An average of one child per day has been killed over the past year by violence in the northern Syrian province of Idlib, according to Save the Children, as a humanitarian crisis in the last rebel-held region of the country threatens to spiral even further out of control.

Entire towns and cities have emptied in the last month as some 300,000 people have fled a new Syrian government offensive to recapture the province.

The grim toll on children has shown no signs of slowing down in the new year. Since the latest round of fighting began in December, 36 children have been killed and more than 150,000 have been displaced, the charity said.

Despite months of dire warnings from aid agencies and charities about a looming catastrophe in northern Syria, the worst-case scenarios for civilians appear to be coming true.

“The United Nations has repeatedly warned about the unfolding of the ‘worst humanitarian disaster’ in Idlib if the violence does not stop. The humanitarian disaster is now unfolding,” said Diana Semaan, Syria researcher at Amnesty International.

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Harsh winter weather has piled misery on the thousands of families who have fled recent fighting and now have nowhere to go. Twelve displacement camps have flooded in the past few weeks, and rising fuel prices have made it extremely difficult for people to escape the cold.

“People gathered what they could of their belongings and left everything else behind,” said Obaida Dandoush, 33, an activist and a volunteer from the town of Kafranbel, who was displaced to Idlib.

“They headed to northern areas where it’s safer, many took shelter in the open air, farms, schools, mosques and under-construction buildings. They have no access to medical care, food or water. Their situation is catastrophic,” he told The Independent.

Hanin al-Sayed, 27, a journalist and activist from Maarat al-Numan who fled her hometown with her family in May last year and has been documenting the humanitarian crisis ever since, said the exodus of the last few weeks has been one of the worst yet.

“The other day there was a pick-up car in front of me, they’ve put whatever furniture they could carry, the mother was sitting on their furniture, crying, while carrying her daughter in her arms to keep her warm from the freezing cold. It was really heartbreaking,” she said.

“So many people couldn’t carry anything of their belongings as they didn’t have cars or vehicles. Many had to flee on foot. They’d wait by the roads for volunteers to pick them up.”

“Nobody should be subjected to such brutality,” she added.

Syrian children in a camp for displaced people in Kafr Dariyan, a short distance from Syria’s border with Turkey, on 28 December 2019 (AFP via Getty) (AFP via Getty Images)

The situation could be made even worse if world powers are unable to agree to renew a mechanism for cross-border aid into Syria.

The UN Security Council is set to vote on rival resolutions on Friday to continue aid deliveries through border crossings to mainly rebel-held areas in Syria, which currently reaches millions of people.

The current mandate expires on Friday, and if it is not extended, the delivery of food, medicine and other essential items will stop.

Veto-wielding members China and Russia, both of which are allies of Syrian president Bashar al-Assad, have put forward a resolution that limits deliveries to two border crossings from Turkey.

A rival draft resolution co-sponsored by Germany, Belgium and Kuwait and supported by the UN humanitarian office would continue the delivery of aid through two crossing points in Turkey and one in Iraq.

“Russia and China’s successive vetoes have effectively blocked over the years any attempts to move towards a path of accountability and justice for the war crimes and crimes against humanity committed in Syria,” said Ms Semaan. “But this time, the consequences will have an immediate and direct impact on the lives of millions of civilians already struggling for survival, and in particular in Idlib, where the civilian population is reeling under the Syrian government’s fiercest yet round of military escalation.”

The failure to come to an agreement puts at risk humanitarian assistance to some 2.7 million people in Idlib, according to Amnesty.

They have no access to medical care, food or water. Their situation is catastrophic Obaida Dandoush, activist

The Syrian army, backed by Russia, launched a new offensive in Idlib three weeks ago alongside massive aerial bombardment. Syrian government forces captured more than two villages before declaring a ceasefire on Thursday.

But violence has continued despite the declared pause. Russian warplanes carried out intensive raids on the strategic rebel-held town of Maaret al-Numan and surrounding villages on Friday, according to the Syrian Observatory for Human Rights. The UK-based organisation, which documents the war in Syria through a network of activists on the ground, also said government forces and insurgents clashed in eastern parts of Idlib on Friday morning.

Turkey’s Defence Ministry said Friday that it had agreed with Russia that a new ceasefire will be implemented in Idlib at midnight on 12 January. The move appears aimed at stemming the flow of displacement caused by the fighting.

Idlib is mostly controlled by al-Qaeda-linked militants, but is home to three million civilians who are trapped in the middle of the fighting with no way to escape. Residents hold regular demonstrations against both the Syrian government and the militants that hold sway in Idlib.

The immediate goal of Assad’s three-week offensive appeared to be taking Maaret al-Numan, which sits on the Damascus-Aleppo highway, in order to re-open the strategic road. It has been closed by the rebels since 2012.

Sonia Khush, Save the Children Syria response director, said: “Thousands of families have begun the new year trying desperately to escape violence with no destination in mind, fleeing with just the belongings they could carry. For many it’s not the first time they’ve had to do this.”

“Save the Children is calling on all parties to stop this war on children. The Syrian conflict must not be allowed to set the precedent for the violation of fundamental human rights and international laws, designed to protect vulnerable children, to become the new normal,” Khush added.