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Last week, Islamic State fighters overran all of Darzab, according to the acting district governor, Baz Mohammad Dawar. Government officials were able to regain control of the districts center, but not most of the rest of the territory; 10 police officers or soldiers were killed in the fight, he said.

With the districts clinic under Islamic State control, 15 patients were evacuated to the capital of Jowzjan Province, Sheberghan, but they died en route, Afghan officials said.

Mohammad Reza Ghafori, the spokesman for the provincial governor, said that Islamic State fighters had destroyed the 50-bed clinic, forcing the patients to flee.

Mr. Dawar said he thought the patients had died of their injuries on the rugged journey because of a lack of medical staff members in the area. Other officials said it seemed likely that the fighters, who controlled the area the patients had to travel through, had killed them.

In the village of Betaw in Darzab, Islamic State militants killed seven local police officers and 15 civilians, according to a local elder, and threatened to kill anyone who held funeral ceremonies for them. Some held them anyway.

We live in a state of fear, the elder said by telephone. All of us who participated in the funeral are now scared that ISIS will attack and kill us. The elder spoke on the condition of anonymity because he feared retaliation by militants. It was not clear if the seven police officers were counted among the 10 cited by the governor, or if they were additional casualties.

ISIS is more powerful than the Taliban were in Darzab because their fighters are brave, said Hajji Obaidullah, the former police chief of the district. He and other local officials said that two former Taliban commanders, Qari Hikmat and Mufti Nemat, had combined forces and switched their allegiance to the Islamic State in recent months. He said the government had rushed in hundreds of reinforcements, in the form of police officers and soldiers from other areas, to keep the district center from falling to insurgents.

There is no Taliban in Darzab now, but only ISIS, said Halima Sadaf, a member of the Jowzjan Provincial Council, who is from Darzab.

They took over the district before Eid al-Fitr, she said, referring to the holiday signifying the end of Ramadan that began on Sunday.

But Afghan national security forces pushed them out of the capital of the district; the rest of the district is all with them, she added. They are strong and regrouping to launch another offensive.

One of the Islamic State commanders, Mufti Nemat, was persuaded last year to quit the Taliban and join the government side after a heavily publicized intervention by General Dostum, the first vice president. Mufti Nemat was previously a religious teacher in General Dostums home village. He later accused the government and General Dostum of reneging on promises made to him, announcing that he was joining forces with Qari Hikmat and would support the Islamic State.

Spokesmen for General Dostum and for the Taliban both confirmed that Mr. Nemat had left the Taliban, joined General Dostums side, but then gone over to the ISIS camp. Nemat is a threat for the government. He knows the Darzab District and the area very well; he is a very dangerous guy, said Enayatullah Babur Farahmand, General Dostums chief of staff. He blamed government inaction for alienating Mr. Nemat.

Zabihullah Mujahid, a Taliban spokesman who was reached via WhatsApp, said both local leaders who had joined ISIS had been rejected by the Taliban. Qari Hikmat, Mr. Mujahid said, had been sentenced to prison by the Taliban on corruption charges but he escaped and joined ISIS.

The Islamic State in Khorasan, as the group is known in Afghanistan, has generally been active only in the eastern province of Nangarhar, where fighters are locked in a struggle with the government as well as with local Taliban forces. Taking a district elsewhere in the country would be a significant advance for the group.

Jawad Sukhanyar reported from Kabul and Rod Nordland from London. Fahim Abed contributed reporting from Kabul.

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ISIS, Aided by Ex-Taliban Groups, Makes Inroads in Northern ... - New York Times