The International Rescue Committee warned on Saturday that continued violence could displace as many as 400,000 in the coming weeks. Activists and the war monitor Syrian Observatory for Human Rights reported limited clashes on the south-eastern edge of the enclave as well as an airstrike that destroyed a bakery in Maasran. A baby is lifted onto a truck carrying civilians fleeing Maaret al-Numan, Syria, last week, ahead of the government offensive. Credit:AP Rehana Zawar, the IRC's country director for northwest Syria, said the enclave was already in the midst of a major humanitarian crisis. Zawar warned that if violence escalated, the number of displaced in Idlib could pass a million. The enclave is already home to many displaced from previous rounds of violence in the war. "Conditions in Idlib are already at a breaking point," Zawar said, calling for an immediate ceasefire.

On Tuesday, the United Nations in Syria sent an email to local NGOs saying its request for a pause in fighting had been met, and encouraged people in Maaret al-Numan to leave. Hours later, Russian warplanes bombed a school, killing six children. Aid agencies warn the situation is untenable and is threatening to turn into one of the worst humanitarian disasters of the eight-year war. A man sorts through the damage to a shop in the city of Saraqeb in the Idlib countryside after an air strike by Syrian aircraft last week. Credit:AP Even Donald Trump, not usually moved to speak out about the plight of Syrians, tweeted on Thursday: "Russia, Syria, and Iran are killing, or on their way to killing thousands of innocent civilians in Idlib province. Don't do it!" Most of the 3.5 million people in the province have been displaced from formerly rebel-held areas across the country and have nowhere left to go.

Turkey, which already hosts the most refugees of any country in the world, closed the frontier with Syria in response to the 2015 migrant crisis and built a wall to stem the flow. Ankara has been sending truckloads of aid into Idlib and accepting some of its most urgent medical cases, but the Turks have signalled they are not prepared to offer much else. It is in Europe's interests to help avoid a large-scale humanitarian disaster, as Ankara has threatened to send new arrivals its way if it is pressured to open the border. This month, Turkey's President Recep Tayyip Erdogan told the EU to prepare for a "new wave" of Syrian refugees, saying his country "will not carry the migration burden alone". Civilians in Idlib say they feel let down by Turkey, which has been the opposition's main backer during the uprising against the Damascus regime.

Turkey has been strengthening its alliance with Russia, a key ally of President Bashar al-Assad's government. Western diplomats say they believe Ankara agreed to something of a quid pro quo with Moscow − if the latter turns a blind eye to the former's operations against Syrian Kurdish militias, it will not stand in its way over Idlib. Idlibis say the move has effectively sold out the revolution. Mustafa Sejari, a senior official in the Turkey-backed Syrian National Army, pleaded with Erdogan in an open letter, asking him to take a "historic stand" by opening Turkey's borders to women and children, and resuming military support to opposition forces. The Syrian offensive is part of the regime's strategy to secure the M4 and M5 highways running through Idlib, both key routes connecting the government-controlled cities of Aleppo and Hama with capital Damascus. Assad has promised to retake "every inch" of Syria, but the rebels, who are largely aligned with the Islamist group Hayat Tahrir al-Sham (HTS), have had years to dig in.

The city of Maaret al-Numan, which had a population of around 100,000, has been at the centre of Assad's most recent campaign. It is known for its fierce resistance to the regime but also in more recent times for its resistance to HTS and other hardline groups. Intense shelling and airstrikes have driven out almost the entire population, leaving a virtual ghost town. Dareen Khalifa, a Syria analyst with the International Crisis Group, said government forces had been "overcompensating" for the slow progress made so far in Idlib by using "devastating" levels of air force. "If the regime continues and if the rebels don't surrender, this will mean the worst humanitarian disaster we've seen in Syria," she said. "The casualties and displacement levels are catastrophic."

Mahmoud Sadeq, a 30-year-old father of two young children, was forced to flee his house in Maaret al-Numan last week. "On Friday, Dec 20, we woke up to the sound of warplanes and airstrikes," he said by phone. "The regime and Russia began a brutal aerial assault as well as shelling from troops on the ground. Friday is a day to remember because the bombing didn't stop for a minute, it was continuous, fierce, and hysterical. "I waited until the bombing eased down. By dawn of Saturday, I rode a motorbike with my wife and my two children, who are three years old and one month old, and we fled towards Binnish in the north-east of Idlib, "I drove slowly because the weather was so cold, so we suffered a lot, the trip took two hours."

The family is now seeking shelter in a building next to an orchid field. All they managed to take with them was a change of clothes, a gas cylinder for cooking, a small amount of food and some photographs. Few places are safe. Earlier this month, a refugee camp was bombed, leaving at least 16 civilians dead and 50 wounded. There have been at least 65 attacks on 47 health facilities in Idlib since the offensive began in earnest in April, according to the Syrian American Medical Society. Earlier this year, UN officials alleged that Russian forces may be targeting hospitals and schools as a tactic to "terrorise" civilians − accusations denied by both Damascus and Moscow. The bombing campaign has killed more than 5262 civilians, including 246 children, since April, according to the Syrian Observatory for Human Rights, a Britain-based war monitoring group. More than 100 of the victims died in the last week.

Russia and China last week vetoed a UN Security Council resolution that would have allowed aid to continue flowing to Idlib while the UN, US and its European partners have been able to do little other than issue statements of condemnation. "It seems that 2019 was the year the international community and the UN completely abandoned Syria and politicians have even run out of words of condemnation," said Raed Al Saleh, of the White Helmets civil defence group, this week. "My biggest fear as the year comes to a close is for the attacks to intensify further, causing new waves of displacement, because there is nowhere left for people to run. "Every olive tree has become a tent and every camp has exceeded its capacity 10 times over," he said. "I still cannot understand how the world's most powerful nations can meet those horrors with silence and inaction."