Airstrikes on a village in rebel-held Syria have killed at least 44 civilians and injured a further 80, the Syrian Observatory for Human Rights (SOHR) has said, in the biggest attack in the area so far this year.

The UK-based war monitor as well as the Syrian Civil Defence service said the attack on Zardana in Idlib province overnight on Thursday involved a “double tap”, in which planes returned to bomb the same area after paramedics arrived at the scene.

A total of eleven women and six children were among the dead in what is believed to be a Russian operation, the observatory said.

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Eight strikes hit the small settlement after dark, during which people were breaking the Ramadan fast.

Graphic pictures shared by the defence service, which is also known as the White Helmets, showed children covered in blood and shrapnel wounds in hospital and residential buildings reduced to rubble.

At least one rescue worker is among the dead, the defence service said. The search for survivors continued after daybreak on Friday. The mounting death toll from the strikes makes the attack the biggest to hit the area in 2018 to date.

Eastern Ghouta bombings: Syrian war in pictures Show all 14 1 /14 Eastern Ghouta bombings: Syrian war in pictures Eastern Ghouta bombings: Syrian war in pictures A Syrian woman and children run for cover amid the rubble of buildings. AFP/Getty Eastern Ghouta bombings: Syrian war in pictures Smoke rises from buildings following the attack on the village of Mesraba in the rebel-held besieged Eastern Ghouta region on the outskirts of the capital Damascu. AFP/Getty Eastern Ghouta bombings: Syrian war in pictures Injured children receive medical treatment. EPA Eastern Ghouta bombings: Syrian war in pictures A Syrian man carries a child injured. AFP/Getty Eastern Ghouta bombings: Syrian war in pictures An injured child receives treatment following bombings on several areas of eastern Ghouta. EPA Eastern Ghouta bombings: Syrian war in pictures A child reacts inside a hospital after relatives were injured in the bombing. EPA Eastern Ghouta bombings: Syrian war in pictures Syrian children cry at a make-shift hospital in Douma following air strikes on the Syrian village of Mesraba. AFP/Getty Eastern Ghouta bombings: Syrian war in pictures Syrian Civil Defense group extinguishing a store during airstrikes and shelling by Syrian government forces. AP Eastern Ghouta bombings: Syrian war in pictures A wounded 12-year-old Syrian boy, cries as he receives treatment at a make-shift hospital. AFP/Getty Eastern Ghouta bombings: Syrian war in pictures Syrians carry a wounded man. AFP/Getty Eastern Ghouta bombings: Syrian war in pictures An injured man covered with blood at a medical point. Reuters Eastern Ghouta bombings: Syrian war in pictures People sit a medical point in the besieged town of Douma, Eastern Ghouta. Reuters Eastern Ghouta bombings: Syrian war in pictures Syrian Civil Defense running to help survivors. AP Eastern Ghouta bombings: Syrian war in pictures Injured children receive medical treatment. EPA

No one has claimed responsibility for the unusually large attack. Both the Syrian and Russian air forces operate over Idlib, but the area has been subject to a de-escalation agreement between government and rebel forces since 2017.

Idlib province in the country’s northwest is the Syrian opposition’s last major stronghold.