Iraqi forces battled Islamist militants deep inside Mosul Wednesday, edging closer to the River Tigris that divides the city and looking for a breakthrough in the seven-week-old offensive.
The fighting to retake the Islamic State (IS) group's last major stronghold in Iraq has prompted a steady trickle of people to leave their homes, many taking refuge in camps where nighttime temperatures have dipped below freezing.
The 9th Armoured Division said it had retaken Al-Salam hospital in a push on Tuesday, the farthest the army has penetrated into east Mosul since the start of a broad offensive launched on October 17.
"We advanced in Al-Salam district but the situation is difficult, there is heavy fighting," Brigadier General Shaker Kadhem told AFP.
"We took control of Al-Salam hospital, which was a command centre for Daesh," he said, using an Arabic acronym for IS.
The five-storey building towers above the neighbourhood and the Islamist militants had been using the upper floors and roof as sniper positions for some time, Mosul residents said.
The elite Counter-Terrorism Service (CTS) has spearheaded the drive into Mosul in the past month, retaking several neighbourhoods in the east of the city.
The army also punched into Mosul in November but its progress has been slower and Iraqi forces barely control half of the eastern side of the city.
Kadhem said the goal of the latest push was to meet up with CTS forces on the banks of the Tigris in the southeast of the city.
A senior CTS officer said the fighting in Al-Salam was fierce and the army had asked for backup.
"The 9th Division's situation is difficult and they have called for support. We are sending a regiment there," the officer told AFP on condition of anonymity.
"They are surrounded now in Al-Salam hospital... we are on the way so we can open a passage for them."
The IS-affiliated Amaq news agency said the Islamist militants had carried out five suicide car bomb attacks in the area during the past 24 hours.
It said the army was holed up in the hospital compound and had suffered heavy losses. Iraqi officers did not provide any casualty toll for the latest fighting.
The Joint Operations Command supervising the fight against IS said CTS forces had retaken the eastern Mosul neighbourhood of Ilam on Wednesday.
Officers and analysts had expected the eastern side of Mosul to offer less resistance but the going has been tough and Prime Minister Haider al-Abadi's promise to retake Mosul by year's end has looked increasingly in question.
Hashed al-Shaabi (Popular Mobilisation) paramilitary forces have retaken significant ground in recent weeks on a western front targeting the town of Tal Afar, which lies on the road linking Mosul to Syria.
Forces on the southern and northern fronts made quick early gains when Iraq launched its largest military operation in years but progress has been slow in recent days.
One of the main factors hampering Iraqi forces in Mosul is the continued presence of hundreds of thousands of civilians, who either want to stay in their homes or are prevented from leaving by IS.
The United Nations on Wednesday put the overall number of people displaced by the offensive at more than 82,000.
That is still less than half the figure the UN expected before the operation was launched.
It its latest situation report, the UN spoke of spiralling civilian casualties as Iraqi forces went house to house in east Mosul, attempting to battle Islamist militants and protect civilians at the same time.
"Partners are rushing to bring trauma care closer to the front lines to give injured civilians the best chance of survival," the Office for the Coordination of Humanitarian Affairs said.
It said work was also under way to repair water and electricity infrastructure in east Mosul, where it described the current water shortage as "critical".
Hundreds of thousands of people in Mosul have gone days without drinking water and have had to boil water from boreholes to survive.
The conditions for those massing in the camps on the city's outskirts were hardly better, with the onset of winter bringing freezing temperatures at night.