Syrian government air strikes killed 23 civilians, including a dozen people at a busy market, as fierce fighting raged for the jihadist-held northwest, a war monitor said on Wednesday.

Regime forces battled to repel a jihadist counteroffensive around the town of Kafr Nabuda that has left 87 combatants dead since Tuesday, the Syrian Observatory for Human Rights said.

The Hayat Tahrir al-Sham alliance, led by Syria's former Al-Qaeda affiliate, controls a large part of Idlib province as well as adjacent slivers of Aleppo, Hama and Latakia provinces.

The jihadist-dominated region is nominally protected by a buffer zone deal, but the government and its ally Russia have escalated their bombardment in recent weeks, seizing several towns on its southern flank.

At least 12 people were killed and another 18 wounded when regime warplanes hit the jihadist-held Idlib province town of Maarat al-Numan around midnight (2100 GMT) on Tuesday, the Observatory said.

The market was crowded with people out and about after breaking the daytime fast observed by Muslims during the holy month of Ramadan.

The bombardment blew in the facades of surrounding buildings, and ripped through the flimsy frames and canvas of stalls in the market square, an AFP photographer reported.

The bodies of market-goers were torn apart.

"Residents are still scared," stallholder Khaled Ahmad told AFP.

The 11 other civilians were killed in regime air strikes and shelling in various parts of the jihadist bastion, including five in the nearby town of Saraqib, it added.

The Britain-based Observatory relies on a network of sources inside Syria and says it determines whose planes carried out strikes according to type, location, flight patterns and munitions.

- 'Worst fears'-

The strikes came as heavy clashes raged in neighbouring Hama province after the jihadists launched a counterattack on Tuesday.

Fresh fighting on Wednesday took the death toll to 87 -- 51 jihadists and 36 regime forces and militia, the Observatory said.

It said the jihadists had recaptured most of Kafr Nabuda from government forces, who had taken control of the town on May 8.

State news agency SANA on Wednesday however said the army repelled a jihadist attack in the area, killing dozens of insurgents.

Russia and rebel ally Turkey inked the buffer zone deal in September to avert a government offensive on the region and protect its three million residents.

But President Bashar al-Assad's government upped its bombardment of the region after HTS took control in January.

Russia too has stepped up its air strikes in recent weeks.

The Observatory says nearly 200 civilians have been killed in the flare-up since April 30.

The United Nations said Wednesday that Idlib's civilian population once again faced the threat of an all-out offensive.

"A full military incursion threatens to trigger a humanitarian catastrophe for over 3 million civilians caught in the crossfire, as well as overwhelm our ability to respond," said David Swanson, a spokesman for the UN humanitarian office.

Swanson said more than 200,000 people have been displaced by the upsurge of violence since April 28.

A total of 20 health facilities have been hit by the escalation -- 19 of which remain out of service, Swanson said.

Collectively they served at least 200,000 people, he added.

- 'Break the status quo' -

The September deal was never fully implemented as jihadists refused to withdraw from a planned buffer zone around the Idlib region.

But it ushered in a relative drop in violence until earlier this year, with Turkish troops deploying to observation points around the region.

The Syrian government has accused Turkey of failing to secure implementation of the truce deal by the jihadists.

But Turkish Defence Minister Hulusi Akar accused the Syrian regime late Tuesday of threatening the ceasefire deal.

"The regime is doing all that it can to break the status quo including using barrel bombs, land and air offensives," Akar told reporters.

"Turkish armed forces will not take a step back from wherever they may be", he however added.

On Wednesday, the civilian arm of HTS held said it had helped free an Italian who had been held hostage for more than two years.

Alessandro Sandrini, 33, from the Italian region of Brescia, disappeared in October 2016 after going on holiday to Turkey, later appearing in a video pleading for help, with masked men.

It was not clear who had held Sandrini, whose release was also announced by Italy.

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