CAIRO — One year after an offensive was launched against the Libyan capital Tripoli, Libya's war is intensifying, and hundreds of thousands of civilians are besieged amid increased shelling and massive water and electricity cuts.

Hospitals are being targeted just as the coronavirus is threatening an already shattered health system.

Haytham Garabiya is among those trapped. The doctor’s field hospital was recently hit by armed drones and shelling, forcing his staff to move to a new location.

“We have no water and no electricity,” Garabiya said in a telephone interview. “There are random missiles flying everywhere. Every civilian building is a target. And now we also have coronavirus. The war is more intense than last year.”

The United Nations, the United States and other countries have pleaded with the warring sides for a “humanitarian pause” to help prevent the spread of the coronavirus. Instead, both sides appear to be determined to take advantage of the international focus on the pandemic and try to gain more territory. After initially agreeing to the “pause,” the warring sides returned to combat within days.

The escalation in violence — the worst since the 2011 Arab Spring revolts and NATO intervention that toppled dictator Moammar Gaddafi — is being fueled in part by outside powers, which continue to supply weapons and mercenaries, despite a U.N. arms embargo

“The distraction associated with Covid-19 has undeniably exacerbated the escalation,” said Jalel Harchaoui, a Libya analyst at the Clingendael Institute in The Hague. “There clearly is no concern or worry about a potential condemnation on the international stage.”

On one side of the conflict is the U.N.-installed Tripoli government, which is supported by a constellation of militias as well as Turkey and several other countries. Battling them is warlord Khalifa Hifter, a dual U.S.-Libyan citizen who lived for years in Northern Virginia and is loyal to a parallel government in the east of the country. He is backed by the United Arab Emirates, Egypt and Russia, among other nations.

Blood clashes break out nearly every day. At least three residential neighborhoods in Tripoli recently came under heavy shelling and artillery fire, forcing more than 3,700 civilians to flee their homes, according to the United Nations. The mayor of a nearby town, who is considered a Hifter loyalist, shut off the water supply to the capital’s more than 2 million people.

Meanwhile, attacks by armed drones supplied by Turkey have also intensified, striking one of Hifter’s command centers, supply lines and killing one of his senior military commanders, according to officials from both sides.

The increasing violence is raising alarms within the United Nations and humanitarian agencies. There are now 24 confirmed cases of the virus and one death. Authorities in both the east and the west of the country have stopped flights from entering or leaving and borders have been closed.

 Libya’s health system has been decimated by the war. As of last month, 27 health facilities have been damaged as a result of clashes, including 14 health facilities that have been closed, according to the U.N. statistics. An additional 23 are at risk of closure because of shifting lines of conflict, U.N. officials say.

There’s a severe lack of specialized medical staff and equipment to deal with the spread of any disease, let alone a coronavirus pandemic. Isolation units, lab reagent detection kits, personal protective equipment and trained health-care workers are lacking, U.N. officials say.

“People have somehow gotten used to the war, but are genuinely scared about what will happen with coronavirus,” said Liam Kelly, country director for the Danish Refugee Council. “I think this is a mixture of fear of the unknown, but also fear of the known lack of capacity in the health system to deal with an outbreak like this.”

Al Khadra Hospital, one of Tripoli’s largest medical facilities, shut down last week after three days of shelling that caused damage and injured one medical worker. The 400-bed hospital had been tapped to treat coronavirus patients.

“This is a clear violation of international humanitarian law,” Yacoub El Hillo, the United Nations’ humanitarian coordinator for Libya, said last week after the first attack on the hospital. “This senseless escalation must stop so that health authorities and aid agencies can respond to covid-19 and continue reaching people in need of urgent humanitarian assistance.”

For months after Hifter launched his offensive in April, the fighting had settled into a military stalemate.

But the arrival of highly experienced Russian mercenaries on Tripoli’s front lines in September bolstered Hifter’s forces and, along with the deployment of armed drones from the United Arab Emirates, allowed him to widen the war to other parts of the country.

The Tripoli government then turned to Turkey for more support. Turkey was already supplying it with weaponized drones, armored vehicles and military forces. After Turkey made economic and security agreements that could be worth billions of dollars to Ankara, Turkey increased its support further, dispatching Turkish-aligned Syrian mercenaries and more weaponry.

By late January, after failed attempts by the United Nations, the United States, and European and Arab countries to persuade both sides to reach a cease-fire, massive amounts of weapons and mercenaries from their respective foreign backers began flowing into Libya.

“The path to a political solution remains blocked, so it was only a matter of time that the escalation would happen,” said Wolfram Lacher, a Libya researcher at the German Institute for International and Security Affairs.

In recent weeks, Turkey’s growing engagement has changed the balance of power, security analysts said. Last week, militias aligned with the Tripoli government have carried out offensives near Tripoli, aided by Turkish drones. But Hifter’s forces, who call themselves the Libyan National Army, have struck back in other areas and most analysts expect the United Arab Emirates to send more weapons to Hifter.

“Both sides are stepping up their war efforts,” tweeted Mohamed Eljarh, a well-known political analyst based in eastern Libya.

Hifter and his allies are also applying pressure in other ways. In January, influential tribes loyal to him seized oil export terminals and pipelines to choke off vital oil revenue to the Tripoli government.

Then, the mayor of Shweirif, south of Tripoli, cut off the Great Man Made River — a vast network of pipes and aqueducts that supplies fresh water to Tripoli and other cities. A Hifter loyalist, he wanted the Tripoli government to release his detained brother and other family members, according to U.N. officials and analysts. It’s unclear, they said, whether the mayor was acting on Hifter’s orders.

The United Nations’ Hillo said in a statement that water should never be used as a weapon. “At this moment when Libya is fighting the threats of the covid-19 pandemic, access to water and electricity is more than ever lifesaving,” he said. “Such individual acts to collectively punish millions of innocent people are abhorrent and must stop immediately.”