BAGHDAD — U.S.-backed Iraqi troops pushed into the last Islamic State stronghold in Mosul on Sunday, launching a major battle for the Old City where some 150,000 civilians are believed to be trapped and risk being used as human shields by the extremists.

The push for the Old City is the final major fight of an eight-month campaign to drive the militants from Iraq's second largest city. The extremists are expected to make their last stand in the densely populated quarter with narrow, winding alleys.

Iraqi special forces, the regular army and Federal Police are taking part in the operation to retake the Old City, said Lt. Gen. Abdul-Amir Rasheed Yar Allah, who commands army operations in Ninevah province.

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This June 6, 2017 photo shows heavy damage in the 17 Tammouz district of western Mosul. Human rights organizations say that Iraqi and coalition forces are using inherently inaccurate and indiscriminate heavy weaponry to dislodge Islamic State militants from the city, putting the tens of thousands of civilians still in Mosul at high risk.
Photo Credit: Balint Szlanko/AP

Iraq state TV aired live footage showing thick black smoke rising from the Old City, with the sound of gunfire rattling inside. It said leaflets were distributed urging civilians to leave through five "safe corridors."

The International Rescue Committee called on Iraqi forces and the U.S.-led coalition to "do everything in their power to keep civilians safe during these final stages of the battle for Mosul."

"With its narrow and winding streets, Iraqi forces will be even more reliant on airstrikes despite the difficulty in identifying civilians sheltering in buildings and the increased risk of civilians being used as human shields by ISIS fighters," said Nora Love, the aid group's acting country director, using another acronym for IS.

The Islamic State group captured Mosul when it swept across northern and central Iraq in the summer of 2014. Iraq launched a massive operation to retake the city last October, and has driven the militants from all but a handful of neighborhoods.

Love warned that the assault on the Old City could lead to even more civilian deaths than the hundreds killed so far in airstrikes across the rest of the city, as "the buildings of the old town are particularly vulnerable to collapse even if they aren't directly targeted."

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A boy walks down a street among the rubble as civilians flee from the Old City of Mosul while Iraqi forces advance on June 20, 2017, during the ongoing offensive by Iraqi forces to retake the last district still held by the Islamic State (IS) group.
Photo Credit: Ahmad Al-Rubaye/AFP/Getty Images

Those who try fleeing to government-controlled areas risk being caught in the crossfire or targeted by ISIS snipers, Love added.

Gen. Abdel Ghani al-Asadi, the head of Iraq's special forces, told state TV he expects the extremists to put up a "vicious and tough fight." Al-Asadi said the troops "will be very careful" to protect the civilians.

The Old City is home to the centuries-old al-Nuri mosque, where ISIS leader Abu Bakr al-Baghdadi delivered a Friday sermon in 2014 as his group declared an Islamic caliphate in the areas it controlled in Syria and Iraq. The militants have lost much of that territory over the last three years, and Mosul is their last urban bastion in Iraq.

Up to 150,000 civilians are believed to be trapped in the Old City, where the militants are using them as human shields, U.N. humanitarian coordinator Lise Grande told The Associated Press on Friday. She said conditions are "desperate," with little food and no clean water.