The ambulance was targeted by a regime air strike, according to an aid organisation and the Syrian Observatory for Human Rights
Maaret al-Numan (Syria) (AFP) - Regime bombardment killed 20 civilians including eight children and three rescue workers in jihadist-run northwest Syria Thursday, as fighting killed dozens on the edges of the anti-government bastion.
The Idlib region, home to some three million people, is supposed to be protected by a months-old international truce deal, but it has come under increased bombardment by the regime and its Russian ally since late April.
The United Nations has warned that the spike in violence could spark one of the worst humanitarian disasters in Syria's grinding eight-year conflict.
A regime air strike targeted an ambulance in the town of Maaret al-Numan, killing three rescue workers inside, the Syrian Observatory for Human Rights said.
An AFP photographer saw a destroyed ambulance and rescuers carrying a survivor from the vehicle with his arm in shreds.
Syrian charity Benefsej which owned the ambulance said three of its workers had been killed.
"It was a direct targeting of the ambulance," said charity member Fouad Issa.
A woman also died in the ambulance while she was being transported for treatment, he added.
In a statement posted on social media networks, the charity described the attack as a "violation of international humanitarian law".
"Ensuring the protection of humanitarian and health facilities via the international community is a necessity for us to continue our work".
- 'Humanitarian disaster' -
Russia and rebel backer Turkey brokered an agreement in September seeking to stave off an all-out regime assault on Idlib, but the deal was never fully implemented as jihadists refused to withdraw from the planned buffer zone.
The Hayat Tahrir al-Sham group, led by ex-members of Al-Qaeda's former Syria affiliate, extended its control over the region, which spans most of Idlib province as well as slivers of the adjacent provinces of Latakia, Hama and Aleppo.
The Syrian government and Russia have upped their bombardment of the region since late April, killing more than 440 civilians, the Britain-based Observatory said.
The United Nations says more than 23 hospitals and one ambulance have been hit in the Idlib region since late April.
Some 330,000 people have been forced to flee their homes, it says.
UN humanitarian chief Mark Lowcock on Tuesday warned the world is facing "a humanitarian disaster unfolding before our eyes".
The same day UN chief Antonio Guterres called on Russia and Turkey to "stabilise the situation", warning "civilians are paying a horrific price".
- 'Liberating the land' -
Fighting raged Thursday in the north of Hama province, leaving at least 27 anti-regime fighters and 31 loyalists dead in the clashes around Tal Meleh village, the Observatory said.
More than 90 fighters were killed in the same area over the two previous days, said the war monitor.
Syrian Foreign Minister Walid Muallem on Wednesday pledged a full return of regime control to Idlib in the latest such warning from the Damascus government.
"Idlib is a Syrian province and the operations the Syrian army is conducting are on Syrian soil and a legitimate right towards liberating the land," he told the Beirut-based Al-Mayadeen television channel.
Analysts have however said they did not expect a full-out offensive to retake the region on Turkey's doorstep for now.
Syria expert Sam Heller said the regime and Russia were seeking to secure neighbouring loyalist areas and a key Russian military airbase to the west of Idlib, as well as exert pressure on Turkey to implement the September buffer zone deal.
"Damascus is still evidently intent on taking the whole of Idlib, and all Syrian territory nationwide," the International Crisis Group analyst said.
"But it's Russia that's enabled this latest military push, seemingly with more limited aims."
On Thursday, President Bashar al-Assad met the Kremlin's Syria envoy Alexander Lavrentiev and Deputy Foreign Minister Sergei Vershinin in Damascus, state news agency SANA reported.
They discussed developments in Syria, including efforts to eradicate "terrorism", SANA said, using the regime's term for rebels and jihadists.
Syria's war has killed more than 370,000 people and displaced millions at home and abroad since it started in 2011 with the repression of anti-government protests.