AL-TAMANA - Intense fighting 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 on Friday.
Government and allied forces backed by Russian warplanes took on mostly jihadist 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 province from rebels dominated by a former Al-Qaeda affiliate, escalated on Thursday.
According to the Syrian Observatory for Human Rights, at least 68 people have been killed since then and the clashes, centred around an area called Al-Tamana, continued on Friday.
At least 21 civilians were among the dead, said Rami Abdel Rahman, who heads the Britain-based monitoring organisation.
They were killed in air strikes carried out by Russian warplanes and by barrel bombs dropped by Syrian aircraft, he said.
He said 27 soldiers and members of allied paramilitary units were killed in the fighting as well as 20 rebels, from Islamist groups or from former Al-Qaeda affiliate Fateh al-Sham.
Abdel Rahman said the latest deaths brought the number of civilians killed in the area since Monday to 42 and the death toll among combatants to 90.
The intensifying fighting in the area appeared to signal the start of a government offensive in Idlib province.
- Worst in months -
An AFP correspondent near the front line said aerial activity was intense and the entire area rocked by frequent air strikes.
Rebel leaders issued warnings through loudspeakers informing remaining civilians in the area that the mainly weekly Muslim prayers were cancelled and all residents should stay home.
Hundreds of civilians fled the scattering of villages in the area, creating queues of cars and pickup trucks loaded down with bags and furniture on the roads towards the city of Idlib.
"The air strikes haven't been that intense in months in this area," said Abdel Rahman, adding that the immediate goal of the latest regime push was to retake control of the southeast of the province.
The Islamic State jihadist group, which proclaimed a caliphate over swathes of Syria and Iraq in 2014, has now lost almost all the land it once controlled.
But other factions opposed to the regime of President Bashar al-Assad still control pockets scattered across Syria, the largest one being Idlib province, which borders Turkey.
Another is Eastern Ghouta, a small enclave east of the capital Damascus, which is controlled mostly by rebels from the Jaish al-Islam group and where around 400,000 residents still live.