Iraqi officials say they expect tens of thousands more civilians to leave Falluja and Ramadi in the coming days, increasing the biggest exodus from the two cities since the height of the sectarian war in 2006.
The United Nations high commission for refugees (UNHCR) said on Friday that 65,000 had left the cities in the past week alone, as militants linked to al-Qaida continue to defy demands to leave from tribal figures and the Iraqi army. Iraq claims 140,000 have left since renewed fighting began in December.
The standoff, now into its second month, shows no sign of being defused. Iraq's prime minister Nouri al-Maliki has insisted he is prepared to order an attack to dislodge the resurgent al-Qaida groups who are trying to reclaim Anbar province as a heartland of operations.
However, unlike the insurgency of 2004-2008 that was eventually pushed back by tribal leaders and the occupying US military, the new al-Qaida push is spilling beyond Iraq's borders into Syria, where its fighters are also playing prominent roles in the civil war.
The al-Qaida group, known as the Islamic State of Iraq in Syria (Isis) now has a footprint across much of northeast Syria, the eastern deserts that spill into Iraq and Falluja and Ramadi, which are only 30-50 miles west of the capital, Baghdad.
Isis's entry into the two cities has also alarmed the US, coming less than 10 years after its military led two large-scale attempts to oust al-Qaida militants in 2004. As the US was preparing to leave Iraq, several army commanders claimed that the foe, which had cost them roughly one third of their battle casualties, had been "strategically defeated".
Now a revitalised Isis is drawing renewed attention from the US, which withdrew from the country in late 2011. Responding to pleas from Iraq, Washington has sent heavy weapons and surveillance drones to Baghdad. The speaker of Iraq's parliament, Osama al-Nujaifi, was in Washington on Thursday adding his voice to pleas for help in defeating the insurgency.
Nujaifi, the most senior Sunni Arab in the Iraqi government, said Barack Obama and vice-president Joe Biden had agreed to send direct support to the Sunni tribes, whose leaders had led the Awakening movement that stabilised the province throughout 2007.
The UNHCR said several neighbourhoods remain trapped and cut off from supplies in both cities. Isis is occupying large swaths of Ramadi and the centre of Falluja. The Iraqi army has partly encircled both urban areas, but has not yet launched anything more than small-scale forays into parts of Ramadi.
More than a million people were displaced at the height of Iraq's sectarian war.
The past six months have been the deadliest across the country since mid-2008, with monthly death tolls tracking upwards and bomb attacks, mainly aimed at Shia communities or government targets, now at their highest levels in at least six years.
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