Samar Hussein, 11, was just waking up one morning a few weeks ago when an explosion ripped through her house. Her parents and three other relatives were killed.
She escaped with a broken right leg and wound up at a crowded hospital run by Islamic State, which controlled her neighborhood in east Mosul.
Militants captured the city of 1.2 million in 2014, but since mid-October they have slowly been losing ground to Iraqi forces aided by a U.S.-led coalition.
Before the start of the offensive, the government air-dropped leaflets and broadcast messages on television urging residents to shelter in place, because camps for displaced people were already crowded and leaders feared that Islamic State fighters would turn a mass exodus into a mass slaughter.
Most residents heeded the advice and stayed. But they have paid a heavy price, with higher-than-expected numbers caught in the crossfire and targeted by militants.
At least 332 civilians were killed in Mosul and the surrounding province last month, according to the United Nations. The U.N. has not released this month’s total, but the violence has been worsening.
Nearly 700 civilians were wounded by snipers, mines and rockets the second week in December, a 30% increase from the previous week. This week, 15 civilians and eight police died, and 50 more people were wounded, in multiple suicide car attacks in the suburb of Gogjali.
U.N. officials said about 40% of casualties have been civilians — far exceeding the 5 to 10% they had expected.
Samar and her aunt, Mayada Habib, a 35-year-old high school physics teacher, were able to take a taxi to the outskirts of Mosul this week to have the girl’s cast replaced at a World Health Organization clinic.
All around them were other trauma victims: a small boy shot in the elbow by a sniper, an older man who broke an ankle fleeing an airstrike, a young woman grazed by a bullet as she sat outside her house,
Unwilling to flee without the rest of their family and worried that such a caravan would be vulnerable to attack, Samar and Habib planned to return to their home in east Mosul’s Nour neighborhood to wait out the military campaign.
“We wish we could get out of there,” Habib said. “Islamic State is always targeting civilians.”
She held little hope that the Iraqi army could save her family or her city, she said. “After the destruction and what we have suffered for years, what are they going to do?”
Another patient, 22-year-old Shukr Mahmoud Salem, whose arm was shattered in a mortar attack, was delivered by Iraqi special forces.
He had originally sought help at a crowded hospital controlled by the militants. But medication was scarce and civilians had to wait while doctors treated Islamic State fighters.
With no place to go, "many civilians can't leave their houses," said Salem, who will not allow his young daughters outside, even to visit neighbors across the street.
There are roughly a half-dozen field clinics around Mosul treating injured soldiers and civilians, including three trauma stations that stabilize the worst cases before sending them by ambulance to Irbil, the nearest major city, 50 miles east.
Emergency rooms there have treated 1,925 wounded civilians since the start of the offensive, said Ajyal Sultany, a WHO spokesman.
Doctors said the wounded this week included a boy who was fleeing the city with his family when they accidentally set off a bomb left behind by militants. Both of his parents died. He lost a hand.
Aid groups and the government have been working to open more trauma hospitals and other facilities to handle the wounded being shuttled east from contested areas.
Ambulances have been delayed by a gauntlet of security checkpoints, said Matthew Nowery, Iraq country director of Samaritan's Purse, a relief group based in Boone, N.C., that plans to open a 50-bed trauma hospital next week about eight miles east of Mosul.
“Every minute is critical,” he said. “People are dying in the process.”
The campaign to take back Mosul has stalled in recent weeks. As Iraqi forces became entrenched in the east, families remain trapped with Islamic State militants.
Maj. Gen. Najim Jabouri, Iraqi army commander of the Mosul offensive, said there are no plans to evacuate the city. But some officials have questioned that decision, arguing that it was difficult to order airstrikes, artillery and rocket attacks as militants hid among civilians.
“The civilians right now are like prisoners under the terrorists,” said Brig. Gen. Tahsin Ibrahim, spokesman for Iraq's ministry of defense.
During a visit with Iraqi military leaders east of Mosul this week, Lt. Gen. Stephen Townsend, the top U.S. commander in Iraq, said there was no easy answer to the dilemma.
“Leaving all the people complicates operations,” he said. “Taking them all out risks getting them hurt.”
When Islamic State fighters seized Mosul two years ago, some residents welcomed them. The city, Iraq’s second largest, is mostly Sunni, and there were widespread feelings of alienation from the Shiite-dominated federal government in the capital, Baghdad.
Whether Prime Minister Haider Abadi is to eventually win trust in Mosul could hinge on whether advising residents not to evacuate proves to be the right decision.
“Abadi made a promise that Mosul residents could stay in their homes, you don’t have to leave, we will rescue you,” said Patrick Martin, an Iraq analyst at the Washington-based Institute for the Study of War.
Some residents have decided they can no longer wait out the offensive.
After his 8-year-old nephew was shot in the head and killed last week, Ahmed Bilal, a 29-year-old chicken vendor, fled Mosul’s eastern Intisar neighborhood with his family.
Bilal and his relatives now live in a 21,000-person camp 20 miles east of the city.
“Many families will die if they stay in their houses,” he said.
Mahmoud Maltroud, a 55-year-old engineer who also fled to the camp, said two sisters are stuck in west Mosul.
“I can’t imagine how they will get out,” he said. “Islamic State is everywhere, on every corner.”