The forces of Syria's government have found a new ferocity and now backed by their faithful allies in the Russian air force their attempt to take back territory has a familiar brutality.
Mark Lowcock, the UN Head of Humanitarian Affairs, told the Security Council it must act now to end the violence, creating what could become the worst humanitarian disaster of the century.
His words came after another brutal attack by Syrian Government forces and their Russian allies against Idlib province, the country's final remaining opposition stronghold.
UN confirmed deaths of civilians in the Idlib province in the last three months.
Mr Lowcock said: "You in the Security Council have ignored all the previous pleas you have heard.
"You know what is happening and you have nothing for 90 days as the carnage continues in front of your eyes," he added.
More than 100 children have been killed in the Idlib province, dying in their homes, hospitals and marketplaces, according to Aid agencies.
"The Syrian and Russian governments know the exact location of most health facilities and yet they continue targeting them and doctors tell us that the hospitals, which should be the safest places in Idlib, are the exact opposite, they are targets," director of policy at Physicians for Human Rights Susannah Sirkin said.
Russia denies that it is targeting civilians but instead is going after the same kind of extremists that the Western powers have fought off elsewhere in the Middle East.
In the last three weeks, at least four medical facilities have been affected by the violence, as well as a water station serving more than 80,000 people, and several schools, settlements for displaced civilians, markets and bakeries, according to the UN.
The Syrian American Medical Society said many medical facilities have suspended their operations, while some are operating under a state of emergency.
Eight water facilities have been attacked in the last two months, diminishing sources of safe drinking water for 250,000 people in southern Idlib.
In the northwest, at least 44 schools have been damaged or destroyed recently, as attacks on educational facilities and personnel have increased.