The Syrian government and its allies dropped 157 bombs over Idlib province in a single day, killing at least 20 civilians – including children – and levelling homes and shops, according to rescue workers and a monitoring group.

The attacks were described as a “massacre” by Syria Civil Defence (SCD), also known as the White Helmets, who warned that the death toll could rise further as more bodies were pulled from the rubble.

“Twenty civilians were killed and 82 others wounded on Wednesday by Russian warplanes and Assad’s helicopters bombing villages and towns of the southern countryside of Idlib, committing two massacres in the city,” spokesperson Ahmed Sheiko told The Independent.

Warplanes targeted civilians who had gathered at a busy vegetable market and nearby shops in the town of Ariha, killing at least 19 people, including two children, Mr Sheiko said. A young man was also killed in regime raids on Hass town centre, south of Idlib.

In a video posted online, rescue workers can be seen struggling to pull a child out from under the rubble.

“Our teams fought with all their might to retrieve him alive, but death was faster for him than us,” the SCD wrote on Twitter.

Syrian regime bombards Idlib Show all 23 1 /23 Syrian regime bombards Idlib Syrian regime bombards Idlib Members of the Syrian Civil Defence, also known as the White Helmets, recover a wounded boy from the rubble of a building following a regime air strike on a vegetable market in Syria's last major opposition bastion of Idlib AFP via Getty Syrian regime bombards Idlib The regime air strikes killed at least nine civilians, striking bustling areas of Idlib city AFP via Getty Syrian regime bombards Idlib An injured woman waits to receive treatment at a makeshift hospital AFP via Getty Syrian regime bombards Idlib Syrian Civil Defence, also known as the White Helmets, searching through the rubble of a building AFP via Getty Syrian regime bombards Idlib A Syrian boy is evacuated AFP via Getty Syrian regime bombards Idlib A drone picture taken on January 15, 2020, shows members of the Syrian Civil Defence, also known as the White Helmets, searching through the rubble of a building at the site of a regime airstrike on Syria's last major opposition bastion of Idlib - Regime air strikes on Syria's last major opposition bastion killed at least nine civilians, striking bustling areas of Idlib city despite a fresh Russian-sponsored truce, a war monitor said. At least 20 other civilians were wounded in the raids that hit a vegetable market and repair shops in Idlib, capital of the jihadist-held province of the same name, said the Syrian Observatory for Human Rights. (Photo by Omar HAJ KADOUR / AFP) (Photo by OMAR HAJ KADOUR/AFP via Getty Images) OMAR HAJ KADOUR AFP via Getty Images Syrian regime bombards Idlib The wreckage of a car AFP via Getty Images Syrian regime bombards Idlib A Syrian boy cries as he is evacuated AFP via Getty Images Syrian regime bombards Idlib Rescuers search for survivors EPA Syrian regime bombards Idlib A drone picture taken on January 15, 2020, shows members of the Syrian Civil Defence, also known as the White Helmets, searching through the rubble of a building at the site of a regime airstrike on Syria's last major opposition bastion of Idlib - Regime air strikes on Syria's last major opposition bastion killed at least nine civilians, striking bustling areas of Idlib city despite a fresh Russian-sponsored truce, a war monitor said. At least 20 other civilians were wounded in the raids that hit a vegetable market and repair shops in Idlib, capital of the jihadist-held province of the same name, said the Syrian Observatory for Human Rights. (Photo by Omar HAJ KADOUR / AFP) (Photo by OMAR HAJ KADOUR/AFP via Getty Images) OMAR HAJ KADOUR AFP via Getty Images Syrian regime bombards Idlib A Syrian boy grimaces in pain after he was wounded in the airstrikes AP Syrian regime bombards Idlib A Syrian youth stands at the site of a regime air strike in Ariha town AFP via Getty Syrian regime bombards Idlib Rescuers search for survivors under the rubble of a collapsed building EPA Syrian regime bombards Idlib A Syrian walks on the rubble of a building following a regime air strike on Ariha town in Syria's last major opposition bastion of Idlib on January 15, 2020. - Regime air strikes on Syria's last major opposition bastion killed at least nine civilians Wednesday, striking bustling areas of Idlib city despite a fresh Russian-sponsored truce, a war monitor said. (Photo by Omar HAJ KADOUR / AFP) (Photo by OMAR HAJ KADOUR/AFP via Getty Images) OMAR HAJ KADOUR AFP via Getty Syrian regime bombards Idlib Firefighters try to extinguish flames EPA Syrian regime bombards Idlib Emergency services look for survivors AP Syrian regime bombards Idlib Emergency services look for survivors after airstrikes in the city of Idlib, Syria, Wednesday, Jan. 15, 2020. Syrian government warplanes struck a market and an industrial area Wednesday in the last territory in the hands of rebel groups in the country's northwest, killing at least 15 people, opposition activists said. (AP Photo/Ghaith Alsayed) Ghaith Alsayed AP Syrian regime bombards Idlib A boy wounded in airstrikes is treated in a hospital AP Syrian regime bombards Idlib Syrian White Helmet civil defense workers extinguish a burning car Syrian Civil Defense White Helmets via AP Syrian regime bombards Idlib A Syrian walks on the rubble of a building AFP via Getty Syrian regime bombards Idlib People walk past destruction by the government airstrikes in the town of Ariha, in Idlib province, Syria, Wednesday, Jan. 15, 2020. Syrian government warplanes struck a market and an industrial area Wednesday in the last territory in the hands of rebel groups in the country's northwest, killing at least 15 people, opposition activists said. (AP Photo/Ghaith Alsayed) Ghaith Alsayed AP Syrian regime bombards Idlib People walk past destruction by the government airstrikes in the town of Ariha, in Idlib province, Syria, Wednesday, Jan. 15, 2020. Syrian government warplanes struck a market and an industrial area Wednesday in the last territory in the hands of rebel groups in the country's northwest, killing at least 15 people, opposition activists said. (AP Photo/Ghaith Alsayed) Ghaith Alsayed AP Syrian regime bombards Idlib People look at destruction by the government airstrikes in the town of Ariha, in Idlib province, Syria, Wednesday, Jan. 15, 2020. Syrian government warplanes struck a market and an industrial area Wednesday in the last territory in the hands of rebel groups in the country's northwest, killing at least 15 people, opposition activists said. (AP Photo/Ghaith Alsayed) Ghaith Alsayed AP

The UK-based Syrian Observatory for Human Rights, which monitors the conflict using a network of sources inside the country, said that the Assad regime and the Russian air force dropped 157 bombs across Idlib, including 28 barrel bombs.

The latest round of bloodshed comes after a ceasefire agreement was signed on Sunday between the Syrian president, Bashar al-Assad, Russia, and Turkey, which backs the rebels.

“Russia proves again its disrespect to any ceasefire in Syria, and that the recent agreement with Turkey, in its fourth day, is nothing but a repetitive scenario of similar failing agreements. With continuing the artillery and aerial bombardment by Russia, the ceasefire has come to an end,” Khaled Khatib, of the White Helmets, told The Independent from inside Ariha.

Despite a string of ceasefires brokered between Mr Assad, Russia and Turkey, the area has witnessed an uptick in violence as the regime renews hostilities against the country’s final area of opposition control.

On Thursday, the United Nations sounded the alarm over the "escalating hostility" in Idlib that it says has displaced about 350,000 people since Mr Assad’s government renewed its offensive against the area on 1 December.

The vast majority – 80 per cent – are believed to be women and children, the UN Office for the Coordination of Humanitarian Affairs (OCHA) said in a statement.

Many are having to shelter in border areas near Turkey, unable to cross. Rescue workers said that many towns and villages south of Idlib, close to the frontlines, are now empty.

“An unstable security situation prevails, with daily reports of bombardments, affecting civilian infrastructure, such as schools and IDP camps,” the statement said.

It warned that this is having a perilous impact on those trapped between regime airstrikes, rebel groups and a hostile border with Turkey.

“Four million people live in northwest Syria, of which 2.8 million are estimated to be in need of humanitarian assistance,” it continued.