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.

Copyright Agence France-Presse, 2017