Russian or Syrian warplanes knocked two hospitals out of service in the beseiged rebel sector of Aleppo on Wednesday and ground forces intensified an assault in a battle which the United Nations said had turned the city into a slaughterhouse.
Two patients died in one of the hospitals and other shelling killed six residents queueing for bread under a siege that has trapped 250,000 people with food running out.
The week-old assault, which could herald a turning point in the war, has already killed hundreds of people, with bunker-busting bombs bringing down buildings on residents huddled inside.
Only about 30 doctors are believed to be left inside the besieged zone, coping with hundreds of wounded a day.
"The warplane flew over us and directly started dropping its missiles... at around 4am," Mohammad Abu Rajab, a radiologist at the M10 hospital, the largest trauma hospital in the city's rebel-held sector, told Reuters.
"Rubble fell in on the patients in the intensive care unit."
M10 hospital workers said oxygen and power generators were destroyed and patients were transferred to another hospital.
Photographs sent to Reuters by a hospital worker at the facility showed damaged storage tanks, a rubble strewn area, and the collapsed roof of what he said was a power facility.
There were no initial reports of casualties there, but medical charity Medecins Sans Frontieres (MSF) said two patients had been killed at the other hospital, in shelling which took it out of service as well, leaving east Aleppo with only seven doctors in a position to undertake surgery.
A lack of medical supplies means children are being left to die on the floor of hospitals.
UNICEF's Kieran Dwyer says a lack of basic healthcare has seen many innocent people lose their lives.
"They're running out of medical supplies. The hospitals and clinics already come under attack in July, and doctors there are telling us they are having to leave wounded children to die on the floor."
It's thought more than 100,000 of the civilians remaining in the area are children. Since the lapse of a ceasefire last week, half of the casualties recorded have been children.
"An attack last Thursday damaged the water pumping station… that left no safe water sources. [Residents] turned to shallow bore holes, which are contaminated."
Mr Dwyer says water and other essentials are both in scarce supply.
"We've had trucks ready to go into eastern Aleppo for more than two weeks, and we have not been granted entry."
Both the World Health Organisation and the Red Cross have called for the urgent evacuation of Aleppo.
The government of President Bashar al-Assad, backed by Russian air power, Iranian ground forces and Shi'ite militia fighters from Iran, Iraq and Lebanon, has launched a massive assault to crush the rebels' last major urban stronghold.
Syria's largest city before the war, Aleppo has been divided for years between government and rebel zones, and would be the biggest strategic prize of the war for Assad and his allies.
Taking full control of the city would restore near full government rule over the most important cities of western Syria, where nearly all of the population lived before the start of a conflict that has since made half of Syrians homeless, caused a refugee crisis and contributed to the rise of Islamic State.
The offensive began with unprecedentedly fierce bombing last week, followed by a ground campaign this week, burying a ceasefire that had been the culmination of months of diplomacy between Washington and Moscow.
Washington says Moscow and Damascus are guilty of war crimes for targeting civilians, hospitals, rescue workers and aid deliveries, to break the will of residents and force them to surrender. Syria and Russia say they target only militants.
Asked by a reporter at the United Nations whether Syria had bombed the two hospitals hit on Wednesday, the Syrian ambassador to the world body, Bashar Ja'afari, appeared to laugh.
The Syrian army said a Nusra Front position had been destroyed in Aleppo's old quarter, and other militant-held areas targeted in "concentrated air strikes" near the city.
UN Secretary-General Ban Ki-moon said those using "ever more destructive weapons" were committing war crimes and that the situation in Aleppo was worse than "a slaughterhouse".
Food supplies are scarce in the besieged area, and those trapped inside often queue up before dawn for food.
Reuters / Newshub.