the statement quoted her as saying.

The UN said that only 800 people had been able to flee Fallujah since May 22, "mostly from outlying areas".

"Some families report having to walk for hours under harrowing conditions to reach safety. People trapped in the city centre are thought to be most at risk Fallujah - Raqqa unable to flee," the UN said.

Grande said that those who managed to flee told of a dire situation inside the city, which lies only 50 kilometres west of the capital Baghdad.

"Food supplies are limited and tightly controlled. Medicines are exhausted and many families have no choice but to rely on dirty and unsafe water sources," she said.

Food supplies are limited and tightly controlled. Medicines are exhausted and many families have no choice but to rely on dirty and unsafe water sources

Starvation tactics

The UN and other humanitarian agencies have been unable to deliver much of the available assistance due to the lack of access since the operation was launched on May 22-23.

Humanitarian corridors discussed with the Iraqi authorities have largely failed to materialise so far.

Extremist fighters holed up in the Fallujah city centre have been imposing a curfew and forbidding residents to leave their homes, apparently using them as human cover.

Residents contacted inside Fallujah have also said that the amount of bombs and booby traps laid by IS in and around the city would make any flight very perilous.

The UN's refugee agency also said on the first day of the operation that supply routes were effectively cut off by the tens of thousands of Iraqi forces surrounding the city, thus also preventing civilians from leaving.

Various rights and other groups had warned the Iraqi government against resorting to starvation tactics to defeat IS in Fallujah, where the UN estimates around 50,000 civilians remain.

Various groups had warned the Iraqi government against resorting to starvation tactics to defeat IS in Fallujah, where the UN estimates around 50,000 civilians remain

Vengeful spirit

On Wednesday evening, Iranian-backed Popular Mobilisation militias continued targeting positions in Fallujah, amid accusations of indiscriminate shelling. 

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One of the targets hit was the city's government hospital, killing and injuring a number of civilians, according to local sources.

This coincided with reports that shelling by Iraqi forces killed 11 civilians in northern Fallujah, including women and children. By Wednesday evening, local sources told °®Âþµº up to 100 civilians have been either killed or wounded by the Iraqi government offensive, which is also backed by international airstrikes.

The United Nations and the International Committee of the Red Cross had issued statements on Monday evening appealing for the warring parties to protect civilians

Prime Minister Haider al-Abadi said the armed forces had been "instructed to preserve the lives of citizens in Fallujah and protect public and private property."

"Those who cannot take the exit routes, they can stay at home and not move," he added in comments aired by state Iraqi TV while on visit to the field command centre near the city.

But the Association of Muslim Scholars of Iraq, a political organisation formed in 2003 to represent Iraq's Sunnis, on Monday condemned the campaign led by Shia-dominated forces against the Sunni-majority city as "an unjust aggression, a reflection of the vengeful spirit that the forces of evil harbour against this city".

It said in a statement nearly 10,000 residents had been killed or wounded by government shelling over the past two years, and warned any victory would be "illusory", but the figure could not be verified independently.

The military campaign could take "many weeks, if not longer", Ranj Alaaldin, an Iraq expert at the London School of Economics, told Reuters, due to lingering support for IS among many residents who may still prefer the militants to a Baghdad government long perceived as sectarian and repressive.

The war in Sunni-majority provinces has turned much of their population into refugees, many of whom still not returned to their liberated towns and villages despite months having passed since IS were driven out

This is not to mention the government's plans for post-IS Fallujah. The war in Sunni-majority provinces has turned much of their population into refugees, many of whom still not returned to their liberated towns and villages despite months having passed since IS were driven out.

In a nod to local sensitivities, meanwhile, Iraqi officials say Shia militias would be restricted to operating outside the city limits.

The local Anbar government is heavily opposed to the involvement of Shia militias and Iranian officers in the battle. Sunni politicians in the country have often accused the militias of grave human rights violations against Sunni communities in areas they liberated from IS, in the Diyala province, Jurf al-Shakher and some parts of Anbar.

But a series of bombings that killed more than 150 people in one week in Baghdad cranked up the pressure on Abadi to do something about the city seen by many Shia politicians as an irredeemable bulwark of Sunni Muslim militancy.

Forgotten civilians in Raqqa

The plight of Syrian civilians still trapped in the de-facto capital of IS and surrounding areas has been one of the most forgotten aspects of the war on the extremists in control there.

Coalition and Russian-regime strikes have routinely killed civilians in the city of Raqqa, but the difficulty of reporting from the ground, where IS imposes a media blackout, has made it near impossible to shed light on these casualties.

As a US-backed, Kurdish-led assault on northern Raqqa province entered its third day on Thursday, reports are coming in of masses of civilians trying to flee the city, fearing the fighting is getting closer.

Although Kurdish forces have insisted the current campaign is only for the rural area north of Raqqa city, the city is expected to be the end goal.

"The ultimate purpose is Raqqa city. It may not be short-term or mid-term, but besieging the city and blocking IS movement is also very important," Washington-based analyst Mutlu Civiroglu told AFP.

Raqqa political activists have been warning that IS is using civilians as human shields, spreading fighters and their weaponry around civilian areas and housing militants in residential areas.

Earlier, international coalition planes dropped leaflets calling on civilians to leave the city into safer ground.

"The time you have been waiting for has come, the time to leave Raqqa,” the flyers read. The leaflets depict three men and a woman with a child escaping urban ruins and heading to a peaceful landscape with the sun shining through clouds.

Sowing panic

However, activists speaking to VOA said the coalition is sowing panic among civilians and risks alienating them.

There are reports some civilians have volunteered to help defend the city.

“If the international coalition wants to ask the people of Raqqa and its suburbs to leave their cities and towns, they should first provide havens and safe roads to secure civilians,” said Hamoud Almousa, an activist with the anti-IS network Raqqa is Being Slaughtered Silently.

He said it appears locals fear the Kurdish YPG group as much as IS.

Raqqa's civilians are also reportedly finding it hard to find a safe area to head to.

Islamic State, according to local sources, has said it will allow civilians to leave only to areas it controls.

In addition to risking retribution from IS, civilians who defy the group's directives will have to use smugglers and pay huge sums of money, in addition to braving minefields, bandits, and the risk of starvation in the desert.

In addition to risking retribution from IS, civilians who defy the group's directives will have to use smugglers and pay huge sums of money, in addition to braving minefields, bandits, and the risk of starvation in the desert

Recently, Raqqans have been fleeing to the province of Suweida via Iraq through the al-Tanaf crossing. Once in Suweida, the regime detains them in camps in schools and only allows them to leave if locals vouch for them.

Some Raqqans have also headed to rebel-held areas in the Aleppo province. However, the military escalation there has made this route unsafe. Dozens have been reported killed by mines or crossfire as they attempted to reach these areas.

Ultimately, to definitively defeat IS, Iraqi and Syrian fighters would have to address local concerns, sectarian politics, and ethnic divisions.

The Soufan Group, quoted by an AFP report, said recapturing Fallujah "poses the biggest military challenge Iraqi forces have faced in the two years" since IS seized Mosul, their main Iraqi city.

In Syria, it wrote, IS fighters' "determination" to defend Raqqa will make the fight to retake it "one of the fiercest yet."

And ethnic considerations are also complicating the effort, as much of Raqqa province is populated by Sunni Arabs while the SDF leading the assault there is a Kurdish-majority force.

"Any liberating army made up of primarily Kurdish fighters will not be seen as liberators," the Soufan Group warned.