Relief workers said the largest remaining Syrian hospital in the rebel-held eastern half of the city of Aleppo was bombed Saturday for the second time in recent days, as Syrian government forces and their Russian allies pressed their deadly offensive to recapture the entire city.
A spokesman for the Syrian American Medical Society said the M-10 hospital was hit by at least two barrel bombs as physicians performed emergency medical procedures on a small cluster of patients.
Adham Sahloul also told reporters that a small number of medical personnel and patients remained trapped in the wrecked facility, one of two hospitals crippled Wednesday by airstrikes that killed several people.
Monitors from the Syrian Observatory for Human Rights said about 30 doctors remained to treat 300,000 residents trapped in Aleppo, as government forces pressured the edges of a key neighborhood in the city's north.
The monitors Saturday reported the deaths of at least 20 people, including six children, in airstrikes elsewhere in the rebel sector of the city.
World Health Organization humanitarian spokesman Rick Brennan, speaking Friday, described the situation in Aleppo as "really unfathomable."
Brennan said that health officials in the city had recorded 338 bombing deaths "in the last couple of weeks" and that the toll included 106 children. More than 800 people have been wounded, he said.
U.N. Secretary-General Ban Ki-moon has denounced the hospital bombings as war crimes, while the United States continues to press Russia for a diplomatic solution to the crisis.
The Obama administration accuses Russia and Syria of targeting hospitals, refugee camps and other critical sites, including water pumping stations and power plants. U.S. officials say the bombings are indiscriminate and that the Russians make no effort to limit their targets to Islamic State fighters.
For its part, Russia insists its forces are targeting terrorists. It also accuses Washington of reneging on a commitment to separate fighters from the al-Qaida-linked extremist group Jabhat Fateh al-Sham (formerly the al-Nusra Front) from moderate rebel factions seeking to oust the Damascus government.
The U.S. State Department says U.S. warplanes have not recently targeted extremists in the city because of their close proximity to civilians and moderate groups.
U.S. effectiveness questioned
Former U.S. Ambassador to Syria Robert Ford said not to expect the growing diplomatic standoff between Moscow and Washington over Aleppo to be resolved soon.
Ford, currently a senior fellow at the Middle East Institute in Washington, said both governments have fundamentally different objectives, formulated by different views of the crisis.
Writing on the think tank's website, Ford noted that the top U.S. priority is counterterrorism directed at Islamic State extremists and their allies, while Russia's military strategy focuses on destroying all opposition to the government of Syrian President Bashir al-Assad.
The monthslong battle for Aleppo has sparked some of the deadliest violence since civil war erupted in Syria more than five years ago.
U.N. officials have estimated as many as 400,000 people have been killed in the fighting, which has also displaced millions of others.