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Beirut — Airstrikes and artillery killed more than 60 people in the past 24 hours in Aleppo, including dozens at a hospital in a rebel-held neighborhood, as Syria’s largest city was turned once again into a major battleground in the civil war, officials said Thursday.

Aid agencies warn that Aleppo is on the brink of a humanitarian disaster with the collapse of a two-month cease-fire and stalled peace talks.

The intensified violence — by far the worst since the partial cease-fire began — coincides with reports of a military buildup outside Aleppo that many fear is a prelude for a government attempt to force a complete siege of the city’s neighborhoods.

Battle-hardened residents were shocked by the bloodshed. Opposition activists accused the government of carpet-bombing rebel-controlled areas, while Syrian state media said more than 1,000 mortar rounds and rockets were fired at government-held districts, killing 22 people.

Video posted online by opposition activists showed rescuers pulling bodies from shattered buildings in the rebel neighborhoods of Sukkari, Kallasa and Bustan al-Qasr.

In one scene, a building’s staircase hung sideways and old men were sobbing.

“The walls, cupboards, everything fell on top of them,” cried one man. In another, a clearly terrified small girl with pigtails wept silently while held by a man.

A blond girl walked from the rubble behind her mother, questioning why they were bombed. “What have we done?” she cried.

In the rebel-held Sukkari neighborhood, 27 people died as a well-known field hospital supported by Doctors Without Borders and the International Committee for the Red Cross was hit overnight, along with nearby buildings, according to opposition activists and rescue workers.

U.N. envoy for Syria Staffan de Mistura appealed to the U.S. and Russia to help revive the peace talks and cease-fire, which he said “hangs by a thread.”

However, the violence only escalated.

Chief opposition negotiator Mohammed Alloush blamed the government of President Bashar Assad for the violence, saying it shows “the environment is not conducive to any political action.”

“What is happening is a crime of ethnic and sectarian cleansing by all means,” Alloush told the Associated Press, adding it was an attempt by Assad’s government to drive residents from Aleppo.

But a citizen journalist said there was little sign of people fleeing the city.

“Where can they go?” said Bahaa al-Halaby.

A Damascus-based Syrian military official denied the government had hit the hospital.

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