Activists say several civilians killed on Tuesday as government-led attacks intensify in Idlib, Hama provinces.

At least 15 civilians, including children, have been killed in Syria‘s northwest region as Russian-backed government forces continued air raids and shelling in the last rebel-held territory in the country, according to activists and volunteer medics.

Three children were among five civilians killed when an air raid hit three homes and a vegetable market in the village of Ras al-Ain in Idlib’s eastern region on Tuesday afternoon, said Ahmed Sheikho, a spokesman for Syrian Civil Defence.

At least 20 others were also wounded, he added.

Hussein al-Sheikh, whose home was hit in the attack, said he lost three cousins – the youngest being five-years-old.

“I was standing near the front door watching the kids play,” said al-Sheikh, whose house is located just a few metres away from his cousins’ home.

“Suddenly we heard another explosion and we knew it was much closer than usual,” he added.

Al-Sheikh saw the building collapse just after the three children ran towards the entrance. In a “matter of minutes”, the children were being evacuated from under the rubble.

“It was a difficult scene to watch,” the 40-year-old said. “I can’t express what I saw.”

Tuesday’s air raids and shelling hit a string of other towns and villages, including the rebel-held Jisr al-Shughoor district, where six people were killed, activists told Al Jazeera. The area is close to a strategic commercial highway, sought by Syrian President Bashar al-Assad and military ally Russia.

Opening the commercial and passenger routes through Idlib province would reassert the government’s control over an economy fragmented during years of conflict.

SANA news agency blamed the latest outbreak of violence on attacks on Syrian military posts by the Hay’et Tahrir al-Sham (HTS) armed group, formerly affiliated to al-Qaeda.

‘Civilian structures’ hit

Attacks earlier on Tuesday also hit villages in adjoining parts of Hama province, according to the Syrian Civil Defence organisation, also known as the White Helmets, killing four civilians.

Sheikho said that dozens of air raids rained over “civilian structures”.

“The sounds of warplanes and explosions have not subsided for days – not in the day, and not in the evening,” he added.

In the past few days, government-led shelling struck at least four hospitals, or medical points, knocking them out of service.

Since April, at least seven facilities have been put out of service, United Nations spokesman Stephane Dujarric said.

“The United Nations is extremely concerned about attacks on healthcare facilities and hospitals in northwestern Syria,” Dujarric said.

The tactic has been used in the past ahead of fully-fledged assaults on provinces and cities held by opposition groups that fought against al-Assad’s government throughout Syria’s bloody civil war – now in its ninth year.

Idlib province lacks adequate medical facilities, which is one of the major issues faced by members of the White Helmets, many of whom volunteer as emergency medical workers.

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“This lack of infrastructure forces us to transfer the injured to far-away locations,” Sheikho, whose team covers the southern region of the province, said.

“Even when we’re on the road, our vehicles are targeted,” he said. “We’re never, ever safe.”

Such indiscriminate attacks, as Sheikho put it, have led to massive delays in transferring those injured to a medical facility for treatment.

The White Helmets have faced so-called double-tap attacks – one bomb followed soon after by a second at the same location, according to Sheikho – which have killed many members of the organisation in the past.

Thousands displaced

The latest shelling and air raids are part of an intensified campaign launched by forces loyal to Assad on April 26.

The UN said on Tuesday the escalation in the northwest has displaced more than 150,000 people in the past week.

“We are alarmed by ongoing reports of aerial attacks on population centres and civilian infrastructure, resulting in hundreds of civilians dead and injured,” said David Swanson, of the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“More than 152,000 women, children and men have been displaced in Aleppo and Idlib governorates over the past week alone,” he told AFP news agency.

In southern Idlib alone, at least 65 people have been killed and more than 146 injured since the escalation began, according to the Syrian Civil Defence group.

Idlib is a densely populated province, home to nearly three million people, most of whom are internally displaced, and is controlled by a range of armed opposition groups – some backed by Turkey.

The biggest group in control of much of Idlib is HTS, which is independent of the Turkish-backed umbrella of opposition factions in the region.

HTS has been designated a “terrorist” group by Russia, and their presence has been used as a justification for intensified attacks despite a deal that was meant to avert a fully-fledged assault in Idlib.

The deal, signed by Moscow and Ankara, included the creation of a so-called “demilitarised” zone in the region.

The UN has called for all sides to abide by the deal, signed September last year with the objective of avoiding a humanitarian disaster and preventing an influx of refugees from entering bordering Turkey.

Additional reporting by Mohammed Khalaf in Idlib