Encircled on all sides by US-backed Syrian rebels and cut off from municipal services in Raqqa, captured Islamic State (IS) fighters are showing increasing signs of malnutrition and drug use.

Among a handful of IS fighters who have surrendered in the Old City, where some 2,500 militants remain, Syrian Democratic Forces (SDF) have found track marks indicating the use of amphetamines. Leaders of the US-led coalition to defeat IS in Iraq and Syria say the condition of IS fighters shows the increasing desperation of militants to keep themselves awake and in the fight.

“As the central services, as water turns off, it makes it very difficult to sustain oneself,” said Col. Ryan Dillon, spokesman for Operation Inherent Resolve, in response to a question from Al-Monitor. “This was a relatively new report of some of these fighters using some sort of drugs to keep them alert and keep them going.”

"As far as I know, this is the first time for me seeing and getting reports on the use of track marks or some kind of intravenous way of keeping yourself above order,” Dillon added. US officials declined to assess how long IS might be able to hold their increasingly tenuous position in the Old City.