Civilians trapped in Raqqa with little access to urgently needed healthcare, organizations warn

— -- During a recent trip back to the outskirts of his hometown of Raqqa, Abu Ismail saw that life in the city, which over the past few years has become the de-facto capital of ISIS in Syria, is now nothing like it was when he left in 2013.

Abu Ismail, 54, was told by residents who had just fled the predominantly Sunni city that they had no clean water inside – instead, they had to drink unsanitary water from wells. Some went without food for days, while others boiled grape leaves and had the soup for dinner. The lack of nutrition and clean water is making many civilians sick, while some sustain injuries from bullets and explosions in the beleaguered city -- and all have little or no access to healthcare, he said.

“Some volunteer doctors from Raqqa have opened clinics for people inside, but there are no hospitals or medical centers or anything, and water and electricity is cut off,” Abu Ismail, an activist who now lives in Turkey, told ABC News.

A few weeks ago, Abu Ismail visited the northwestern outskirts of Raqqa to see his brother for the first time in four years. During his trip, he said residents who had just left Raqqa told him that only one hospital in the northern Syrian city remains partially functioning. And ISIS fighters have first priority there.

“If a child and an ISIS fighter are wounded, they will treat the ISIS fighter instead of the child,” said Abu Ismail -- which, meaning "father of Ismail," is a nickname he goes by. He uses the name out of fear of potential repercussions he may face for traveling back into the Raqqa area.

The U.S.-backed Syrian Democratic Forces (SDF) -- which is dominated by Kurdish People's Protection Units militia, also known as YPG -- launched its campaign to seize Raqqa from ISIS in early June. About 45 percent of the city is now under SDF control, according to Col. Ryan Dillon, spokesman for the U.S.-led coalition fighting ISIS in Iraq and Syria. As the frontline tightens around the estimated 20,000-50,000 residents still living inside Raqqa, civilians are being injured and killed.

Given the danger on the ground and lack of access to Raqqa, it’s difficult to determine the state of the security and humanitarian situation. But the World Health Organization (WHO) reports that some health workers who recently fled the city say that all hospitals and health centers there are now out of service. In addition to injuries from coalition airstrikes and sniper fire, civilians in Raqqa are at risk of waterborne epidemic diseases such as cholera and hepatitis, as they’ve had no access to clean drinking water for 48 days, the WHO said.

“In addition, the majority of local physicians as well as the other health workers have fled the city, and the medicines are quite scarce, and their prices are excessive,” a WHO spokesperson told ABC News.

Since June, the organization Doctors Without Borders, commonly known by its French acronym MSF, said it has treated more than 400 patients from Raqqa and surrounding villages. Most patients are civilians with injuries caused by improvised explosive devices, landmines, unexploded ordnance, shrapnel and gunshot wounds, MSF said.

Some of MSF's patients were civilians who sustained wounds upon returning to their old neighborhoods after fighting there ended, said Vanessa Cramond, MSF’s medical coordinator in Northern Syria.

A Raqqa-based family had returned to their home and was tidying up the house after being away for a long time. The family’s two teenage girls were making the bed when a device placed either in or under the bed exploded, killing one sister immediately and injuring the other critically, Cramond said. And last week, a young boy picked up an unexploded ordinance and brought it home, not knowing what it was. The device detonated, killing two of his immediate family members and injuring the whole family, she said.

“I think it’s just the precariousness of that situation and how devastating it is for the whole family just going about their daily business,” Cramond told ABC News via phone during a recent trip to Northern Syria. “That is a relative norm, unfortunately, as war has become normal for so many people in Raqqa.”

Cramond said she believes the level of access to healthcare inside Raqqa changes from moment to moment – sometimes people have more freedom to walk around and seek care than at other times. Some of the residents MSF has treated over the past months actually seemed to have received a good level of care inside Raqqa, she said, while other times injuries were addressed too late.

“We see people with shrapnel inside them from the impact of a blast… so the wound is really infected, and that often means that we see people who need to be amputated because we’re seeing them very much after the injuries occurred and we’re unable to salvage them,” Cramond said.

MSF’s team on the ground has not seen patients with ongoing health issues such as uncontrolled asthma, diabetes, and heart disease, said Cramond, and the number of patients they do see is relatively small.

“That worries us,” she said, adding that this tells her that many civilians are unable to reach medical centers, or don’t know where to go for necessary treatments and surgeries.

Hodeb Shahada, an activist who fled Raqqa for Turkey about a year and a half ago, said he was in touch with some of his friends who have remained in the city, until they decided to flee in mid-July. When they had access to the internet inside Raqqa, they would send him voice recordings about what life is like inside. They told him that only three to four doctors remained in the only hospital that was partially functioning. Some residents died on their way to seek treatment.

“Everything that moves in the street is a target, so at the end no one dares to take people to the hospital,” Shahada told ABC News.

Shahada’s friends told him about an ambulance worker who had lost his wife after their home was hit by an airstrike. The worker later tried to help four boys who were injured after a different strike hit their home, but he was killed when his vehicle was also struck.

The cause of many of the issues Raqqa’s residents are facing, however, is the lack of clean water, Shahada said.

“People drink bad water from wells and it leads to diseases. Some are killed on their way to get water,” he said.

Some civilians have reportedly died because they were caught in the crossfire on their way to get water from the Euphrates river, the WHO said.

The ongoing military campaign in Raqqa means that the WHO doesn’t have access to send health teams into the city. For the first time in three years, the WHO on Tuesday delivered medicine and medical supplies -- enough for 150,000 treatments to Al-Qamishli, northeast of Raqqa, where some residents displaced from Raqqa live in temporary camps.

More than 200,000 people have fled their homes around Raqqa since April 1, according to the United Nations. In 2004, Raqqa was the sixth largest city in Syria, with a population of 220,000.

But not everyone wants to flee, Cramond said. While it’s dangerous to live inside Raqqa, getting out is also unsafe. A number of residents have been killed while fleeing.

Abu Ismail says that his brother is one of those who want to stay. His brother had moved from the city of Raqqa to what was once the family's vacation house, about 12 miles away from the city, in an area that is now controlled by the SDF, but was ISIS-held. Abu Ismail offered to try to bring his brother, his wife and children to Turkey.

"But my brother said 'I stayed in Raqqa under ISIS for two and a half years. We endured under ISIS, so we can take it a little longer,'" Abu Ismail said.

"I would ask people I met in the area, 'why didn't you leave two months ago?' he said. “They responded that they hadn't expected that the battle would last this long. People also don't like to stay in refugee camps. Some say that they'd rather die in their homes."