In January 2015, the Islamic State (ISIS) imposed a siege on the regime controlled parts of the city, which are some of the western neighborhoods and the military airport adjacent to them, after it drove out the moderate and Islamist opposition groups. ISIS’s siege on regime-controlled Deir Ezzor is in its sixteenth month, and constitutes one of the single largest areas that the United Nations has designated as being under siege. Since the siege started in January 2015, the siege has steadily worsened because of continued lack of resources in the besieged areas, coupled with the regime’s rigid control of the few resources available.

The combination of ISIS’s siege and the regime controlling markets and resources in the besieged area has made Deir Ezzor’s siege exceptionally severe. In 2012 the regime had already begun taking direct control of the agriculture and oil sectors. The regime built a wheat mill and oil refinery for food and fuel supplies so it could become more self-sufficient and maintain a long term presence in the city. The regime also took control local trade commodities, and its military and security forces continue to control the flow of goods in and out of western Deir Ezzor.

The regime controls the markets and supply of goods in the besieged areas of Deir Ezzor, either directly or by empowering loyalist merchants. Economically the lack of resources drives prices up while the regime and the traders further raise prices for their personal benefit. For example, the government manages the wheat and fuel reserves and provides them to its loyalists and soldiers first. The goods left over are not enough to sustain residents and the food quality is poor.

Locals mistrust the Syrian Arab Red Cross (SARC) and accuse it of colluding with the government. In April 2015, residents reported that SARC reserved as much as sixty percent of the food aid for the Syrian army, and gave the remainder of goods to residents after regime forces had taken what they wanted. A few months later, in August 2015, the Syrian regime confiscated all of the aid that SARC brought. Out of ten aid drops from April 2015 until February 2016, civilians received four, and the remainder went to regime forces and employees.

Meanwhile, cost of goods and housing continue to increase. Gasoline is at SYP 4,500 ($20.49) per liter which is roughly the equivalent of $56 per gallon. Heating and cooking fuel is at SYP 12,000 ($54.65) for a tank, if it is available, otherwise residents resort to buying wood and candles. Even wood prices have increased to 150 SYP per kilo (about $.70). Sugar and oil prices are now 10 times higher than twelve months ago. Without sufficient oil to supply electricity for the city, water pumps cannot sanitize local drinking water, which has led to health problems. Access to water is only three hours every few days, which is not enough to meet people’s needs. Residents have taken to purchasing water tanks for SYP 2,000 ($9.81) and getting water directly from the Euphrates River.

While food and commodity prices continue to increase, unemployment has risen but salaries have decreased, putting an enormous strain on an already impoverished area. Inflation is currently at 140%. Fruit and vegetables are too expensive to purchase and bread is the last staple available for families. The regime has seized bakeries to ensure it has a supply for its own soldiers and to control the local population’s food supply. Before the siege, seven bakeries operated in what is now the besieged areas of Deir Ezzor. The regime stopped supplying four of these bakeries with fuel and flour, and the bakeries were forced to shut down. Residents wait ten to twelve hours in line for bread, and regime soldiers who oversee the process harass and beat them. The cost of bread from regime controlled bakeries is SYP 300-350 ($1.47-1.72) which is between two and eight times the amount found in other besieged areas. Private bakeries, meaning they do not receive any government support, have opened up to meet the people’s needs, but charge twice as much.

Malnutrition is on the rise because families cannot get enough food. To cope with the lack of food and increased prices, families eat only one meal a day, and even then cut their eating portions in half. They also often rely on only one food item because they cannot afford or find a variety of foods.

Health issues have increased due to malnutrition. Chronic diseases are on the rise including diabetes, heart disease, and asthma. There is little medication available in the besieged areas, and the regime controls all of it. A lack of medication, clean facilities, and professional medical workers means that civilians cannot get needed surgeries. The medical staff left are primarily emergency response medical workers. Doctors for long term health such as surgeons and gynecologists have left the besieged areas. Siege tactics include shutting down factories that make medication. Prices have sky rocketed to the point where people purchase medications by the pill. SARC and the International Committee of the Red Cross have delivered some medical aid, including medication for chronic kidney problems. Basic health and hygiene items, such as soap, are scarce, and families prioritize food over hygiene supplies, which has led to an increase of lice, scabies, and hepatitis. Half the medical centers in the besieged areas have shut down since the beginning of the siege. The military hospitals are still operational but only provide services and medication for soldiers.

Both ISIS and the regime keep civilians trapped in the city. The regime military has set up various checkpoints where security forces search and seize civilians without warrants or reason. Residents resort to bribery to get through checkpoints, paying off guards SYP 20-25,000 ($3,571-$4,475). If residents try to leave they must smuggle themselves out by paying SYP 30,000 ($5,357) on foot or between SYP 75,000-100,000 ($13,392-$17,857) by army helicopters in the still operational airport.

The education sector has also been hit by the siege as teachers and students both leave the city due to the harsh living conditions. Older students withdraw from school to avoid arrest and conscription into the regime’s military forces. The population has dropped from 545,000 people since the siege started to 340,000 currently as residents. Of those left, a quarter are locals and the majority are internally displaced from rebel-held areas. Before ISIS seized control most of Deir Ezzor and the surrounding countryside, Deir Ezzor was a destination for Syrians fleeing from fighting in other parts of the country. These internally displaced people arrive without most of their belongings and have few resources to on which to survive.

Justice for Life Observatory in Deir Ezzor is a Syrian NGO that produces reports about and documents events in Deir Ezzor. It works through a network of civil society activists in the province of Deir Ezzor. This analysis is based on a February 2016 report by JFLDZ.

Image: Photo: Residents queue up to receive humanitarian aid at the Palestinian refugee camp of Yarmouk, in Damascus March 11, 2015. The Palestinian Yarmouk refugee camp in Damascus, which is under siege by Syrian government forces fighting rebels, has received its first relief supplies since the beginning of December. The aid was delivered by the United Nations Relief and Works Organization (UNRWA) on March 5, the organisation said in a news release. REUTERS/Stringer