Airstrikes and artillery barrages have killed some 200 people in the city of Aleppo in the last few days, the Syrian Observatory for Human Rights has said.

The renewed fighting around what is the last remaining stronghold of the country’s relatively moderate opposition comes despite a promised truce and is inflicting enormous suffering on the civilian population.

One regime airstrike destroyed a hospital in the city, killing dozens and prompting the United Nations to plea with world powers to try to salvage a “barely-alive” ceasefire.

Britain’s The Guardian newspaper reports that forces loyal to Bashar Assad are encircling east Aleppo, which is held by the opposition, and are fighting in the countryside to cut supply lines in the north from Turkey.

The civilians who remain in what was Syria’s largest city before the start of the uprising in 2011 are bearing the brunt of the fighting. Barrel bombs have been dropped on outdoor markets. Civil defense has been targeted by airstrikes and a missile launch. With electricity, fuel and water already in short supply, the situation is dire, aid groups say.

“In the east, people are living in the rubble, burning trash to get a bit of heat or make morning tea. I don’t know how they can cope if the fighting really hits Aleppo harder,” said Pawel Krzysiek, the Red Cross’ spokesman in Syria

Broken truce

The Aleppo offensive makes a mockery of the “cessation of hostilities” Russia and the United States negotiated in February.

Russia supports the Assad regime while the United States back some of the rebel groups in Syria.

The Atlantic Sentinel argued when the truce was announced that Assad only agreed to it to buy his troops time.

The Institute for the Study of War similarly predicted that the regime would eventually seek to complete its encirclement of Aleppo.

The result could be a protracted siege, the think tank warned, “that bolsters the political leverage exerted by Syrian president Bashar al-Assad while subjecting the remaining civilian population in opposition-held districts to a punishing campaign of starvation and aerial bombardment.”

That has now come to pass.

Foreign support

The attempt to retake Aleppo has hinged on military support from Assad’s allies, Iran and Russia.

The former has raised an expeditionary corps of Shia Islamists for the front south of Aleppo.

The Russians intervened in the Syrian war last year, claiming to support Assad in his fight against fanatical Islamist groups like the self-proclaimed Islamic State.

But from the start, Russian warplanes have carried out more strikes in the vicinity of Assad’s Alawite homeland in the northwest of Syria than over the desert lands that are in the hands of the Islamic State.

Squeezed

The push to Aleppo comes on the heels of Assad’s retaking of the Nusayriyah Mountains that separate the Latakia region in the northwest from the Sunni-populated highlands.

The objective appears to be to consolidate the regime’s hold on Syria’s most populous areas and squeeze those rebels who are supported by the Arab states, Turkey and the West in between Assad’s loyalists on the one hand and the Islamic State militants on the other.