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BEIRUT: Syrian activists and a first responder group said on Sunday that shelling and rocket fire in the suburbs of Damascus killed 19 civilians a day after medical evacuations were completed to save the lives of 29 others.
Regime forces have advanced against fighters on the edge of the northwestern province of Idlib, the last outside government control, a monitor and the state news agency said.
Regime forces backed by Russian warplanes have been battling fighters in an area straddling the border between Idlib and Hama provinces.
The fighting, which could signal the start of a major offensive to seize Idlib province from militants dominated by a former Al-Qaeda affiliate, escalated on Thursday.
On Saturday, regime troops advanced, seizing several villages and surrounding areas, said the Syrian Observatory for Human Rights, a Britain-based war monitor.
State news agency SANA said regime forces had taken control of five villages, areas and 鈥渟trategic hills鈥� in the northeast of Hama province.
An AFP correspondent said civilians continued to flee areas near the battle zone, heading north toward the provincial capital of Idlib with their belongings piled high on pickup trucks.
鈥淲e were the target of strikes more than once 鈥� we couldn鈥檛 stay,鈥� said Abu Ahmed, a man in his 60s from the southeast of Idlib province, fleeing with his family in a pickup.
鈥淚 don鈥檛 know how to say how I feel, leaving my land and home at my age. We are leaving without even knowing where we鈥檙e headed.鈥�
In the Maaret Al-Numan area, some people have put up tents, pots and pans piled at the entrance flaps.
鈥淲e escaped for the sake of the children. They were terrified by air raids and strikes,鈥� said Abu Khaled, a bearded man in his 30s wearing a red and white checkered keffiyeh headscarf.
The father of four, from Hama province, had already fled once with his family 鈥� to Idlib, where they lived in a camp for the displaced.
Since Thursday, the clashes have killed dozens of regime soldiers and allied members of paramilitary units, as well as 29 militants from opposition groups or from former Al-Qaeda affiliate Fateh Al-Sham, the Observatory said.
Assad forces first aim to take control of the southeast of Idlib province, Observatory head Rami Abdel Rahman said.
This would allow the regime to have full control of a road that links the capital Damascus to Aleppo.
Russia intervened on the side of Bashar Assad鈥檚 regime in 2015, helping it to take back control of swathes of territory including Aleppo.
鈥淎fter finishing off IS (Daesh), the regime鈥檚 forces are concentrating their operations on Idlib鈥檚 jihadists,鈥� Abdel Rahman said.
Outside Damascus, Eastern Ghouta has also come under increasing bombardment from Assad鈥檚 forces.
Regime airstrikes on Harasta killed eight, while six died in regime shelling of Misraba, Kfar Batna, Nashabiyeh and Outaya.
At least 43 more civilians were wounded.
鈥淭he regime intensified its shelling and airstrikes on Saturday after Fateh Al-Sham and Islamic factions attacked its positions near Harasta鈥� on Friday, Abdel Rahman said.
Eastern Ghouta has been under regime siege since 2013, causing severe food and medicine shortages for some 400,000 residents.
The war in Syria has killed more than 340,000 people and displaced millions from their homes since it began in 2011 with the brutal repression of anti-Assad protests.