Three weeks into its military campaign in Syria, Russia is taking some heat amid reports that medical facilities have been targeted by air strikes, hundreds of civilians have been killed, and Russian fighters are dying in battle.
A medical NGO and a monitoring group said Russian air strikes have hit three hospitals in northwestern Syria in a four-day period this week, killing at least 12 people.
The Syrian American Medical Society (SAMS) and the British-based Syrian Observatory for Human Rights (SOHR) said one strike on a hospital in the town of Sarmin late on October 20 left a physiotherapist, a nurse, and a civil defense worker dead.
Russian Foreign Ministry spokeswoman Maria Zakharova on October 22 called the information "fake," and described SOHR as no more reliable than "a waiter in a pizzeria."
But Dr. Muhammad Tennari, the director of the SAMS hospital in Sarmin, said the facility appeared to have been directly targeted in the air strike and could no longer care for patients because of the damage from the attack.
SAMS -- a medical charity that operates in Syria, Jordan, Turkey, and Lebanon -- claimed the attack was the third on a medical facility in Syria in four days.
WATCH: The Aftermath Of The Strike On A Syrian Field Hospital (WARNING: Graphic Scenes)
It said in a statement that Russian air strikes had also targeted the only two hospitals operating in Aleppo on October 18-19, causing damage that forced patients to be evacuated and the facilities to be closed.
"SAMS adds its voice to the calls of medical personnel on the ground urging the Russians to end the targeting of medical facilities and civilians," the foundation said October 19.
The Syrian News Agency reported that Russian strikes had destroyed a "terrorist" headquarters in Sarmin but did not mention the hospital.
Russian warplanes have carried out dozens of strikes in the provinces of Aleppo and Idlib, where Sarmin is located.
The International Committee for the Red Cross (ICRC) said on October 22 that the Russian bombardment is making it "more difficult for us to reach some areas" and deliver desperately needed aid to civilians in Syria, where a civil war has killed more than 220,000 people since 2011 and caused millions to flee their homes.
The ICRC had been planning to evacuate the wounded from areas in west and northwest Syria as part of a recent cease-fire agreement.
But the organization's Middle East and North Africa operations, Robert Mardini, said that "now it's harder because of the beginning of Russian military operations."
The reports of the attacks on medical facilities come two days after SOHR -- which relies on dispatches from monitors throughout Syria -- said Russian air strikes had killed at least 370 people, including 36 children among a total of 127 civilians since Moscow's military campaign in Syria began on September 30.
Fighting has been particularly intense in the central Homs Province, where SOHR said about 60 people were killed in Russian air strikes and fighting.
The Local Coordination Committees, an activist network in Syria that also monitors the fighting, said 57 people had been killed.
Russia has said it is targeting "terrorists," but there have been reports of indiscriminate bombing by Russian warplanes in Syria since shortly after its air campaign began, with monitors reporting field hospitals, a market, and other civilian sites being hit.
The U.S.-led coalition that has been bombing Islamic State (IS) fighters since it began its campaign one year ago accuses Moscow of targeting moderate rebel groups -- including the U.S.- and Turkey-backed Free Syrian Army -- which are battling both Syrian forces and IS fighters.
The Russian military has repeatedly rejected claims of civilian casualties, saying its planes haven't targeted populated areas.
But Ruslan Leviyev, one of the founders of the Russian-based investigative organization Conflict Intelligence Team, told RFE/RL's Current Time television that it has documented Russian air strikes being carried out in city centers.
Most recently, Russian officials also denied reports that they had dropped cluster bombs in civilian areas in Syria.
The monitoring group Human Rights Watch said Russian fighter planes dropped cluster munition bombs during an air strike near the village of Kafr Halab, southwest of Aleppo, on October 4.
The group presented photos of the alleged ammunition, but on October 22 Russian Defense Ministry spokesman Igor Konashenkov refuted the allegations, calling them "absurd."
Moscow also dismissed reports that some of its military personnel have been killed in Syria, reiterating its claim that no Russian servicemen are involved in combat operations there.
On October 20, the Reuters news agency quoted a senior pro-government military source in Syria as saying three "Russians" who had been fighting alongside Syrian government forces were killed when a shell hit their position in the coastal Latakia Province.
The pro-government source said that at least 20 Russians were at the post in the Nabi Yunis area when the shell struck.
SOHR's Abdul-Rahman told Reuters that his sources in the area had confirmed the deaths, but he did not have a figure. He said he believed they were not regular Russian forces, but volunteers.
Addressing the reports on October 21, Kremlin press secretary Dmitry Peskov said that "as far as I know this has been refuted and, most importantly, these reports do not have a concrete source."
The Russian Defense Ministry and the Russian Embassy in Damascus also rejected the reports of three Russian soldiers being killed in Syria.
Embassy spokeswoman Asiyat Turuchneva told the Interfax news agency on October 20 that "moreover, we would like to declare once again that Russian military servicemen are not involved in ground military operations" in Syria.
The Ukrainian Defense Ministry's Chief Intelligence Directorate said on October 20 that 26 dead marines from Russia's Black Sea Fleet had been brought to the Crimean city of Sevastopol the same day.
The Russian force in Syria is comprised of more than 50 aircraft and helicopters, including Sukhoi Su-24M, Su-25SM, and Su-34 aircraft.
It was hastily assembled before the bombing campaign started and built off of the small Russian navy facility at the Syrian port of Tartus.
Russia has also used four missile ships belonging to its navy's Caspian Flotilla to fire Kalibr cruise missiles at targets in Syria.
But U.S. Secretary of Defense Ash Carter said on October 9 that at least four of the missiles missed their targets and crashed into northwestern Iran.
Although Russia has denied the failures, there were several local reports in the Iranian media of flying objects, explosions, damaged buildings, and even casualties in western Iran near the Iraqi and Azerbaijani borders shortly after the October 7 launching of the missiles.
Iranian Foreign Ministry spokeswoman Afkham Marzieh said on October 9 that "we don't confirm" this information when asked if Russian cruise missiles had landed in Iran.