What attackers do. Attackers exploit vulnerabilities in internal network services, such as file sharing, remote desktop or database services, to gain access to other systems after they are already inside. This serves the Lateral Movement tactic.
How to defend. Patch internal systems as well as internet-facing ones, segment networks so that workstations cannot reach server management services, and disable unneeded services and legacy protocols. Network detection and intrusion prevention systems can catch exploitation of known vulnerabilities. Prioritise patches for internal services with known exploits, as these are favoured by ransomware groups.
Signs to look for. Look for exploit signatures in internal network traffic, services crashing and restarting, and new processes started by network services. A common gap is assuming internal services are safe because they are not exposed to the internet.