Boris Johnson, the foreign secretary, accused Russia of carrying out illegal “double tap” strikes, in which an area is bombed and then struck again minutes later to kill first responders as they try to rescue the injured.

As US-led diplomatic efforts to broker a truce continued to stall, Moscow warned Washington against intervening militarily against the Assad regime, saying that American strikes against Damascus would have “terrible, tectonic consequences”.

It also emerged that more than 80 per cent of UN aid convoys to besieged areas were blocked or delayed in September, leaving civilians without badly-needed supplies, according to the Guardian.

The assault force gathering outside Aleppo is reported to be made up of 10,000 troops and their goal is to finally recapture the rebel-held east of the city and bring an end its four-years of defiance against Bashar al-Assad and his regime.

“There appears to be forces massing for some kind of assault on Aleppo,” said Mark Toner, a spokesman for the US State Department. When asked how long before the city fell to attackers, he replied: “It could be soon”.

If Aleppo did fall back into the control of the Syrian regime it would be potentially the single biggest turning point in six years of fighting and a major defeat for rebel forces.

The Syrian regime and the Russian air force dramatically escalated airstrikes on east Aleppo in preparation for the attack and the World Health Organisation (WHO) said that 338 people were killed in the last week, including 106 children.

Strikes on Saturday hit the M10 hospital where thousands of wounded civilians, including Omran Daqneesh, the little boy with the haunted expression whose photograph was published on newspaper frontages around the world, have been treated.

Doctors and nurses inside M10 have spent months working with few supplies and intermittent water and electricity to save lives even as the medical facility itself has been repeatedly targeted.

Mohammed Abu Rajab, an X-ray technician at the hospital, sent a frantic audio message on Saturday morning as another bomb struck. “Another direct targeting on M10 with cluster bombs!” he shouted. “The hospital is being destroyed now.”

The UN has warned Moscow and Damascus many times that the deliberate targeting of hospitals is a war crime.

Wissam Zarqa, an English teacher, said that the increased rate of strikes was being interpreted in Aleppo as a possible harbinger of the ground assault to come.

“Targeting hospitals, bakeries and the infrastructure systematically in the last few days could be an indication there is something new looming on the horizon,” he told the Sunday Telegraph.

Syrian regime forces first encircled east Aleppo earlier this year have fought back-and-forth battles with rebels and jihadist forces without either side able to achieve a decisive breakthrough.

But the regime hopes that breakthrough will come with the assault force now preparing to attack.

Yasser Yousef, a spokesman for the Islamist rebel group Harakat Nour al-Din al-Zenki in Aleppo, said the rebels were prepared for the attack if and when it comes.

“Our reconnaissance units have spotted Lebanese, Iraqi, Afghani and Iranian militias, mobilized around Aleppo,” he said. “We are aware of their plans and intentions. They said Aleppo will fall four or five years ago and we are still fighting.”

The UN has warned that such an attack would lead to massive civilian casualties and widespread destruction inside Aleppo. “It’s going to be a slow grinding street by street fight over the course of months, if not years, whereby the ancient city will be almost completely destroyed,” said Staffan de Mistura, the UN special envoy for Syria.

The intensified bombing campaign has not been limited to Aleppo.

Airstrikes in the Kafr Batna suburb of Damascus reportedly killed at least seven children on Friday. The Siege Watch monitoring group said it appeared that Russian jets had dropped at least three vacuum bombs on the area.

More than 50 areas across Syria under siege, including east Aleppo, and many are in desperate need of humanitarian aid.

Mr Johnson also accused Russia of deliberately targeting aid and rescue workers with “double tap” strikes. “One thing I think is a war crime is the double tap. We have good ground to believe that the Russians have been doing that,” Mr Johnson told the Sun.

As the violence continued on the ground, high-level diplomatic talks between the US and Russia remained stalemated.

John Kerry, the US secretary of state, had threatened to cut off discussions with Moscow altogether if the Russian air force continued its attacks on Aleppo but conversations continued on Friday between the American diplomat and Sergey Lavrov, the Russian foreign minister.

Leaked audio tapes revealed Mr Kerry’s frustration that his demands for an end to the bombardment of Aleppo were not being backed by a credible American military threat.

Mr Kerry told a group of Syrian activists that he had made the case that the US should use be prepared to use force against the Assad regime but “I lost that argument” to other aides of President Barack Obama who argued that US should stay out.

The debate in Washington over intervention has been renewed, however, following the collapse of last month’s brief ceasefire and the continuing attacks on Aleppo.

In response, a spokeswoman for the Russian foreign ministry warned that American intervention would lead to “terrible, tectonic consequences not only on the territory of [Syria] but also in the region on the whole”.

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http://www.telegraph.co.uk/news/2016/10/01/john-kerry-suggests-syrian-elections-include-assad-as-hospitals/