Medics say women and children among those killed in government-led attacks in Syria’s rebel-held Idlib province.

Syrian rescue workers and activists say government warplanes bombed the last rebel-held stronghold in the country again, levelling a building and killing five people inside, including three members of the same family.

The Syrian Civil Defence, also known as White Helmets, said its volunteers pulled bodies and survivors from under the collapsed building in Maaret al-Numan, a town in southern Idlib province that was hit in an air raid on Thursday.

The group says a mother and her two children were among those killed while the woman’s third son survived. Activist-operated Baladi News agency also reported that five people were killed.

180818152943556

In recent weeks, Syrian government forces, backed by Russian military assistance, have escalated an offensive on the northwest province in Syria, home to nearly three million people – half of whom are internally displaced.

A civilian in Maaret al-Numan said people in the area “are dying under the rubble”.

“Children, women and the elderly are dying … look around, this has become our reality,” he said.

Analysts predict that the government of President Bashar al-Assad and its allies are likely to continue applying sustained military pressure on the rebel-held territory while attempting to preserve a fragile truce agreement reached in Russia last year to spare the region a large-scale humanitarian disaster.

The so-called demilitarised zone, agreed upon by Turkey and Russia last year, is meant to create a buffer to help the Syrian government gain control over what was once a major commercial highway linking the country to neighbouring Turkey and Jordan.

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

Turkey said it is in talks with Russia to de-escalate violence in the region and reinstate the agreed-upon ceasefire.

But more than 250 Syrians have been killed in recent weeks, and some 270,000 people have been displaced since late April, according to the United Nations, which warned its humanitarian operations in the region are at risk.

Aid agencies have been forced to suspend their work in some areas, where 22 hospitals and clinics had been hit by air raids or shelling since April 28.

Mohammed Hallaj, head of Response Coordination Group in Idlib, told Al Jazeera that only 30 percent of those in need are receiving aid.

“[This is] because the numbers of displaced in the past month drastically increased,” he said. “And the intense bombardment is preventing aid workers from reaching some areas.”

Idlib and parts of the neighbouring provinces of Aleppo, Hama and Latakia are under the control of the armed group Hay’et Tahrir al-Sham (HTS), a former al-Qaeda affiliate, which the Syrian government has vowed to destroy.

Along with sharing a border with Turkey, Idlib is adjacent to Latakia province, a Syrian government stronghold that is home to the biggest military airbase of its major ally, Russia.