Witnesses reported seeing bodies in the streets after the insurgents -- believed to be affiliated with the Islamic State terror group -- attacked Palma from three directions, Human Rights Watch said on Saturday.
The town is close to a large liquefied natural gas project run by the French company Total. The attack came hours after the Mozambican government and Total announced a resumption of operations at the vast Afungi project -- north of Palma -- where work had been suspended since January after a series of insurgent attacks.
Video from Thursday obtained by CNN shows helicopters -- flown by military contractors deployed by the government -- passing over a hotel lodge an apparent effort to secure an escape corridor for dozens of people who had fled there as the attack unfolded.
Among the people visible in the video from the hotel compound, at least 20 appeared to be foreign workers.
In another video obtained by a CNN, a Mozambican who was also trapped in the hotel in Palma described the situation as "critical," saying "we don't have food, we only have water."
In the video recorded Thursday, he said: "We have been under attack since yesterday ... We've been under cross-fire for 24 hours.
"We don't know how we're going to get out of here. We're going to be evacuated but we don't know when, at what time, how and by whom," he added.
"The helicopters are circling the area of the Amarula Hotel to be sure that the roads are free to get to the beach but as you can hear, we don't know if this will be possible. The situation is critical. We don't have food. We only have water." Helicopters could be heard in the background as he spoke.
The Portuguese Foreign Ministry confirmed that one of its nationals was injured in a rescue operation from the region, the Portuguese news agency LUSA reported on Saturday.
A journalist working with CNN in Mozambique said at least some of those trapped were able to reach the town of Pemba in a convoy on Friday.
Dewa Mavhinga, Southern Africa director at Human Rights Watch (HRW), said the militants had "fired on civilians in their homes and on the streets in Palma, as they tried to flee for their lives."
HRW said it reached several civilians by phone before communications with the town were cut on Thursday.
It quoted one witness as saying that "People were running and shouting 'Al-Shabaab is here ... It's Al-Shabaab ... They're killing everybody."
The insurgents are known locally as "Shabaab" but have no links to the Somali group of the same name. The full name of the group is Ahl al-Sunnah wa al Jamma'ah (ASWJ), and it formally joined the Islamic State's self-declared Central Africa Province last year. Earlier this month, the US designated the group a terror organization under the name "ISIS-Mozambique."
Two hotel workers told HRW that armed men had fired at people and buildings, including the hotel.
An audio recording received by CNN from someone at the hotel on Thursday also included heavy gunfire.
Mozambique's Defense Ministry said on Thursday that an army operation to restore security in Palma was underway but has provided no further updates.
It's unknown if the insurgents still control the town. On Friday, a senior security source with direct knowledge of the events told CNN that the militants in Mozambique were likely still operating in the area.
The source said that fierce fighting between the insurgents and Mozambican forces and police lasted for hours, with private contractors providing helicopter air engagement to push insurgent forces out of the center of town.
The insurgents attacked military and police installations and robbed two banks in the town overnight Wednesday and set them alight, said the source.
'Meticulous planning' by insurgents
Jasmine Opperman, a security analyst who writes a weekly digest of events in Cabo Delgado said the attack had demonstrated "meticulous planning" by the insurgents.
Even before the assault on Palma, the town was inaccessible by road because of insecurity along the route south, leading to food shortages in the area.
Alexandre Raymakers, Senior Africa Analyst at Verisk Maplecroft, told CNN that the assault on Palma was a "major setback for the government, especially after Total announcement, and seriously brings into question their ability to secure LNG projects vital for the country's long term financial prosperity."
Raymakers said that "Total's decision to resume construction was contingent on Maputo guaranteeing a 25 kilometer security perimeter around the Afungi peninsula, which would include Palma."
In August last year, ASWJ staged a large-scale assault on the port of Mocimboa da Praia, and continue to occupy the area despite government efforts to retake it.
ASWJ has made large parts of Mozambique's most northern province, Cabo Delgado, inaccessible and insecure as its attacks have grown in reach and sophistication since 2017.
Raymakers says that "ASWJ's war-fighting capacity, command and control, and overall confidence has grown enormously in the last year. "
The fighting between the group and government forces has left more than 1,500 civilians dead and displaced more than 600,000, according to HRW.
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