Air strikes killed 10 civilians near a bakery and a medical clinic in Syria's last major rebel stronghold on Thursday, as government forces pressed a fierce ground offensive.
The Britain-based Syrian Observatory for Human Rights said Russian warplanes hit the Idlib province town of Ariha, but the Russian defence ministry said its "aviation did not carry out any combat tasks in this area of Syria."
The government and its Russian ally have upped their deadly bombardment of northwestern Syria, which hosts some three million people including many who fled violence elsewhere in Syria.
Slowly chipping away from the south, pro-regime forces have shrunk rebel-held territory to just over half of Idlib province and slivers of neighbouring Aleppo and Latakia.
Damascus loyalists retook the strategic Idlib town of Maaret al-Numan on Wednesday.
Early on Thursday, Russian air strikes hit near a bakery and the Al-Shami clinic in Ariha which is now out of service, the Observatory said.
The monitor says it determines whose planes carried out strikes according to type, location, flight patterns and munitions used.
A dust-covered doctor ran out of the clinic screaming following the strike, which partially damaged the facility's walls, an AFP correspondent reported.
Nearby, three entire buildings had collapsed and several vehicles were reduced to mangled wrecks. The wailing of women and children rang out as rescue workers searched for corpses beneath the rubble.
Toufic Saado, a paramedic, said he was inside the medical facility when three air strikes ravaged the area. "The wounded were lying on the floor outside the medical centre," he said.
The latest deaths bring to 21 the number of civilians killed by Russian air strikes in Idlib since Wednesday, the Observatory said.
Earlier this month, Russia denied launching any combat operations in the region since a ceasefire it agreed with rebel supporter Turkey took effect on January 12.
But the truce has become a dead letter and the number of reported Russian raids has risen sharply in the area, dominated by jihadists of the Hayat Tahrir al-Sham alliance, led by a former Al-Qaeda affiliate.
Turkish President Recep Tayyip Erdogan accused Moscow on Wednesday of "not honouring" several deals intended to avert a broad military offensive in the area.
It was a rare critical remark from Erdogan, who has largely sought good relations with Russian President Vladimir Putin since a 2016 rapprochement.
Thousands of Russian troops are deployed across Syria in support of the army, while a contingent of Russian private security personnel also operates on the ground.
Moscow's military intervention in 2015, four years into the Syrian conflict, helped keep President Bashar al-Assad in power and started a long, bloody reconquest of territory lost to rebels in the early stages of the war.
Government forces pushed north from Maaret al-Numan on Thursday towards the town of Saraqeb, whose residents have mostly fled in the face of heavy bombardment.
The front line is now within two kilometres (one mile) of the town, the Observatory said. Both Maarat al-Numan and Saraqeb lie on the key M5 highway connecting the capital Damascus to second city Aleppo.
The road has been a key government target as it seeks to revive a moribund economy ravaged by almost nine years of war. Some 50 kilometres (30 miles) of the M5 remain outside regime control, the Britain-based Observatory said.
Tens of thousands of civilians have fled the government's advance, seeking safety closer to the Turkish border further north.
The violence in the northwest has displaced more than 388,000 civilians since December, the United Nations says. At least 20,000 of them have moved in the past two days, UN undersecretary general for humanitarian affairs Mark Lowcock said on Wednesday.
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