Government forces cut off Castello Road, the only supply route to rebel-controlled Eastern Aleppo, over three weeks ago. A number of counterattacks by rebels to retake the road have not since succeeded, with the latest attempt coming on Sunday. Following the failed rebel offensive, Syria’s state radio reported that a “wide-scale counterattack” was underway in Aleppo. On Thursday, government forces backed by Russian air strikes recaptured two hilltops and two villages taken by rebels earlier in the week.

As a result of the blockade and the fighting, civilians in Aleppo face increasing shortages of food and other basic supplies in the city, as well as severe price hikes. Speaking to Al Jazeera, independent journalist Abd Alkader Habak said:  “Prices have risen by 300 percent, which is affecting people who already don't work or may have low incomes…Castello Road is the city's artery, and its cut-off ended food and medical supplies … People are fighting over loaves of bread to feed their families now.”

Britain-based Syrian Observatory for Human Rights reported that at least forty civilians (including twenty two-children) have lost their lives since the escalation of violence on Sunday. Dozens of fighters from either side are also believed to have died. At least six hospitals have been attacked in air raids by the government, New York-based Physicians for Human rights has alleged on Wednesday, while the Russian Ministry of Defense accuses a Washington-backed rebel group of using toxic gas shells the previous day. Seven individuals, including five civilians, were killed in the attack.

As the country’s largest city and economical heart, long-divided Aleppo has great psychological and tactical value for all parties in the Syrian conflict. With government and rebel forces locked in battle across a number of districts, the fight for Aleppo, and the difficulties faced by the city’s residents, are unlikely to end anytime soon.