The United States and Russia brokered a renewed cease-fire in parts of Syria, but excluded the main battlefield of Aleppo where intense fighting has killed more than 200 people in the last week.
Under an agreement worked out by U.S. Secretary of State John Kerry and Russian Foreign Minister Sergei Lavrov on April 29, a truce lasting one day took hold at 1 a.m. local time on April 30 in the Damascus suburb of Ghouta. while a truce lasting three days was instituted in the coastal province of Latakia,.
While it was quiet in those areas, the carnage continued in Aleppo, where at least 50 people were killed in air strikes on one hospital alone, and dozens more were killed in fighting elsewhere in what was once Syria's largest city and commercial center.
The Syrian regime launched a major offensive on Aleppo shortly after peace talks were adjourned for the month in Geneva this week, provoking outraged statements from top leaders of the United States, European Union, and United Nations.
Violence is "soaring back to the levels we saw prior to the cessation of hostilities" originally brokered by the United States and Russia in February, said United Nations human rights chief Zeid Ra'ad al-Hussein.
"There are deeply disturbing reports of military build-ups indicating preparations for a lethal escalation," he said on April 29, denouncing the "monstrous disregard for civilian lives by all parties to the conflict."
U.S. officials said Kerry tried to extend the renewed truce to Aleppo, but Russia refused to go along. Russia has contended that the banned terrorist group Al-Nusra Front operates out of the city, and the cease-fire does not apply to the Al-Qaeda affliate.
Other rebel groups with links to Nusra also are located there, and Moscow moved this week to put them on the same UN blacklist as Al-Qaeda, which would mean the cease-fire would not apply to them either.
The failure to include Aleppo in the truce was "in part a recognition that Aleppo is very complex and the fighting around there is indeed alarming," said State Department spokesman Mark Toner. "We need to start somewhere and we're going to start with Latakia and east Ghouta."
"We want to focus on strengthening the cessation of hostilities, renewing it, reaffirming it, so that we can quell the fighting," he said.
The International Committee of the Red Cross reported on April 29 that another four medical facilities in Aleppo were damaged extensively. It said dozens of people had died and were injured in "another day of relentless fighting."
"There can be no justification for these appalling acts of violence deliberately targeting hospitals and clinics, which are prohibited under International Humanitarian Law," said Marianne Gasser, the Committee's Syrian chief.
"People keep dying in these attacks. There is no safe place anymore in Aleppo. Even in hospitals. For the sake of people in Aleppo, we call for all to stop this indiscriminate violence."
The Syrian Observatory for Human Rights said air strikes and shelling in Aleppo killed 202 civilians in the past week, including 31 children on both sides. Syrian state TV reported that 85 people were killed and more than 600 wounded in government-held areas alone in the past week.