Civilians in opposition-held Syria face a cold, hungry start to the winter with an intensified bombing campaign forcing thousands to flee their homes while fuel shortages threaten medical care and push up prices of food and transport.

At least 90 people have been killed and 12,000 have fled the town of Maaret al-Numan in southern Idlib province after heavy bombing over the last week, local activists said. They fear the bombing campaign, which has included air strikes, barrel bombs and shelling, could be preparations for a ground offensive.

Charities and hospitals are struggling to respond to the crisis because of soaring fuel prices, which have more than doubled in the area since early October.

One hospital director said he had turned off heaters on his wards despite plunging winter temperatures to save fuel for ambulances and generators that power vital medical devices. Aid workers say they have had to cut back support for some of the internally displaced people in the region.

“We have faced many barriers to our work over the last three years,” said Haytham Abu Husam, who lives in southern Idlib and works for a Syrian-run aid group there. “But none are on the scale of the current crisis.

“We have continued despite countless risks, including targeting of humanitarian workers in Idlib, where many have been kidnapped and two killed in the last few months. Warplanes and helicopters haven’t left the skies. We didn’t stop our work despite all that, but if the fuel crisis continues, we would have to stop.”

More than 3 million people are estimated to be living in Idlib, many of them refugees displaced from other parts of the country, as President Bashar al-Assad and his Russian and Iranian allies reclaimed areas that had been under rebel rule and opposition supporters fled.

The long offensive has been marked by a willingness to violate international law by targeting civilian infrastructure, including hospitals, before the intensive bombing of the last week that hit busy markets and an olive oil processing plant, making it harder for families to buy food.

Ali Saraqbi was in his family’s fruit and vegetable store in Maaret al-Numan, which is a hub for the area, when a bomb hit during mid-morning trading on 2 December. It killed nine and injured 12, activists said.

“I became deaf for some minutes and then I started hearing the screaming, groaning, yelling and the ambulance sirens,” Saraqbi said. “Then I went outside my store and saw some bodies, including owners of three neighbouring shops and two porters.”

It was the fifth time the town’s market has been hit. Saraqbi said he would not even attempt to reopen his family’s fruit and vegetable store. He was already heavily in debt and shoppers were staying away. Instead he might buy a push cart to sell vegetables in the street.

Syrian Civil Defence forces search for survivors in rubble in the village of Tal Mardikh in Syria’s north-western Idlib province. Photograph: Omar Haj Kadour/AFP via Getty Images

People were already cutting back on food because of soaring prices. Fuel shortages made transportation costlier, so staples like tomatoes, cucumber and aubergine were at least three times more expensive than a month earlier.

These bombing attacks make fuel for ambulances vital. “We move around a lot to reach urgent cases especially in the current aerial campaign against civilians in Idlib,” said Abu Husam, the aid worker.

Budgets for this period had already been allocated, so when fuel costs went up, cuts had to be made. “We made it a priority to secure fuel for the bakeries, to make bread for the people who are still in the south of Idlib and neighbouring villages and towns,” he said. “Now we are having difficulties reaching more distant areas, so our activities have been limited.”

For years, much of the fuel in Idlib had come from oil fields in north-eastern Syria, near Hassakah. Crude oil was trucked west along roads held by Kurdish and rebel forces to be turned into gasoline, diesel and fuel oil in makeshift refineries.

But after the US president, Donald Trump, decided to abruptly abandon the US’s Syrian Kurdish allies, leaving Turkish forces to sweep into some areas they held, fighting closed the main trucking route.

The situation has calmed again, but the crossing remains closed, said one trader who operates several 125-barrel tanker trucks but has not been able to make any runs since mid-October. “The clashes have eased and the situation is stable on both sides near Manbij now, so I don’t understand why the border is still closed,” he said.

Complicating the situation, in late November activists said strikes by unidentified planes hit several of the refineries around north and north-east Aleppo, hampering any attempt to processcrude oil should it start to arrive again.

Hussein Akoush contributed to this report





