Here we go again in what now seems a yearly exercise: the United States has put Russia and the Syrian government on notice as both ramp up airstrikes on Idlib province in Syria's northwest. The last time Russian jets and the Syrian Army prepared for a major assault on the al-Qaeda held province was in September of last year — an offensive that had been ultimately called off at the time when the Trump administration threatened another military strike against Damascus.

The State Department on Tuesday slammed the renewed assault as "indiscriminate" and a "reckless escalation" of violence, according to Reuters. "Indiscriminate attacks on civilians and public infrastructure such as schools, markets and hospitals is a reckless escalation of the conflict and is unacceptable," a spokesperson said. "The violence must end."

Image via Al-Masdar News

International reports have cited over 200 civilian deaths since government operations gained in intensity this month, following a series anti-Assad insurgent attacks against government areas outside nearby Hama as well as Latakia province.

Damascus says it's retaliating for stepped up HTS terror operations (Hayat Tahrir al-Sham/Syrian AQ/formerly Nusra) in a pattern of escalation that looks to continue. Russia’s Khmeimim airbase has also faced more severe attacks in the past weeks via HTS rockets, mortars, and terror drones.

Early this week an anti-Assad opposition official urged immediate military intervention by Turkey, a call which in the past also been requested of the United States and western allies.

Meanwhile, international media reports have again begun spotlighting the potential for mass humanitarian disaster and refugee displacement. But the mainstay of al-Qaeda's dominant force in Syria is now lodged among some three million civilians in the area — a fact which even the US government has previously recognized.

The Washington Post noted earlier this month that "a final showdown" is looming over Idlib, which could bring Syria straight back into the international spotlight once again, also as both the US and Israel ramp up efforts against "Iranian expansion" in the region, and a US carrier strike group and bomber task force is still in the Persian Gulf region.

And last week a large bipartisan group of lawmakers sent a letter to President Trump urging him to take more muscular approach in Syria, saying they were "deeply concerned" about Iranian influence, Russian intervention, and the presence of extremist groups.

Though Syria has long been out of the headlines since Assad solidified hold over most of the country, driving the final insurgent pockets from Damascus suburbs of east Ghouta last year, it looks like the proxy war nature of the theater is fast heating up once again.