After a brief period of relative calm, residents trapped in rebel-held east Aleppo are once again fearful for their lives as ferocious shelling hits schools and medical facilities.

Five hospitals in east Aleppo and the surrounding rebel-held countryside, including a children’s hospital, have been hit and damaged in the last 48 hours since Russia announced a new offensive targeting Idlib and Homs provinces.

The Russian moratorium on strikes on east Aleppo is still in place, a Kremlin spokesperson said on Wednesday – but whether the bombs are dropped by Russian or Syrian government planes, the result for the people on the ground is the same.

The huge new offensive means “there are more warplanes than birds in the sky”, teacher and rebel activist Abdulkami al-Hamdo said via a messaging app on Thursday. The thundering of low-flying jets upsets his infant daughter. “It feels like they’re right over our heads,” he said. “It is our Judgement Day.”

The Syrian Observatory for Human Rights said on Thursday that Syrian air strikes and shelling killed 25 civilians in eastern districts of Aleppo The bombardment hit at least six rebel-held neighbourhoods, the monitoring group said.

This followed reported strikes on Wednesday that hit two hospitals, a blood bank and close to a school, killing 21 people, the group said.

“The supplies for medical facilities will finish soon – in not more than two weeks,” Dr Hatem, the director of the badly damaged Bayan Children’s Hospital said, describing how he and staff had to shelter in the hospital’s basement for hours while helicopters and jets overhead dropped barrel bombs.

The White Helmets, civil defence volunteers, put the death toll across Aleppo province from the first 48 hours of the bombardment at 87, but expected the number to rise as more injured arrived at hospitals throughout the night and the already fatigued medical facilities struggle to cope.

Around 19 people died in the village of Batbo alone.

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

The pattern of targeting civilian infrastructure such as hospitals has alarmed aid groups and sparked condemnation from the international community.

“Reports of air strikes hitting hospitals and camps full of displaced Syrians are not only sickening but could also violate international humanitarian law,” UK International Development Secretary Priti Patel said. “I urge Russia and the Assad regime to prove that they can show restraint.”

Nato intelligence had previously suggested that Syrian President Bashar al-Assad and his ally Russian President Vladimir Putin would renew the attack on east Aleppo, the last major rebel stronghold in Syria, while the US was distracted by the presidential election and its aftermath.

Russia announced coordinated missile strikes against Isis- and al-Qaeda-affiliated rebels across northern Syria on Tuesday, utilising the country’s only aircraft carrier in combat for the first time. The defence ministry did not mention any targets in Aleppo.

Drone footage of Aleppo

One US-based activist working for Sams, a charity which supports medical facilities across Syria, was critical of the international community’s inability to broker more a more lasting peace during the Russian moratorium announced on 18 October.

“The situation in Aleppo province in general is unprecedented. The world media doesn’t seem to reflect that,” he said. “I am afraid we will pay a hefty price for this silence sooner or later.”

Even without the prospect of intensified bombing, the situation for east Aleppo’s 250,000 residents is desperate: the UN said it handed out its last food packages last week and the population is facing starvation as winter sets in.

Protests alleging corruption on the part of those in charge of aid distribution and the estimated 8,000 rebels in the area were reported on Tuesday, and supplies stolen from food warehouses.

East Aleppo has not received any aid since government forces cut off the rebel supply lines in July. Mr Assad’s strategic combination of siege tactics and bombing has been effective at beating exhausted civilian and rebel populations into submission in other areas of Syria during the almost six-year-long civil war, which has left 400,000 people dead.

Devastation in a civilian area of east Aleppo on Wednesday

Syrian state-owned television announced late on Wednesday that government troops were mobilising for an imminent ground offensive on what it called terrorists on several fronts in the Aleppo theatre.

Retaking the whole of the divided city would be a significant victory for the Syrian regime.