Despite assurances from President Donald Trump that the Islamic State is no more, the U.S.-led battle to oust the militant group from its last Syrian stronghold has intensified in recent weeks. Amid heavy fighting between the Kurdish-led, U.S.-backed Syrian Democratic Forces and hardened Islamic State fighters, scores of civilians and prisoners have been killed by American airstrikes in the eastern province of Deir al-Zour, according to sources on the ground. As part of that campaign, U.S. warplanes bombed a hospital in the village of Al Shaafah late last month, killing patients and the families of medical personnel working there. The hospital was “reduced to only stones and a huge crater in the middle,” an ISIS fighter said in an interview. Two senior U.S. diplomats with knowledge of the fight against ISIS who spoke to us on the condition of anonymity confirmed the airstrike on the hospital. One of them maintained that it was justified and legal. He said the ISIS soldiers were firing at coalition forces from the hospital, making it a legitimate target. On Wednesday, Trump announced a withdrawal of U.S. troops from Syria, tweeting: “We have defeated ISIS in Syria, my only reason for being there during the Trump Presidency.” What Trump’s announcement means for the aerial campaign against ISIS remains unclear. On Thursday morning Reuters reported that American airstrikes against ISIS would be ending, citing unnamed U.S. officials. Pentagon spokesperson Com. Rebecca Rebarich, however, said in a statement, “As long as there are U.S. troops on the ground, we will conduct air and artillery strikes in support of our forces. We will not speculate on future operations.” The reality of ISIS’s demise, however, is far more complex. It’s true that the militant group, which once controlled a wide swath of land stretching from Syria to Iraq, has been significantly weakened. But it still controls some pockets of land in eastern and northeastern Syria, and over the last few weeks, it has waged fierce battles against U.S.-backed forces while facing sorties from U.S. warplanes in the sky. What’s more, ISIS fighters in Syria are confident that they are still being led by Abu Bakr al-Baghdadi, the self-declared caliph and ISIS leader whose death has been reported by Iraqi, Russian, and Iranian media. It is unlikely that the militants will give up on their fight with Baghdadi still in power. Multiple sources have told us about recent airstrikes in eastern Syria that have killed the families of ISIS members, as well as a late-November bombing that killed Kurdish prisoners and dissidents being held by the group. In October 2017, when ISIS began to lose control of its de facto capital, Raqqa, multiple U.S. and British news organizations described the battle there as the group’s “last stand.” But it was largely an orchestrated one. As part of a negotiated withdrawal of Raqqa, the Syrian government provided buses to transport ISIS fighters and their families to towns in Deir al-Zour, a province near the border with Iraq that at the time was, for the most part, under ISIS control. Last week, Syrian Democratic Forces captured Hajin, which had been the only urban area still under ISIS control in Syria. The remaining pockets of ISIS-held territory are villages in Deir al-Zour, along the Euphrates River. These areas are largely under siege by Syrian government forces on one side and Kurdish forces on the other. For weeks now, markets in these towns and villages have been barren, leaving local civilians with little food. “Things here are very difficult now,” an injured former ISIS fighter in a village south of Hajin said in an interview. U.S. planes have been dropping leaflets in the remaining ISIS-controlled areas of Syria. The ISIS fighters and residents of those areas often rip up the leaflets and leave them on the side of the road. One side of a leaflet, an image of which we obtained, shows a soldier in fatigues looking out victorious over the desert as two fighter jets fly toward the horizon. The other side shows a tattered ISIS flag as an ISIS fighter throws down his weapon and retreats. “The Syrian Democratic Forces are coming,” the leaflet reads in Arabic.

Leaflets dropped by U.S. fighter jets onto Deir al-Zour. “The Syrian Democratic Forces are coming,” one side reads.Photos: Obtained by The Intercept

The humanitarian situation was worsened by a U.S. air campaign that took place from November 25 to December 1 as part of Operation Roundup, which has targeted the Middle Euphrates River Valley and Iraq-Syria border region. In a December 5 press release, U.S. Central Command disclosed the bombings of ISIS armored vehicles, supply routes, staging positions, and a storage facility, among other military targets. But these airstrikes also have targeted heavily trafficked open-air markets and other civilian areas, according to multiple sources on the ground. The late November attack on the Al Yarmouk Hospital in the village of Al Shaafah, also near Hajin, was part of that operation. The hospital had patients on the first floor, including captured Kurdish fighters; doctors’ families lived on the second floor. The hospital was hit with a so-called double-tap strike — one bomb, followed soon after by a second at the same location — according to sources on the ground. The monitoring group Airwars reported that between 10 and 45 civilians were killed, based on local news accounts. The intentional bombing of hospitals and civilian areas during armed conflict is a violation of international law. CENTCOM has said it “is committed to avoiding and in every case minimizing civilian casualties” in bombing campaigns against ISIS. While one U.S. official said the hospital was being used as an ISIS attack site, an ISIS fighter presented an alternative narrative in an interview. While he admitted that his understanding was that ISIS fighters were using the hospital as a meeting point, he said the group had been negotiating with the Syrian Democratic Forces to release the Kurdish fighters in its custody in exchange for opening the single main road out of the region, used to get supplies, for up to nine months. The ISIS fighter, who has knowledge of but was not directly involved in the negotiations, said the group believes the United States did not want the deal to happen and bombed the hospital to kill the Kurdish prisoners, thus eliminating ISIS’s bargaining chip. We could not independently verify the claims of the U.S. official or people on the ground. The U.S. official evaded questions about the presence of civilians at the hospital. A Defense Department spokesperson did not respond to questions about the hospital bombing.

Photo: Mohammad Hannon/AP

ISIS Power Struggle As ISIS has suffered defeats on the battlefield, it has become increasingly riven by internal conflicts over questions of ideology, as well as allegations of corruption on the part of its leaders, according to three sources with knowledge of the divisions, and internal communications we reviewed. Some religious scholars in towns and villages the group controls have questioned ISIS’s leadership and ideological doctrine, the sources said. Due to their religious authority, these scholars represent a credible threat to ISIS’s control over the region. In recognition of this threat, ISIS’s secret security service had been imprisoning a number of these dissidents in a large building south of Hajin, three sources closely connected to ISIS said. Also held in that prison were Kurdish fighters captured on the battlefield. According to sources on the ground, a U.S. bombing sortie leveled the prison where the ISIS critics and Kurdish fighters were being held in an airstrike in late November. The Defense Department did not respond to questions on the reports of this bombing. Among those said to have been killed in the strike were a notorious Austrian militant named Mohamad Mahmoud al-Namsawi, who had been seen in videos taking part in executions, and Yousef Simrin, a Jordanian also known as Abu Yacoub al-Urduni, who was formerly a senior religious official within ISIS. Despite their bloody track records, these men had become internal theological critics of the group. Some of the other men killed in the recent prison airstrike were former high-ranking members of ISIS’s religious and militant leadership. According to sources, the imprisoned former leaders were accused of “apostasy” for opposing some of the group’s extremist practices, such as excommunicating Muslims for not following ISIS’s strict religious edicts. Others were imprisoned for their alleged communication with Jordanian Abu Muhammad al-Maqdisi, who is considered one of the key religious scholars behind modern militant Salafi jihadism, an extremist ideology associated with groups like Al Qaeda and ISIS. Maqdisi was a mentor to Jordanian militant Abu Musab al-Zarqawi, who is credited by some with laying the foundation for ISIS. Maqdisi has also criticized ISIS’s extremism and wanton killing of noncombatant Westerners and Muslims. Maqdisi’s opposition to ISIS and his early refusal of personal overtures to join the group, including from Baghdadi himself, caused the group to label him an apostate.