Air strikes and shelling killed 13 civilians in northwestern Syria on Tuesday, a monitor said, in the latest escalation to rattle a months-old truce and spark displacement.

At least 53 fighters have also been killed since Monday, in one of the deadliest flare-ups since a demilitarised zone around the Idlib region was agreed in September last year, the Britain-based Syrian Observatory for Human Rights said.

Several deadly skirmishes have occurred since the deal was reached between regime ally Russia and rebel backer Turkey, but the last few weeks have seen an uptick in violence inside the planned buffer zone.

The region of some three million people is under the control of a former Al-Qaeda affiliate, in one of the last parts of Syria which President Bashar al-Assad has yet to take back.

The September deal aimed to avoid an all-out government offensive on the enclave.

But a surge in attacks since April 20 has raised new fears a government offensive is imminent, prompting thousands of civilians to flee their homes towards quieter areas deeper inside Idlib province.

"This is the third time we have been displaced but this time is the scariest," said Abu Ahmad, a 40-year-old from southern Idlib who was fleeing Tuesday with his family towards areas near the border with Turkey.

"Overflights by warplanes and shelling have been relentless," said the father of three, his blue pick-up truck stacked with mattresses, bed sheets and household appliances.

- 'Urgent de-escalation' -

Battles between jihadists and pro-government forces raged overnight around a hilltop in the northern countryside of Hama province, following an advance by Assad's forces.

Twenty-four pro-government fighters were killed in fierce fighting, the Observatory said, along with 29 jihadists.

The latter were members of Hayat Tahrir al-Sham (HTS), a group dominated by fighters from a former Al-Qaeda affiliate, and of the Turkistan Islamic Party, a Uighur-dominated jihadist group.

Fighting subsided early Tuesday after pro-government forces thwarted several counter-attacks and consolidated new positions, Observatory chief Rami Abdul Rahman told AFP.

But the air and artillery bombardment continued for an eighth straight day, killing the 13 civilians, the war monitor said.

At least nine civilians were killed in shelling and air strikes on Monday.

State news agency SANA said Syrian troops launched rocket attacks on armed groups in northwestern Hama province on Tuesday, killing several fighters, but it did not provide any toll.

French President Emmanuel Macron expressed his "extreme concern" over the heightened violence.

"The humanitarian situation in Syria is critical and no military option is acceptable," he said on Twitter Tuesday.

"We demand a halt to the violence and support the UN in backing a necessary political solution."

UN chief Antonio Guterres has called "for an urgent de-escalation of the situation as the holy month of Ramadan begins" and urged "the parties to recommit fully to the ceasefire arrangements of the memorandum signed on 17 September 2018."

A UN statement said Guterres was alarmed by "reports of aerial attacks on population centres and civilian infrastructure".

At least seven health facilities have been hit since April 28, it said.

Nine schools have also been struck since April 30, and many more have closed their doors indefinitely, it added.

- 'Limited offensive' -

It remains unclear whether the Syrian government and its Russian ally are planning to launch a full-scale assault.

Aron Lund, from the US think tank The Century Foundation, said "a limited offensive into Idlib, peeling off a few areas, should be easily within their capabilities".

He said the recapture of two key highways running through Idlib -- the M4 and the M5 -- could be among the "many goals" behind such an operation.

Under the September deal, hardliners were supposed to withdraw from the planned buffer zone, allowing traffic to once again flow along the two strategic highways, which connect government-held areas with the Turkish border.

Turkey has failed, however, to secure the jihadists' withdrawal, prompting government forces to take matters into their own hands, Syria specialist Fabrice Balanche said.

Taking the two highways would help Assad boost the recovery of Syria's nearby second city Aleppo, which remains cut off from most of its countryside and poorly connected to the rest of the country, he told AFP.

"Restoring traffic on these two axes will reduce transport costs to Aleppo," he said.

Retaking the road between the regime's coastal stronghold of Latakia and Aleppo in particular would cut the rebel-held region in two, making it easier for government forces to recapture its southern part and isolate the jihadists in the north, Balanche added.

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Air raids hit three hospitals in Syria's Idlib: monitor
Hass, Syrie (AFP) May 5, 2019
Air strikes by Syrian regime ally Russia on Sunday forced the closure of two hospitals and also damaged a third one in the jihadist-held Syrian province of Idlib, a war monitor said. It came as eight civilians were killed in bombardment by the regime and Russia across the northwestern province, the Britain-based Syrian Observatory for Human Rights said. Idlib and other adjacent territories of Syria held by jihadists have faced intensifying bombardment in the past month. On Sunday, air strike ... read more