As the deadly Battle for Raqqa between U.S.-backed forces and the so-called Islamic State rages toward its 100th day, the toll on the Syrian city and its surviving residents has been devastating: Tens of thousands of people remain trapped in a war zone with an all-but-destroyed health care system, Physicians for Human Rights reports.

Much of Raqqa, ISIS’ last Syrian stronghold, has been reclaimed since the campaign for its liberation was launched in June, but hundreds of civilians have died in the crossfire. Many were killed by coalition airstrikes or used as jihadists’ human shields, according to the United Nations. Those attempting to flee are endangered by ISIS land mines, snipers and airstrikes, PHR noted.

In a grim stroke of irony, the fighting in Raqqa has drastically increased the population’s need for emergency services while decimating the vast majority of its health care operations. Raqqa’s National Hospital, a poorly equipped facility with limited staffing, is now all that remains.

Violence in the region has hindered aid convoys from delivering desperately needed medical supplies. The next closest hospitals are in the town of Tal Abyad, more than 50 miles away.

“Conditions in Raqqa are truly unthinkable ... it’s hell on earth,” Dr. Homer Venters, director of programs at PHR, said Friday. The small staff at Raqqa’s National Hospital have so few resources that they’ve resorted to sanitizing wounds with water and salt, he added.

DELIL SOULEIMAN/AFP/Getty Images Smoke billows in Raqqa on Sept. 3. "Conditions in Raqqa are truly unthinkable ... it’s hell on earth,” says Dr. Homer Venters, director of programs at Physicians for Human Rights.

“The stories coming out of Raqqa right now are truly nightmarish,” said Racha Mouawieh, PHR’s lead Syria researcher. “The city has been under nearly continuous bombardment since June, demolishing hospitals and clinics. Raqqa is a deathtrap where civilians who have already suffered for years under ISIS rule now also suffer the deadly consequences of the fight against ISIS.”

Last year, Syrian medical facilities were attacked more than 250 times. The seemingly targeted strikes have left many citizens who are in need of medical treatment too fearful to go to a hospital, a Raqqa-based clinician told PHR.

The medical specialist, whose name has been withheld to protect his identity, says he attempted to flee the city with his daughter after his house was destroyed by a coalition strike. A land mine exploded, injuring him and killing his daughter.

“You can hear about it, but you will never imagine it. Living it is not like hearing about it. This is beyond imagination,” he told PHR. “We had nothing to do with anything in Raqqa, and we are paying the highest price. This is indescribable. There is misery at every level.”