Since Russia launched its first round of airstrikes in Syria three weeks ago, reports have emerged that civilians were making up a shockingly large portion of the casualties.
A report by a Syrian activist group is lending further weight to that accusation.
The Syrian Observatory for Human Rights said this week civilian deaths constitute nearly one-third of the 370 people killed by Russian warplanes since the campaign began.
"One-hundred twenty-seven civilians, 36 of them children, were killed by Russian airstrikes," Rami Abdel Rahman, director of the Britain-based group told VOA in an interview Thursday.
In one of the latest attacks, at least 13 people including medical staff were killed when Russian jets hit a field hospital Tuesday in the northwestern province of Idlib, according to the Observatory.
There have also been reports of Russian bombs hitting what appear to be exclusively civilian targets, including schools and post offices.
Russia defends campaign
Russia has defended the air raids, saying it is taking the utmost precautions to protect civilians. But that has not stopped the complaints from rights groups and opposition activists.
Ammar Abdulhamid, a Syrian pro-democracy activist currently living in the United States, tells VOA his contacts in Syria confirm civilian casualties from Russian airstrikes.
"The Russians have much more tolerance when it comes to 'collateral damage' than the U.S.," Abdulhamid said, referring to the U.S.-led campaign of airstrikes targeting mainly the Islamic State group in Syria and Iraq.
Russia has been criticized for aiming most of its bombs at rebel groups other than the Islamic State, also known as ISIS, despite initially saying the extremist group would be a main focus.
Abdulhamid says that by targeting non-Islamist rebels, Russia has likely killed more civilians.
"Rebels are not like ISIS, they are often members of the local communities, and are taking an active part in administering these areas. As such, they are heavily intermixed with the civilian population," he explains.
US-led coalition campaign
The U.S. has also been criticized for civilian casualties resulting from its coalition airstrikes, as well as an alleged lack of transparency in the matter.
In its latest estimate, the Syrian Observatory said in June civilian deaths made up just 162 of the of the approximately 3,000 people killed in the U.S.-led strikes, or less than half of 1 percent of all casualties.
But another independent organization, Airwars, which monitors and investigates coalition airstrikes, puts the figure much higher. The group estimates the civilian fatality range is anywhere from 608 to 1,817.
The coalition has acknowledged two "likely" civilian deaths, which occurred during a November 2014 U.S. strike in Syria. It also says it is investigating several other incidents in which civilians may have died.
Nadim Houry, deputy director of Human Rights Watch's Middle East and North Africa division, has documented civilian casualties from both the Russian and U.S.-led bombardment campaigns.
Houry says it is difficult to compare casualty figures from the two campaigns, not only because the Russian airstrikes have recently begun, but also because of the different areas in which the airstrikes are being conducted.
"The challenge [with U.S.-led coalition airstrikes] is investigating because they're in ISIS-controlled areas. So we can't go there and most people in ISIS-controlled areas can no longer get on the Internet very easily because they've put in restrictions," he said.
"With the Russian airstrikes — on the one hand, it's easier to get data because it's in areas where people are online, and there are activists that we've known for years that are sending us information," Houry said. "The challenge there is that Russian airstrike are taking place at the same time as the Syrian army is trying to advance, shelling, it's coming from all sides."