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Dr. Sherko Shwani walks away after assisting a fleeing Mosul woman into an ambulance along the highway from Mosul to the Kurdish region's capital of Irbil on Saturday, Dec. 17, 2016. Shwani said he frequently treats civilian casualties suffering from sniper wounds or blast wounds.

Dr. Sherko Shwani walks away after assisting a fleeing Mosul woman into an ambulance along the highway from Mosul to the Kurdish region's capital of Irbil on Saturday, Dec. 17, 2016. Shwani said he frequently treats civilian casualties suffering from sniper wounds or blast wounds. (Chad Garland/Stars and Stripes)

Dr. Sherko Shwani walks away after assisting a fleeing Mosul woman into an ambulance along the highway from Mosul to the Kurdish region's capital of Irbil on Saturday, Dec. 17, 2016. Shwani said he frequently treats civilian casualties suffering from sniper wounds or blast wounds.

Dr. Sherko Shwani walks away after assisting a fleeing Mosul woman into an ambulance along the highway from Mosul to the Kurdish region's capital of Irbil on Saturday, Dec. 17, 2016. Shwani said he frequently treats civilian casualties suffering from sniper wounds or blast wounds. (Chad Garland/Stars and Stripes)

Dr. Sherko Shwani watches as buses carrying civilians fleeing Mosul pull up to a medical station where he treats wounded civilians, just inside Kurdish-held territory, on Saturday, Dec. 17, 2016.

Dr. Sherko Shwani watches as buses carrying civilians fleeing Mosul pull up to a medical station where he treats wounded civilians, just inside Kurdish-held territory, on Saturday, Dec. 17, 2016. (Chad Garland/Stars and Stripes)

A Kurdish soldier talks to a boy, one of about 450 fleeing civilians who arrived on buses at this medical aid station near Mosul, on Saturday, Dec. 17, 2016. Aid workers gave the civilians food, water and clothing, and offered them medical aid.

A Kurdish soldier talks to a boy, one of about 450 fleeing civilians who arrived on buses at this medical aid station near Mosul, on Saturday, Dec. 17, 2016. Aid workers gave the civilians food, water and clothing, and offered them medical aid. (Chad Garland/Stars and Stripes)

Qusai, an Iraqi man fleeing Mosul with his family, is pictured here on Saturday, Dec. 17, 2016, after receiving a warm sandwich from aid workers at a stop just inside Kurdish-held territory along the highway to the region's capital of Irbil.

Qusai, an Iraqi man fleeing Mosul with his family, is pictured here on Saturday, Dec. 17, 2016, after receiving a warm sandwich from aid workers at a stop just inside Kurdish-held territory along the highway to the region's capital of Irbil. (Chad Garland/Stars and Stripes)

Akhmed, center, holds an infant while stopped at an aid station along the highway from Mosul to the Kurdish region's capital of Irbil on Saturday, Dec. 17, 2016. Three chartered buses each carry about 150 civilians fleeing Mosul.

Akhmed, center, holds an infant while stopped at an aid station along the highway from Mosul to the Kurdish region's capital of Irbil on Saturday, Dec. 17, 2016. Three chartered buses each carry about 150 civilians fleeing Mosul. (Chad Garland/Stars and Stripes)

One of hundreds of civilians fleeing Mosul who arrived at an aid station in Kurdish-held territory on buses on Saturday, Dec. 17, 2016, kisses an infant as Kurdish fighters look on. Islamic State militants have reportedly targeted civilians fleeing the battle for Mosul.

One of hundreds of civilians fleeing Mosul who arrived at an aid station in Kurdish-held territory on buses on Saturday, Dec. 17, 2016, kisses an infant as Kurdish fighters look on. Islamic State militants have reportedly targeted civilians fleeing the battle for Mosul. (Chad Garland/Stars and Stripes)

SHAQOLY, Iraq — A coalition aircraft swooped over the Mosul neighborhood, and Qusai and his family made their move.

“When we saw the plane was in the sky and ISIS shooting at it, we knew it was time to go,” he said, using an acronym for the Islamic State group. The militants would not be paying attention to his escaping family, said the father of three, including a newborn.

In recent weeks, fleeing civilians like Qusai, 29, have become targets of militant snipers and frequent victims of indiscriminate bombing attacks in residential areas of Mosul, according to Human Rights Watch, which this week reported findings based on interviews with more than 50 Iraqis forced to flee their homes.

Thirty-one gave firsthand accounts of 18 mortar or sniper attacks, car bombings or detonations of improvised explosive devices by the militants that killed or wounded civilians.

Militants have justified the attacks, which are considered war crimes, telling those who refused to retreat with them that they were “unbelievers” and valid targets, the civilians told the nongovernmental group. But the civilians said they feared being used as human shields if they went along.

“If ISIS really cared about the people trapped in its so-called caliphate it would let them flee to safety,” Lama Fakih, deputy Middle East director at Human Rights Watch, told the Associated Press. “Instead, it is indiscriminately or deliberately killing and wounding people for refusing to be human shields.”

The report said Iraqi troops deployed in populated neighborhoods and coalition strikes in dense residential areas of Mosul also had caused civilian casualties. The effort to oust the Islamic State group from the city of 1 million has proved complicated for the Iraqi forces, who seek to minimize casualties.

About 120,000 civilians have fled, but several Iraqi army officials said those who remain are the major obstacle in the fight, now in its ninth week. Snipers, mortar attacks and car bombs are other challenges troops frequently have cited.

Iraqi commanders have been reviewing their initial strategy, which involved telling civilians to stay in place and to avoid known militant locations, according to several reports.

They feared the slow pace and high civilian and military casualties — some Iraqi army units were reportedly suffering rates of 50 percent — threatened to turn the offensive into a meat grinder.

Some officers have said the army is unwilling to use heavier weapons, such as mortars, against militant positions in populated areas. Forces also have chosen to forgo night assaults.

Brig. Gen. Nasser Hassan of Iraq’s 15th Division at Qayara Airfield West denied that the military had miscalculated, however, saying civilians were staying in the city because they couldn’t leave.

“We can’t do anything about it,” Hassan said. “ISIS is holding them back.”

But some civilians continue to trickle out.

On Dec. 17, two days after beginning his escape, Qusai — who gave only his first name — arrived at a medical aid station just inside Kurdish-held territory on the highway to the region’s capital of Irbil. He came on one of three charter buses, each packed with about 150 civilians. Several nearby ambulances waited for arriving casualties. Sherko Shwani, a doctor there, said many civilians arrived with gunshot wounds from militant snipers or blast wounds from mortars or bombs.

In a report this month, the U.N. Assistance Mission in Iraq found that in November, 332 civilians were killed and 114 were wounded in acts of terrorism, violence and armed conflict in the Nineveh governorate, where Mosul is located.

The U.N. report cited vicious Islamic State group tactics, including forcibly moving civilians and using them as human shields.

Another passenger on the bus with Qusai, who gave only his first name as Akhmed, said Islamic State fighters told Mosul residents that it would be dangerous to flee and that they would be safer with the militants.

But what Akhmed found were Kurds offering help, he said. Aid workers handed out water, fruit juice and warm sandwiches made with traditional flat samoon bread. They also gave out blankets and warm clothing.

Conditions under Islamic State were harsh, with scarce supplies of food, electricity and fuel, Akhmed said. His needs as he traveled to a displacement camp were simple — “to be safe and have food to eat.”

The Associated Press contributed to this article.

garland.chad@stripes.com Twitter: @chadgarland

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Chad is a Marine Corps veteran who covers the U.S. military in the Middle East, Afghanistan and sometimes elsewhere for Stars and Stripes. An Illinois native who’s reported for news outlets in Washington, D.C., Arizona, Oregon and California, he’s an alumnus of the Defense Language Institute, the University of Illinois at Urbana-Champaign and Arizona State University.

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