ISTANBUL — Airstrikes on rebel-held areas in the Syrian city of Aleppo destroyed a hospital supported by Doctors Without Borders, the aid group said Thursday, killing at least 14 patients and staff members in the latest attacks that have all but unraveled a cease-fire accord.
A separate airstrike killed as many as 20 people, according to the Britain-based Syrian Observatory for Human Rights, amid mounting worries among international relief coordinators and diplomats that Syria’s conflict could be moving onto dangerous new ground with Aleppo as a pivot point.
The chief U.N. envoy to Syria broke it down in a stark tally covering recent days — an average of one Syrian killed every 25 minutes, one wounded every 13 minutes.
It was not immediately clear who carried out the air attacks that left more than 60 people dead since late Wednesday.
But the Syrian air force — backed by Russia — has stepped up its raids in Aleppo in recent days, striking civilians and rebel factions despite U.N.-led efforts to restart peace talks in Geneva.
In Moscow, a statement by the Russian Defense Ministry denied its warplanes were involved, saying no Russian planes have carried out airstrikes in recent days in the Aleppo area.
A rebel defeat in strategic Aleppo would strengthen the government’s position and pave the way for regime gains elsewhere. It also would mark a huge setback for rebel groups, including some backed by the West and allies, and raise further complications in attempts to send aid to civilians caught in the fighting.
Meanwhile, clashes broke out along another growing fault line.
Turkish forces and Islamic State militants traded fire across the border as part of escalating attacks on both sides in recent weeks.
Turkish officials said one howitzer gun battery was damaged by Islamic State mortar shells in the town of Karkamis — about 60 miles northeast of Aleppo — and Turkey responded with counterfire. An Islamic State video posted online purported to show three Turkish tanks destroyed by an antitank missile. The authenticity of the video could not be immediately verified.
According to the Reuters news agency, Jan Egeland, chairman of the joint U.N.-International Syria Support Group humanitarian task force, said Aleppo has suffered “catastrophic deterioration” in the past two days.
“I cannot express how high the stakes are for the next hours and days,” Egeland said.
The overnight raids — including a direct hit on Aleppo’s al-Quds hospital — killed at least 27 people, rights monitors and rescue volunteers said. At least 14 patients and medical staffers were killed at the hospital, Doctors Without Borders said on its Twitter account.
The group, also known by the French name Médecins Sans Frontières, or MSF, said at least three doctors, including one of the last pediatricians in the city, were among the dead.
The Quds hospital “was well known locally” and “hit by direct airstrike” late Wednesday, said a tweet from the organization.
There was no immediate response from Syrian President Bashar al-Assad’s government. But Syrian state TV on Thursday said 14 people were killed in the government-held area of Aleppo. It was unclear whether this was a reference to a separate attack.
Earlier Thursday, the government-run network said four people were killed by rebel shelling on government-held neighborhoods.
The city, once Syria’s largest and a sprawling commercial center, has been divided between rebel- and government-controlled sections since 2012.
In recent months, rebels have been encircled by troops and fighters loyal to Assad. Russia has also lent support to the embattled leader, sending troops and aircraft to pound rebel fighters.
In February, the United States and Russia agreed to enforce a truce between the two sides in order to kick-start peace talks in Geneva. But those talks, between the Syrian government and representatives of the opposition, have largely broken down.
On Wednesday, the U.N. special envoy for Syria, Staffan de Mistura, called on the United States and Russia to intervene to save the cease-fire.
He said the talks have “been overshadowed . . . by a substantial and indeed worrisome deterioration of the cessation of hostilities.”
“In the last 48 hours, we have had an average of one Syrian killed every 25 minutes. One Syrian wounded every 13 minutes,” Mistura told reporters Wednesday after he briefed the U.N. Security Council.
The cease-fire is “still there, but it’s in great danger,” he said. “It’s still alive, but barely.”
In further blows to diplomatic efforts, the chief Syrian opposition negotiator, Mohammed Alloush, blamed the government for the airstrikes. He told the Associated Press that the latest violence shows “the environment is not conducive to any political action.”
The five-year-old conflict, which started as a pro-democracy uprising, has claimed an estimated 400,000 lives and sent millions fleeing for safety, according to de Mistura. There has also been a rise in attacks on hospitals and medical personnel, rights groups have said.
The Aleppo hospital had an emergency room, intensive-care unit and operating theater, Doctors Without Borders said.
In Geneva, a statement by the International Committee of the Red Cross called the hospital attack “unacceptable” and said it pushed the city closer to the “brink of humanitarian disaster,” but it did not place specific responsibility for the airstrike.
“We urge all the parties to spare the civilians,” said Marianne Gasser, head of the ICRC mission in Syria. “Don’t attack hospitals. Don’t use weapons that cause widespread damage.”
In October, U.S. Special Operations forces strafed a Doctors Without Borders hospital in Kunduz in northern Afghanistan, killing at least 42 patients, medical staffers and caretakers. President Obama apologized for the airstrike, which the U.S. military described as a mistake during missions to drive out Taliban fighters. Doctors Without Borders has pressed for a full international investigation and possible war-crimes charges.
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