Images of the Yarmouk camp siege keep coming. They are tragic and familiar. The infant Taqeh Yousef was photographed Nov. 1 on her deathbed after seizures and oxygen deprivation stopped her beating heart. Last week, ageing refugee Fatima Hassan al-Khalili reportedly died in hospital after crucial delays getting medical treatment. Queues of civilians, mostly women in black abayas, stand around gray checkpoints demarcating regime, rebel and jihadi areas of control in the south Damascus suburbs.

The first complete siege was imposed by pro-government forces around Yarmouk in mid-2013. The now concentric sieges-within-sieges — by pro-government forces outside and Islamic State (IS) within —encircling what was once Syria’s largest prewar Palestinian community still regularly cost civilian lives. Recent checkpoint closures by rebel groups have only made things worse.

Yarmouk’s remaining civilians — estimated at around 4,500 people, according to the Jafra Foundation — might not be dying of abject starvation anymore, as was the case during the worst of the regime’s siege during 2013-14, one of the Syrian conflict’s earliest and arguably most brutal sieges. On an almost weekly basis, however, civilians succumb to often-treatable conditions because of a lack of proper medical care due to the siege by the Syrian government and its allies. Many of the victims are children and the elderly.

The siege conditions have been made worse by recent clashes between rebel groups and IS, which controls most of Yarmouk and the neighboring city of Hajar al-Aswad. The clashes followed the Oct. 12 announcement in Cairo of a “de-escalation” cease-fire between pro-government forces and rebel groups in four rebel-held areas of south Damascus: al-Qadam (to the west of Yarmouk), and Yalda, Babila and Beit Sahem (to its east).