Intense fighting on Friday killed dozens of people on the edge of the last Syrian province entirely outside government control as aid workers completed a series of medical evacuations from another rebel-held area.
Government and allied forces backed by Russian warplanes took on mostly extremist fighters in an area straddling the border between Idlib and Hama provinces.
The fighting, which could signal the start of a major offensive to wrest Idlib Governorate from rebels dominated by a former al-Qaeda affiliate, escalated on Thursday.
Since then, at least 68 people have been killed in the ongoing clashes centered around an area called al-Tamana, the Syrian Observatory for Human Rights said.
Among them were at least 21 civilians, said Rami Abdel Rahman, who heads the Britain-based monitor.
They were killed in airstrikes carried out by Russian warplanes and by barrel bombs dropped by Syrian aircraft, he said.
A total of 27 soldiers and members of allied paramilitary units were killed in the fighting, as well as 20 rebels from Muslim extremist groups or from former al-Qaeda affiliate al-Nusra Front, he added.
The latest deaths raised the number of civilians killed in the area since Monday to 42 and the death toll among combatants to 90, Abdel Rahman said.
Hundreds of civilians fled the scattering of villages in the area, creating lines of cars and pickup trucks loaded down with bags and furniture on the roads towards the city of Idlib.
“The airstrikes haven’t been that intense in months in this area,” Abdel Rahman said, adding that the immediate goal of the latest regime push was to retake control of the southeast of the province.
The Islamic State group, which proclaimed a “caliphate” over swathes of Syria and Iraq in 2014, has now lost almost all the land it once controlled.
However, other factions opposed to the regime of Syrian President Bashar al-Assad still control pockets scattered across Syria, the largest one being Idlib Governorate, which borders Turkey.
Another is Eastern Ghouta, a small enclave east of the capital that is controlled mostly by rebels from the Jaysh al-Islam group and where about 400,000 residents still live.
The humanitarian situation there has deteriorated sharply in recent months and on Friday aid workers completed a series of medical evacuations of some of the most critical cases.
The last 13 in a group of 29 priority patients have now been evacuated, together with 56 members of their entourage, a health official said.
They were deemed among the most pressing cases on a list of about 500 people the UN last month said could die without urgent treatment outside the enclave, which has been besieged for four years.
The patients were evacuated as part of a deal that saw the rebels who control Eastern Ghouta release hostages and prisoners, the observatory said.
Separately, state media reported that dozens of bodies of civilians and Syrian troops killed by Islamic State militants had been found in two mass graves in the west of Raqqa Governorate.
It was not immediately clear when they had been killed or how many bodies there were in total.
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