Tens of thousands of people have fled a government assault on Idlib, Syria’s last rebel-held province, prompting warnings of a humanitarian catastrophe.

The regime advance comes amid what a senior aid worker described as a “systematic” attack on hospitals in the region. Eight have been hit at the end of December and beginning of January. One such attack in the town of Maarat al-Numan on 3 January killed a baby girl, who was just two hours old, and her father. Two nurses and a doctor were wounded. “The major goals are to deprive people of healthcare, kill opposition medical workers and push people to flee,” said Ahmad al-Dbis, safety and security director for the Union of Medical Care and Relief Organisations (UOSSM), which runs dozens of hospitals in Syria. “The medical situation is a tragedy.”

Facebook Twitter Pinterest Displaced people from a village in southern Idlib head on the Damascus-Aleppo motorway towards the northern part of the rebel-held province. Photograph: Omar Haj Kadour/AFP/Getty Images

According to UN figures, more than 70,000 people have fled their homes and moved further into Idlib in recent weeks to escape the latest wave of violence to grip Syria, seven years into a civil war that has killed half a million people. There are already an estimated 1.1 million people in the province who have fled from other parts of Syria, or were allowed safe passage there after rebel groups surrendered.



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Many have sought refuge near the Turkish border after forces loyal to the regime of Bashar al-Assad launched a ground offensive for the first time in nearly three years into Idlib province, which is wholly controlled by rebels fighting to depose the Syrian strongman. A coalition of mostly Islamist rebels, including the then al-Qaida-affiliated Jabhat al-Nusra, ousted the regime from the province in the spring of 2015.

The government’s push into Idlib appears to be aimed at taking control of Abu al-Dhuhour airbase and establishing a foothold in the province, but experts say it is unclear whether it plans to venture further into the province in a broader ground campaign.

Assad’s forces are reportedly within five miles of the military complex, advancing under a massive wave of air and artillery bombardment.

UOSSM said some hospitals had been repeatedly targeted, putting several out of service.

Meanwhile, activists say whole villages near the frontline have been abandoned, and fear a widening of airstrikes on swelling population centres could lead to a disaster for civilians.

“There could be a really parlous humanitarian catastrophe,” said one European diplomat.

Idlib is supposed to be a “de-escalation” zone under the terms of an agreement brokered by Russia, Turkey and Iran to reduce violence around the country. Ankara maintains a presence of peacekeepers in the province, but the violence has continued despite them.

It also comes weeks before a conference slated for later this month in Sochi under Russian auspices that was expected to bring the regime and members of the opposition together for a “national dialogue” to pave the way for a peace settlement, after a failed round of UN-sponsored talks in Geneva.

The Turkish foreign minister, Mevlüt Çavuşoğlu, said the latest wave of violence was endangering efforts to reach a political settlement, adding the Assad regime was using the excuse of fighting extremists in order to bombard mainstream opposition fighters.

Quick guide Hay'at Tahrir al-Sham Show Hide What is Hay'at Tahrir al-Sham? Hay'at Tahrir al-Sham (HTS), the most powerful rebel faction in Idlib, is a coalition of militias led by the former al-Qaida affiliate Jabhat Fateh al-Sham (JFS), formerly known also as Jabhat al-Nusra. HTS became the dominant group in the province after defeating another Islamist militia – and former ally – Ahrar al-Sham. They had once fought together to oust forces loyal to Bashar al-Assad from the whole province in the spring of 2015. HTS and its predecessors have formally severed ties with al-Qaida, but western officials maintain that it is an extremist organisation with enduring ties to the global terror network. In cities under its control, the group has imposed harshly conservative laws, prompting protests by locals, many of whom oppose HTS as well as the Syrian regime. It recently formed a “government of national salvation,” to act as its political front in Idlib.

The predominant military faction in Idlib is Hay’at Tahrir al-Sham (HTS), led by the latest incarnation of Jabhat al-Nusra. The group controls much of the province, and has continued to impose draconian rules on the populace, prompting protests against the measures by civilians, who also oppose the Assad regime.

Tens of thousands of people have sought refuge in Idlib over the years, including 30,000 people from the city of Aleppo. They came after local reconciliation deals with the government led to the handing over of territory under opposition control in exchange for allowing them safe passage to Idlib.

The province has endured years of airstrikes and even chlorine attacks, and last year the town of Khan Sheikhun was the target of a sarin gas attack. But the regime thrust into the province is the first large-scale ground campaign in years.

Western officials worry the regime is seeking to force HTS into a smaller area with a dense population, and then launch an aerial campaign that will devastate population centres and drive more people towards the border.

The government’s advance into Idlib is the latest setback for a scattered opposition weakened by infighting. The Assad regime has the military momentum after a string of battlefield victories in late 2016 and throughout 2017 that was allowed by the unrelenting support of Moscow, Tehran, and Shia militias from Iraq and Lebanon.

Victories on the ground have given the regime and its allies leverage in the negotiations for a peace settlement, and weakened the hand of those who demand a transition away from Assad’s rule. Still, Russia is eager to push for a deal in order to limit its spending on the conflict ahead of elections this year.

The violence has continued elsewhere in the country, with the last major rebel enclave under crippling siege, eastern Ghouta, enduring two weeks of heavy bombardment that activists said killed more than 130 people.

Eastern Ghouta, once the breadbasket of the capital Damascus, has been under tight siege with little food or medical supplies for a population the UN estimates to be around 400,000. The Syrian Observatory for Human Rights, a war monitor, said more than a dozen airstrikes followed by shelling targeted the region on Tuesday alone.