The U.N. says armed clashes in the Libyan capital Tripoli along with random shelling and explosives placed on roads are hampering the evacuation of civilians and the delivery of aid.

Forces loyal to Field Marshal Khalifa Hifter launched an offensive to take Tripoli in early April and are battling militias loosely allied with the U.N.-supported government based there.

U.N. spokesman Stephane Dujarric said Wednesday that since the conflict began, 102 civilian casualties have been verified, including 23 fatalities, and over 45,000 people have fled their homes, according to the U.N. migration agency.

He said the hostilities are also impacting health workers and health facilities.

U.N. officials report that at least four health workers have been killed and 11 ambulances have been damaged or destroyed in the conflict, Dujarric said.