As many as 10,000 civilians at a Palestinian refugee camp on the outskirts of Syria’s capital are facing a dire situation, including extreme food shortages, as extremists continue to fight for territory there, the United Nations warned this weekend.

The Islamic State launched an attack on the Nusra Front in the Yarmouk camp in south Damascus 11 days ago and the continued violence has made it unsafe for U.N. officials to send food and water.

Supplies from the Palestinian arm of the U.N. were already scarce, and now people are trapped inside their homes, hiding from armed extremists and violence.

A spokesperson for the United Nations Relief and Works Agency (UNRWA) said in a statement Saturday that the agency was “greatly alarmed and concerned by the desperate humanitarian consequences being inflicted on civilians.”

“The fighting has been intense, and is taking place in the most densely populated areas of Yarmouk, with the use of heavy weapons, explosive devices and weapons of indiscriminate effect,” UNRWA spokesperson Chris Gunness said.

At less than a square mile, the Yarmouk camp was established in 1957 for Palestinian’s fleeing the Arab-Israeli War. It soon became the biggest Palestinian camp in the Middle East, with at least 150,000 refugees living in it.

But thousands have died or fled since it was ravaged by the Islamic State and other extremist groups. Many of the estimated 18,000 who remain are trapped in the latest crossfire and have gone without U.N. supplies for more than a week.

Starvation was already the leading cause of death at the camp in 2014, when Amnesty International reported that the Islamic State was using the tactic as a weapon of war. People there have been foraging for leaves, cats and dogs for years, often surviving without electricity and other essentials.

“Whatever supplies of food and water they had have long been exhausted,” Gunness said. “Civilians are enduring yet another extraordinary episode of deep trauma and abject suffering.”

Calling for a ceasefire so the UNRWA can continue deliveries, the agency stated that it is “anxiously monitoring the situation and will maintain in the strongest terms its demands for the safety and protection of civilians in Yarmouk.”