Activists describe scenes of besieged camp in southern Damascus as Syrian forces attempt to drive ISIL out.

There’s only one thought that comes to Rami al-Sayed’s mind when asked to describe an ongoing Syrian government offensive against an ISIL pocket south of the capital, Damascus.

“Doomsday,” says the 35-year-old. “It’s like Judgement Day.”

Al-Sayed is a former resident of Hajar al-Aswad, one of the neighbourhoods of the besieged Palestinian refugee camp of Yarmouk which is currently under attack by forces loyal to Syrian President Bashar al-Assad and Russian fighter jets.

Activists say at least 15 civilians have been killed and more than 100 wounded since the fierce push to retake Hajar al-Aswad, Tadamun and Beit Sahem – which make up a considerable chunk of Yarmouk – began on April 19.

Before the Syrian war started in 2011, the camp was home to Syria’s largest Palestinian refugee population.

In the years that followed, most of its residents fled to other parts of Syria or neighbouring countries seeking refuge. In 2015 Yarmouk came under the control of the Islamic State of Iraq and the Levant (ISIL, also known as ISIS) group.

The six-day operation by Syrian government forces and their allies to drive out ISIL fighters has now turned the camp into a “ghost town”, al-Sayed, who is currently based in the nearby rebel-held town of Yalda, told Al Jazeera on Monday.

“No clinics, no doctors, no supplies – it’s pretty much empty,” he added.

“People are not able to leave to purchase things they need. If they leave, they have to walk miles before seeing another person in the street; it is that uncommon to see people outside.”

‘Bigger siege’

The United Nations agency for Palestinian refugees (UNRWA) estimates that over the past few days some 5,000 Palestinians from Yarmouk have been displaced to Yalda. The agency, which cited “reports” for the figure, has not been able to provide assistance to the camp since 2015.

Local activists say there have been no “formal” evacuations, and those who managed to make it to neighbouring Yalda did so under a rebel-brokered agreement.

UNRWA spokesperson Chris Gunness told Al Jazeera that only 1,200 people remain inside Yarmouk, while activists in nearby towns held by rebel factions have given a similar figure.

Yarmouk residents have had little access to the outside world, owing to a lack of cell service and a government-imposed siege in place since 2012. Activists in the area say these obstacles have made documenting the number of people killed and wounded in the camp a daunting task.

“The humanitarian situation in Yarmouk is simply indescribable,” Ammar al-Midani, one of several Yalda-based activists who work on compiling information from Hajar al-Aswad through their communication with trapped civilians, told Al Jazeera on Monday.

“From surface-to-surface missiles to barrel and cluster bombs and mortar fire, simply disastrous,” al-Midani said.

At times, al-Midani says activists like him are unable to reach residents who are hiding underground, other times, he says, they manage to get through to their friends and family in the area.

“People are terrified, mostly hiding in man-made bunkers. No one is able to reach those in the heart of the camp because of ISIL’s control of the area – it’s a new kind of siege.”

Since last week, Syrian government forces and their allies have intensified efforts to regain all ground near Damascus.

Besides Yarmouk, their goal is to also drive out fighters from rebel groups Jaish al-Islam and Hay’et Tahrir al-Sham, which remain in control of pockets such as the towns of Yalda, Babbila, and al-Qadam – all of which lie south of Damascus and only one kilometre away from Yarmouk.

Palestinian leadership’s silence

On Tuesday, government forces launched air raids in Yalda, killing 10 fighters from Jaish al-Islam, according to activists.

Meanwhile, state-news agency SANA said on Tuesday that government forces were targeting ISIL “tunnels and trenches” in Yarmouk.

According to activists, more than 580 air raids struck Hajar al-Aswad and Tadamun since Thursday evening, the majority of which targeted “civilian basements”.

On Sunday, Yarmouk’s only hospital was totally put out of service after being destroyed in an air raid.

Both al-Midani and al-Sayed said the toll of 15 victims so far included only those whose deaths were able to be documented, while others remain “unfound, and unaccounted for under the rubble”.

Residents of the besieged camp have called on Palestinian leaders, including the Palestinian Liberation Organization (PLO) – an umbrella of major Palestinian political parties – to help bring relief to the people of Yarmouk.

A journalist based in neighbouring Babbila, who identified himself only as Youssef, said people in the camp are puzzled as to why no one from the Palestinian leadership has spoken out about recent events affecting thousands of Palestinian refugees.

‘A war on stomachs’

The escalation is the latest in a series of devastating episodes to have hit civilians in Yarmouk.

The camp was home to 160,000 Palestinian refugees before 2011. But as Syria slid into war, fighting between rebels and Syrian forces quickly extended to Yarmouk too, with residents paying the price of a deteriorating humanitarian situation.

Residents in Yarmouk line up to receive food supplies in 2014 [AP/UNRWA]

Over the years, the lack of food and medicine amid the siege, coupled with heavy battles – including between rebel groups – and the seizure of the camp by ISIL in 2015, pushed many to negotiate evacuation deals.

Among those forced to leave was Majd al-Masry. Born in the camp, the Palestinian former paramedic is now based in Yalda and among those documenting violations taking place in Yarmouk.

The closure of the camp’s only “lifeline”, a corridor that led to Yalda, during the siege was one of the cruelest war tactics, al-Masry said.

“A war on stomachs; a war on health; and a psychological war,” he said, summarising the three years he witnessed at the camp before leaving in 2015.

“Managing attacks from multiple fronts, and diseases like salmonella, kidney failure, typhoid fever, and more – this was my life,” al-Masry said.

‘Annihilation’

The Syrian government has since 2015 regained control of the majority of Syria, with opposition groups now restricted to the northern part of the country, namely Idlib province.

It has thus far managed to regain large swaths of land through a series of evacuation deals that usually come amid a military offensive.

On Monday, Syrian state TV reported that government forces were moving to encircle ISIL fighters from the nearby rebel-held suburbs in an attempt to land an evacuation deal or a withdrawal.

Activists Al Jazeera spoke to said the “destruction” campaign in Yarmouk was a “classic” tactic employed by the government before such a deal.

Amid similar circumstances earlier this month, the government regained control of Eastern Ghouta, a major Damascus suburb that was once home to 400,000 people.

With the offensive in southern Damascus likely to mark the latest rebel defeat, the balance of power in Syria’s war– now in its eighth year, keeps tilting in favour of Assad and his allies.

However, activists say the situation in Yarmouk cannot be described as a “war”.

“We can’t say this is a war. In war, there are emergency medical teams, hospitals, shelters, a chance for a truce and for safe corridors,” al-Sayed said.

“But here, it’s annihilation.”