Updated answer
This update describes the workflow to create an inclusion within an inclusion mesh based on an image in more detail.
In this case, ImageForestingComponents
appears to do a good job separating the regions. We can use DominantColors
to separate by color and view as a dataset.
pts = {{250, 200}, {100, 200}, {20, 200}};
ifc = ImageForestingComponents[img, pts, 3] // Colorize;
ds = DominantColors[ifc,
3, {"NearestHTMLColor", "Coverage", "CoverageImage"}, "Dataset"]

Ultimately, we want an image with the middle region stripped out. This way, we will be able to create an element mesh that we can extract a boundary mesh so that we can apply region markers. The negative of the coverage image of row 2 meets the requirement.
Print["Image of the middle region removed"]
domImg = ds[2, -1] // ColorNegate

Now, we will create a mesh based on the above image, extract a boundary mesh, and build a mesh with the appropriate region markers.
Print["Mesh the domain image"]
(m = ToElementMesh[domImg])["Wireframe"]
Print["Extract boundary mesh"]
(bm = ToBoundaryMesh[m])["Wireframe"]
Print["Final mesh with region markers"]
mesh = ToElementMesh[bm, "RegionHoles" -> None,
"RegionMarker" -> {{#1, 1, 1000}, {#2, 2, 1000}, {#3, 3, 1000}} & @@
pts];
mesh["Wireframe"[
"MeshElementStyle" -> {FaceForm[Green], FaceForm[Red],
FaceForm[LightBlue]}]]

Original answer
Something like this works, but you may want to do something to smooth the outer ellipse because it is over-refined.
cc = ClusteringComponents[img, 3];
bm = ToBoundaryMesh@
ToElementMesh[Colorize[cc /. {3 -> 0}] // Binarize];
mesh = ToElementMesh[bm, "RegionHoles" -> None,
"RegionMarker" -> {{{250, 200}, 1, 1000}, {{100, 200}, 2,
1000}, {{20, 200}, 3, 1000}}];
mesh["Wireframe"[
"MeshElementStyle" -> {FaceForm[Green], FaceForm[Red],
FaceForm[LightBlue]}]]

Here is a version that applies a GaussianFilter
to the image.
bm = ToBoundaryMesh@
ToElementMesh[
GaussianFilter[Colorize[cc /. {3 -> 0}], 10] // Binarize];
mesh = ToElementMesh[bm, "RegionHoles" -> None,
"RegionMarker" -> {{{250, 200}, 1, 1000}, {{100, 200}, 2,
1000}, {{20, 200}, 3, 1000}}];
mesh["Wireframe"[
"MeshElementStyle" -> {FaceForm[Green], FaceForm[Red],
FaceForm[LightBlue]}]]

The results are much nicer.