Human Rights Watch (HRW) on Thursday called on Iraqi forces to allow aid to enter the Islamic State-held city of Fallujah where it said tens of thousands of residents face acute shortages of food and medicine.
The Iraqi army, police and Iranian-backed Shiite militias — backed by air strikes from a US-led coalition — have maintained a near total siege on Fallujah, located 50 km (30 miles) west of Baghdad, since late last year.
Residents were making soup from grass and using flour from ground date seeds to make bread, HRW said in a report. Food, when available, costs up to 50 times the normal price.
"The people of Fallujah are besieged by the government, trapped by (Islamic State), and are starving," said Joe Stork, HRW's deputy Middle East director. "The warring parties should make sure that aid reaches the civilian population."
Fallujah — a long-time bastion of Sunni Muslim jihadists — was the first Iraqi city to fall to Islamic State, in January 2014, six months before the group swept through large parts of northern and western Iraq and neighboring Syria.
New York-based HRW also called on the militants to allow food and medicine into the city and to permit residents to leave. Iraqi and US officials have said they are worried the insurgents would confiscate any aid sent to Fallujah.
Defense ministry spokesman Naseer Nouri accused Islamic State of using civilians to obstruct the advance of Iraqi forces.
"The real siege is not by Iraqi forces," Nuri said.
"The Iraqi forces are liberating, they want to liberate the city's residents who have been held hostage by Daesh (Islamic State) for more than three years. Daesh is the one really besieging Fallujah."
Nuri said Iraqi forces had opened three corridors for civilians to flee but alleged the militants had barred them from leaving.
Since recapturing Ramadi — a further 50 kilometers to the west — from Islamic State more than three months ago, Iraqi authorities have not made clear whether they will attempt to take Fallujah soon or leave it contained while the bulk of their forces head north towards Mosul, the largest city under the militants' control.
The humanitarian crisis has made recapturing Fallujah from Islamic State a priority, Nouri said, but added it is up to military leaders to decide when.
In the past two weeks, Iraqi forces backed by coalition air strikes have retaken significant parts of Hit, a strategic town 50 km northwest of Ramadi, and three villages in the Makhmour area, which is set to be a key staging ground for a future assault on Mosul.
HRW, which has not had access to Fallujah, said it relied largely on activists in Baghdad to communicate with residents directly or through people in contact with them.
"The humanitarian picture in Fallujah is bleak and getting bleaker," said Stork. "Greater international attention to the besieged towns and cities of the region is needed or the results for civilians could be calamitous."