This week, the Syrian regime of Bashar Al Assad and his Russian backers launched a large air offensive over the country’s north, killing civilians and destroying hospitals.
The move comes days after Russian President Vladimir Putin said the time was not right for an all-out offensive on Idlib province, the last major area held by rebels and hardline factions in Syria.
It is also home to nearly 3 million civilians, many of whom were displaced by regime offensives in other parts of the country.
“Aerial, ground and sea-launched bombs pounded north Syria,” said Mohammad Hallajh, director of the local Response Co-ordination Group.
The UN on Wednesday said 140,000 people were displaced in Idlib since bombing began to intensify in February. It has also recorded at least 200 civilian deaths since February.
"The UN is deeply concerned over the recent escalation," said David Swanson of the UN Office for the Co-ordination of Humanitarian Affairs.
Mr Hallajh said: “Since last February when the escalation began, the attacks were mostly mortar bombs. But yesterday, helicopters, barrel bombs and air raids were intense.
"The attacks targeted residential area, causing much damage to civilian properly and leaving people destitute."
He said his charity had recorded 12 civilians killed and 42 wounded since Tuesday.
Mr Hallajh said that the bombardment was focused around Hama and rural Idlib, and air strikes left two hospitals shattered and unable to operate.
“The humanitarian crises following the attacks is terrible," he said. "Families are fleeing towards the mountain near the Turkish borders and large numbers of them have no aid or relief."
Turkey has been a leading voice against a military operation to clear Idlib province of rebels, including Al Qaeda affiliate Hayat Tahrir Al Sham.
Ankara fears such a push would displace hundreds of thousands of civilians who will head towards its border seeking sanctuary.
"They have killed my father," Sharif, 28, a civilian from the town of Al Lataminah, told The National.
“Our house was attacked in yesterday's barrel bombardment in the morning while we were hiding at home, scared of the sounds of explosions."
Sharif said that the blast knocked him out.
“I woke up lying next to my father, who is 51, in the ambulance, covered in blood,' he said.
“My injuries were not dangerous but my father was severely injured as the wall of the house fell on his back head and body. I didn’t see him alive again."
He said that he and his family were now homeless and destitute.
“We will have to stay in the camps, sharing a tent with another family,” Sharif said. “This is just hell and it will not stop. It will get even worse.”
In Maarat Al Numan, rural northern Idlib, mother of two Zakeya Horane also came under attack.
“We had a horrific day and until now the sounds of explosions and warplanes are here," said Ms Horane, 29.
“My children have been incapable of going school and my husband is going to drive his minibus every day between villages, having no idea if he will come back alive or not.
“The Turkish military bases are around us but they are only observing how many of us are being killed.
"It is very disappointing to end up back at square one. I am scared and concerned for the future. “I am displaced again now and might not be able to get back home again.
"We do not know when this will end – not anytime soon – and everyone is expecting worse to come.”
Ahmad Rahal, a military expert in Istanbul, said the regime and Russian raids were an attempt to drive civilians out of the rebel-held pocket.
“This wave of attacks is part of a joint Russian-regime scheme to force people to flee their hometowns so that eventually their ground forces can attack rebel areas bit by bit,” Mr Rahal said.
He said the attacks on Hayat Tahrir Al Sham were supposed to have been avoided after a de-escalation agreement between Russia and Turkey to avoid an offensive.
The deal meant heavy weapons and militias groups such as Hayat Tahrir Al Sham would be moved past a buffer zone around the edges of the region.
Turkey built the chain of watchtowers across the province to monitor the agreement but the deal has not been fully implemented.
“It looks like a ground operation might follow the attacks to capture north Hama and southern Idlib, and push more towards the Turkish border to take control over the international railway,” he said.
On Tuesday, the US urged Russia to abide by its commitments and end its escalation in Idlib.
"The violence must end. The United States reiterates that any escalation in violence in north-west Syria will result in the destabilisation of the region," State Department spokeswoman Morgan Ortagus said.
