Heavy fighting raged in northwestern Syria on Friday after rebels launched a counterattack to repel an offensive by government forces in the war-torn region.

Syria and ally Russia ramped up deadly air raids and artillery fire on the rebel-controlled northwest in late April against Hay’et Tahrir al-Sham (HTS), a former al-Qaeda affiliate whose fighters dominate the area.

Thursday’s push back by HTS troops and allied rebel groups against the village of Jibeen follow a series of Syrian government advances in recent weeks, the Britain-based Syrian Observatory for Human Rights war monitor said on Friday.

“The insurgents are launching a counter-attack … They are making strategic advances,” Observatory head Rami Abdel Rahman told AFP news agency.

Rebel factions said they seized three key villages in the Hama countryside in Thursday’s counterattack.

State news agency SANA said opposition fighters fired rockets into a number of villages in northern Hama province, destroying homes.

Syrian state television said Syrian troops thwarted the assault on the villages of Tal Maleh and Jibeen. The report could not be independently verified.

Air raids pounded Idlib and nearby areas on Thursday as battles were fought, the Observatory said, adding at least one civilian was killed.

Monitors, rights groups and residents say the government of President Bashar al-Assad and his backer Russia have relentlessly and systematically attacked residential areas, hospitals, markets and infrastructure to break the will of people living in rebel-held areas and to pressure them to flee.

Bombing “targets everything: bakeries, hospitals, markets. The aim is to stop all services to civilians. Everything,” Wasel Aljirk, a surgeon whose hospital was blasted by the attacks, told The Associated Press news agency.

Tens of thousands of people have fled their homes, many of them sheltering at the Turkish border from air raids that have killed scores of people.

Under its deals with Russia, Turkey has deployed forces in Idlib at a dozen positions.

Turkish forces are also spread out across a swathe of territory to the north under the control of rebel factions Ankara backs.

‘T actic to pressure civilians’

Diana Samaan, a Syria researcher with Amnesty International, said homes are targeted as a “tactic to pressure civilians to succumb”.

Striking civilians with impunity has been so characteristic of the bloody eight-year civil war that it rarely even raises much international outrage or attention, observers say.

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Monitors say the pattern of attacks clearly show that, far from being collateral damage, civilian homes, businesses and infrastructure are intentional targets of the government.

“Even wars have rules,” said Misty Buswell, the Middle East advocacy director for International Rescue Committee, adding that two hospitals it supports were hit by air attack.

In this war, she said, attacks on civilians “have happened with absolute impunity”.

Sara Kayyali, a Syria researcher with Human Rights Watch (HRW), said her group and others have “documented enough attacks on residential buildings to at least indicate an appearance of unlawful approach.”

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Nearly 300 people have been killed by air raids and shelling in the area since late April, according to the United Nations. The bombardment displaced nearly 270,000 people in May alone.

A total of 24 health facilities and 35 schools have been hit during the latest escalation, according to the UN’s humanitarian office.

“It is appalling … and it must be brought to an end,” UN Office for the Coordination of Humanitarian Affairs (OCHA) spokesman Jens Larke told reporters in Geneva on Friday.

Even in hospitals that have not been hit, he added, “they fear that they may be hit. So the doctors, the health care personnel are leaving, the patients are not going.”

The war in Syria has killed hundreds of thousands of people since it started in 2011, with millions more displaced.