Deir Ezzor, a once relatively prosperous city of more than 300,000 people, is modern-day Syria in a microcosm. When anti-government protests broke out in 2011, the government sent in tanks. When rebels occupied the city, the ideals of those who protested state repression were betrayed by the arbitrary arrests and Islamist repression of al-Qaeda’s Syrian affiliate, Jabhat al-Nusra. Now, half the city is occupied by the Islamic State, which for more than a year has been besieging and starving the other half controlled by the Syrian government led by Bashar al-Assad—with the complicity, current and former residents say, of the government itself.

What’s left today of government-controlled Deir Ezzor is a poor and tired population. Some of those people are stubborn, or proud: having survived nearly five years of a war that has killed more than 250,000 of their fellow Syrians, they refuse to abandon their homes. Most, however—the vast majority—are there not because they choose to be, but because they have no choice. Many are refugees from other areas of Deir Ezzor province or from the city’s other half, taken over by the Islamic State in July 2014, on the other side of the Euphrates River.

Nashwan Alsaleh, a 38-year-old math teacher, fled the IS-occupied half of his hometown about three months ago. “I was wanted by Daesh for having been a soldier with the Syrian Army,” he told me, using the Arabic acronym for the Islamic State group. Fleeing to the government-controlled side of the city was not an option: Alsaleh defected from the military in 2012.

Still, “I have relatives on both sides,” he said, with whom he keeps in contact. “Areas under Daesh are not under siege and have food, vegetables, and meat available at normal prices. But the government areas under siege lack food and prices are high, sometimes 100 times more expensive.”

According to the United Nations, the 200,000 or so people who remain in Deir Ezzor “are facing sharply deteriorating conditions”—and “most” of them, the UN says, “are women and children.” Last year, between 15 and 20 people reportedly died from starvation, while those still living are “surviving on bread and water.” Other goods are still available, but only at “highly inflated prices,” and while schools are still open, absenteeism is common “as children suffer from frequent fainting due to malnutrition.”

The UN says around 400,000 Syrians live in areas it officially considers “besieged” by government forces, rebels and the Islamic State alike. The real number is likely much higher: For political reasons, the UN is sometimes hesitant to call a thing what it is, for fear its limited access to suffering communities may be limited even further. In Madaya, for instance—besieged since July 2015 by the Syrian Army and Hezbollah—more than 50 people have died from starvation since December, according to Doctors Without Borders, but it is still not “officially” facing a siege at all. The reason the town is known at all is not due to the global governing body, but thanks to the efforts of the town’s own hungry inhabitants and activists from around the world to publicize it in the media.

The primary cause of the suffering in Deir Ezzor is the siege imposed since January 2015 by the Islamic State group, which has choked off all access to the city by land. The Syrian government, however, continues to control the city’s military airport—and to offer a way out for the besieged, at a price. That has led to what former residents call a “dual siege”: one imposed by the extremists of the Islamic State group and one profited from by those who purport to be defending them.

“What’s going on in Deir Ezzor right now is that only the civilians are starving, while the fighters and officers are OK,” said Karam Alhamad. An anti-government activist who was 20 at the time the Arab Spring swept the region, he spent more than a year in prison, he told me—and in October 2014, two months after he was freed, he bribed his former jailers for a ride on a government helicopter. A year ago, he said, that trip would have cost some 400,000 Syrian pounds, or more than $1,800 (in a country where, before the war, the average monthly salary was around $300). Last month, he said, that same trip out of besieged Deir Ezzor would cost a million Syrian pounds, or more than $4,500, according to relatives who recently fled.

Alhamad now lives in Turkey, along with more than 2 million other Syrian refugees. The rest of his family left late last year—except for his father, who refused to give up the home where he raised his children. But since freedom from want is not free, the masses remain behind because they have no other option, the last of their savings drained by the savagery of war capitalism; by smugglers who, Alhamad alleged, are effectively working for both sides, smuggling food from IS-controlled territory and selling it for multiple times the cost at a regime checkpoint. Aid flown in on government helicopters—and, on Jan. 15, dropped by Russian planes—is also sold at highly marked-up prices, enriching local commanders and politically connected traders.

Profit over people, who are dying. As one man described as a “wealthy entrepreneur” told the Financial Times: “If you go to the bars and restaurants around the Four Seasons in Damascus, you can’t find a place to park: there are all these people driving new Porsches, Range Rovers, Maseratis.” A friend explained to him that in terms of selling to besieged towns, canned goods are the new gold; suffering for some in Syria now means a new sports car for someone else. “Our nouveau riche,” the businessperson explained, “is making money off misery.”

Add to that a renewed Islamic State group offensive to take the remaining parts of Deir Ezzor, begun around the time of the last aid drop, and a humanitarian crisis looks to be on the verge of catastrophe, with the United Nations citing unverified reports of hundreds of dead civilians.

The last we spoke, Alhamad had not heard from his father since.

“What is happening in Deir Ezzor is a shame on humanity,” said Moaz Talab, a 33-year-old activist and former member of the city’s local revolutionary council. He lived through government and rebel offensives alike and was arrested by Jabhat al-Nusra, he said, “because of my civil society work and for taking part in demonstrations against them for their forced recruitment.” But when the Islamic State group came to town he fled: As bad as al-Qaeda’s Syrian affiliate might be, the extremists who now occupy half of Deir Ezzor are on another level. He believes they would probably kill him.

As many bad actors as there might be in Syria, however, Talab blames the rest of the world. “The international community is directly responsible for this catastrophic situation,” he told me. The “regime sells assistance to civilians at high prices, of up to a hundred times [the normal price],” he said, and the UN, in his view, refuses to “put pressure on the regime” to allow in support from non-governmental aid groups. (Doctors Without Borders, for instance, says that “Despite the scale of the humanitarian needs in the area,” the Syrian authorities have not authorized the deployment of international impartial medical assistance.)

“Shame on every state that speaks about ‘human rights,’” said Talab.

“Our contacts out in Deir Ezzor, they also describe it as that they are besieged by both ISIS and the regime,” said Valerie Syzbala, executive director of The Syria Institute, a project launched in 2015 by the Foundation for Justice and Development, an initiative launched by Syrian-Americans to support the education of Syrian refugees. “The people there feel the government is intentionally withholding,” she said. “It is certainly not taking care of them in the besieged areas. And now it has started treating them like it does the areas that it is besieging across the country, where it basically extorts money out of them,” in the form of bribes to get out and in marked-up food for those who stay behind.

Rebel groups have been accused of similar behavior. In rebel-held Douma, a besieged suburb of the capital Damascus, “you actually saw some citizens protesting against Jaish al-Islam, the group in control there, because they felt they were hoarding supplies, which is probably true—that they were hoarding supplies for their soldiers while people were hungry,” said Syzbala. But she argues against conflating incidents like that with what appears to be a policy imposed by a state that is a standing member of the United Nations.

What’s allegedly taking place in Deir Ezzor “is something that we have seen Damascus do for years as a strategy,” Syzbala told me. “It’s this long, slow, suffering process where it allows a few traders that is in cahoots with to sell goods to people in besieged areas at very inflated prices—hundreds, thousands of times the real prices—and takes a cut of the profit.” In an economy that has collapsed, the state looks for revenues where it can. “This is what people have been describing.”

Alsaleh, the former government soldier, agrees that greed is killing his countrymen. “The officials in the army are doing business from the aid with high prices,” he told me. “Damascus buys their loyalties that way.” But Alsaleh reserves most of his criticism for the world powers bombing his country—the ones “trying to contain Daesh in the area of Deir Ezzor while ignoring the civilians there.” Keep doing that, he said, and “the world should know that it will face hatred from the people of Deir Ezzor that will not be easy to solve.”

Syzbala advocates airdrops, ones “that go not to government forces, but directly to besieged people. In Deir Ezzor, the U.S. is already flying planes, and I’m not aware of any being shot down.” If it can drop bombs that kill civilians—potentially hundreds, according to monitoring groups—then it could at least try to spare a few lives, winning hearts and minds with full stomachs. That will require pressure, however, of the sort that cannot be left to international organizations like the UN, a spokesperson for which told me that it has approval from the Syrian government to deliver aid but that it has been unable to do so because of the security situation.

Some would say unwilling: While large cargo planes are no longer able to land at Deir Ezzor’s airport, government helicopters arrive with regularity. In an extreme situation, where people are starving to death, some advocate extraordinary measures—and Russia has already shown that aid can be dropped from the air. The world must be pressured into acting, but that pressure does not appear forthcoming from either world leaders or the world’s governing body.

“Madaya is an excellent example of an area that is besieged that they [the international community] didn’t acknowledge,” said Syzbala. “It took activists to get the world’s attention. And Madaya’s not the only place that should get that attention.”

Alsaleh is cynical. “The world can stop this war, but it does not want to until each country satisfies its interests,” he argued. Broken promises to the Syrian people, he said, explain why Syria is where it finds itself today. Earlier pledges of support never came, he maintained—the Free Syrian Army took rhetoric to be support and escalated its war on the government only to be “undermined several times” by those calling themselves the “Friends of Syria.” This, he argued, was exploited by al Qaeda and its two branches, ISIS and Nusra, who could claim to have known all along that the likes of the U.S., Britain and France—all now bombing Syria—were no friends of any Muslim.

“The promises and statements by the Western countries is what led to the situation the country is in now,” said Alsaleh. “At least they could air-drop aid for the besieged areas.”

But like many Syrians, he ultimately wants much more than an airdrop.

“Stop this war,” he pleaded, “and save our children.”