A moratorium on Russian air strikes on opposition neighbourhoods of east Aleppo is still in place, Moscow has claimed, despite evidence that rebel areas have been targeted by warplanes within the first 24 hours of a new Russian bombing campaign in Syria.

East Aleppo has not been bombed for 28 days, Kremlin spokesperson Dmitry Peskov said on Wednesday.

The day before, the Russian Defence Ministry announcing coordinated missile strikes against rebels in Homs and Idlib provinces, utilising the country’s only aircraft carrier in combat for the first time.

Strikes were not targeting Aleppo, Mr Peskov told reporters. However, activists in the city and a monitor say strikes on Wednesday hit close to a hospital and school, killing 20 people.

At least five children and an emergency worker died in the bombings, the Syrian Observatory for Human Rights said, in attacks that were either carried out by Russian or Syrian jets.

“The helicopters won't stop for a single moment,” Bebars Mishal, a civil defence service volunteer said. “Right now, the bombing won't let up,” he added, estimating more than 40 strikes had hit the city since daybreak.

The Observatory and residents said three neighbourhoods were hit by rocket strikes by jets, barrel bombs dropped from helicopters and artillery fired by government forces on Wednesday.

Dahiyet al-Assad - Aleppo Show all 16 1 /16 Dahiyet al-Assad - Aleppo Dahiyet al-Assad - Aleppo A girl who fled areas of conflict rides a vehicle in Dahiyet al-Assad, west Aleppo city, Syria REUTERS/Ammar Abdullah Dahiyet al-Assad - Aleppo Rebel fighters from the Jaish al-Fatah (or Army of Conquest) brigade have a tea in a building under construction Getty Dahiyet al-Assad - Aleppo A rebel fighters' armoured vehicle in Dahiyet al-Assad Reuters Dahiyet al-Assad - Aleppo Rebel fighters from the Jaish al-Fatah (or Army of Conquest) brigades sit on a tank Getty Dahiyet al-Assad - Aleppo Abandoned magazine of shells after rebel fighters took control of Dahiyet al-Assad Reuters Dahiyet al-Assad - Aleppo Rebel fighters ride a pick-up truck with civilians who fled areas of conflict in Dahiyet al-Assad, west Aleppo city, Syria Reuters Dahiyet al-Assad - Aleppo A rebel fighter gestures with a girl who fled areas of conflict while they ride a pick-up truck in Dahiyet al-Assad Reuters Dahiyet al-Assad - Aleppo Smoke rises near a damaged road in Dahiyet al-Assad, west Aleppo city, Syria Reuters Dahiyet al-Assad - Aleppo Syrians carry their belongings as they leave the southwestern frontline neighbourhood of Dahiyet al-,Assad Getty Dahiyet al-Assad - Aleppo A view shows a damaged minaret of a mosque after rebel fighters took control of Dahiyet al-Assad, Syria Reuters Dahiyet al-Assad - Aleppo Rebel groups have pledged to push from newly captured positions in the Dahiyet al-Assad district towards Hamdaniyeh. Rebels and allied jihadists launched a major offensive on October 28, 2016 to break through government lines and reach the 250,000 people living in the city's east Getty Dahiyet al-Assad - Aleppo Rebel groups have pledged to push from newly captured positions in the Dahiyet al-Assad district towards Hamdaniyeh Getty Dahiyet al-Assad - Aleppo Rebel fighters from the Jaish al-Fatah (or Army of Conquest) brigades hold a position at an entrance to Aleppo, in the southwestern frontline neighbourhood of Dahiyet al-Assad Getty Dahiyet al-Assad - Aleppo Smoke billows from the frontline district of Dahiyet al-Assad following an attack by rebels on Syrian regime forces in the northern city of Aleppo Getty Dahiyet al-Assad - Aleppo Syrians carry their belongings as they leave the southwestern frontline neighbourhood of Dahiyet al-Assad Getty Dahiyet al-Assad - Aleppo People who fled areas of conflict ride a pick-up truck in Dahiyet al-Assad, west Aleppo city, Syria Reuters

Syrian state television said President Bashar al-Assad's air force took part in strikes against what it called terrorist strongholds in Aleppo's Old City, and Russia said Isis and al-Qaeda affiliated rebels had been targeted and hit, but did not mention Aleppo.

The previous pause in strikes on the city declared on October 18 was supposed to allow rebels and civilians leave regime siege barricades under the terms of an amnesty, although both sides blamed the other for sniper and mortar fire on checkpoints into west Aleppo which prevented almost all those who wanted to from leaving.

The UN, which said the pause in fighting did not meet its security guarantees, was unable to deliver any aid, leaving the area’s 250,000 residents - living under siege conditions since July - facing starvation as winter approaches.

Also on Wednesday, Syrian state television said that the government was preparing to deploy troops for a renewed ground offensive on several fronts in Aleppo. “Zero hour,” was imminent, reports said.

The balance of the five-and-a-half year old civil war tipped in President Assad’s favour after his Russian allies began providing military assistance in 2015.