By Jim Muir
BBC News, outside Nahr al-Bared
Nahr al-Bared is called a camp but there are no tents here.
Thousands of refugees have been fleeing from the camp
It is a dense urban sprawl along the coast north of Tripoli, Lebanon's second biggest city.
It is encircled by the Lebanese army, which is pounding the camp with artillery and tank fire as well as engaging the militants from Fatah al-Islam in heavy exchanges of machine gun and small arms fire.
These eruptions have been flaring up and dying away here all day.
It is not a sustained battle but it is not a truce either.
Informal ceasefire understandings have come and gone, but nothing is solid and there is growing concern now for the fate of thousands of civilians trapped inside the camp.
'History repeating itself'
Saad Touhan angrily holds out a piece of bloodied shrapnel. It passed through the stomach of her teenage daughter Manal, and wounded her in the hand as well.
There was no first aid she says, no doctors and no-one to help her daughter.
But Saad and Manal are among the few who have been evacuated to a hospital in another camp nearby.
Anisa Ismail, another evacuee, compares what is happening at Nahr al-Bared to famous atrocities at other Palestinian camps in Lebanon.
"This is history repeating itself. It's like the massacre at Sabra and Shatila. I lost my sister there. If they just want to hit Fatah al-Islam why are they cutting off the food and water and besieging us like this?"
The hospital here is being run by Dr Yusuf al-Sidi.
He describes the kind of patients that have been brought here from Nahr al-Bared so far.
"At the hospital we have many injured. There is chest injury and abdomen injury. We have five children who are dehydrated because they have been three days without water, without any food," he says.
Among the international organisations deeply concerned about the plight of the camp's civilians is Human Rights Watch.
"They've been running short on water, they haven't had electricity in three days," says the group's representative in Lebanon, Nadim Houry.
In addition to fires and attack from tanks and artillery shells, they also talk about sniper fire, so many people are actually afraid of leaving their basements and their homes to try to get supplies.
"Our second main concern has really been the use by the Lebanese army of indiscriminate weapons," Mr Houry says.
"The tanks and artillery they've been using are not very precise and when you use them in areas which are so densely populated - and the camp we're looking at is the second most densely populated camp in Lebanon with 30,000 people over one square kilometre - it's going to be very hard to avoid civilian casualties and actually they are not avoiding civilian casualties."
Back at Nahr al-Bared it is believed there are still many seriously injured who have not yet received attention.
But until there is a solid ceasefire and a lifting of the siege, they and other civilians stuck at the camp will remain in dire conditions.