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At least 20 people are dead or missing after missile attacks on two hospitals in Syria, including a suspected Russian air strike that destroyed a four-storey makeshift clinic supported by the

international aid group Doctors Without Borders (MSF).

At least 14 civilians were killed when missiles hit a children’s hospital, a school and other locations in the rebel-held Syrian town of Azaz near the Turkish border on Monday, a medic and two residents said.

They said at least five missiles hit the hospital in the town centre and a nearby school, where refugees fleeing a major Syrian army offensive were sheltering.

Tens of thousands of people have fled the town, the last rebel stronghold before the border with Turkey, where there is heavy fighting between the Syrian army and militias.

READ MORE: Turkey continues strikes on Kurdish militia in Syria despite Washington’s call for restraint ahead of planned ceasefire

“We have been moving scores of screaming children from the hospital,” said medic Juma Rahal. At least two children were killed and ambulances ferried scores of injured people to Turkey for treatment, he said.

Another attack occurred near Maaret al-Numan in the northern province of Idlib, where a hospital supported by the medical charity MSF was “deliberately” hit by air strikes and eight people are missing, MSF said in a statement.

“This is a deliberate attack against a health establishment,” said Massimiliano Rebaudengo, MSF head of mission. “The destruction of this hospital deprives about 40,000 people of healthcare in this conflict zone.”

MSF said the hospital was destroyed after being hit by four missiles following two attacks within a few minutes interval. The hospital, which has 54 staff and holds 30 beds, is financed by the medical charity. MSF also supplies medicines and equipment to the facility.

READ MORE: For a durable peace in Syria, warring sides must continue talks

The Britain-based Syrian Observatory for Human Rights said Russian warplanes targeted the makeshift hospital, destroying it and killing nine people. The Observatory, which tracks the casualties in Syria’s five-year civil war, said dozens were also wounded in the air strike.

Syrian troops have been on the offensive in northern Syria under the cover of Russian airstrikes over the past week. The ground offensive has been focused on the northern province of Aleppo while Monday’s air strike struck the clinic in the nearby Idlib province.

“The entire building has collapsed on the ground,” said opposition activist Yahya al-Sobeih, speaking by telephone from Maaret al-Numan. He added that five people were killed near the clinic and “all members of the medical team inside are believed to be dead”.

READ MORE: World powers agree ‘cessation of hostilities’ in Syria but deep divisions remain over future of Assad regime

Al-Sobeih said the four-storey building that once was a cement company but had served as a makeshift clinic during the five-year civil war was hit with four missiles.

Casualty figures are often sketchy and conflicting, and cannot be independently verified because of the inaccessibility of the conflict zones.

The civilian casualties come after US President Barack Obama urged Russia on Sunday to stop bombing “moderate” rebels in Syria in support of its ally President Bashar al-Assad, a campaign seen in the West as a major obstacle to latest efforts to end the war.

Major powers agreed on Friday to a limited cessation of hostilities in Syria but the deal does not take effect until the end of this week and was not signed by any warring parties – the Damascus government and numerous rebel factions fighting it.

Russian bombing raids directed at rebel groups are helping the Syrian army to achieve what could be its biggest victory of the war in the battle for Aleppo, the country’s largest city and commercial centre before the conflict.

There is little optimism that the deal reached in Munich will do much to end a war that has lasted five years and cost 250,000 lives.

The Kremlin said President Vladimir Putin and Obama had spoken by telephone and agreed to intensify cooperation to implement the Munich agreement.

But a Kremlin statement made clear Russia was committed to its campaign against Islamic State and “other terrorist organisations”, an indication that it would also target groups in western Syria where jihadists such as al-Qaeda are fighting Assad in close proximity to rebels deemed moderate by the West.

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