On Thursday, the Syrian regime managed to win back strategic areas of the Aleppo countryside during a brutal, lightning attack on rebel positions involving hundreds of bombing sorties by Russian planes and thousands of Iranian-backed militants.
The result was not only a loss of land to the regime but also a humanitarian catastrophe, as Aleppans fled the advancing militias and Russian cluster bombs.
Pro-regime forces are now poised to completely encircle opposition-held Aleppo - and judging from past experiences, will likely try to starve the rebels into submission.
This fear has forced 70,000 Syrians from their homes, who are now stranded on the closed Turkish border.
"MSF is extremely worried about the situation for people in Azaz district [border area] in northern Syria, as fighting intensifies across the region," said Pablo Marco, Medecins Sans Frontieres operations manager for Syria.
"The situation is extremely fluid, and we expect the humanitarian consequences to be severe. We are already seeing massive displacement as people flee north towards the Turkish border in search of safety."
Marco said that MSF had set up stocks of emergency medical and other supplies, and workers were preparing to respond - but the overall situation remains grim.
|The situation is extremely fluid, and we expect the humanitarian consequences to be severe.
- Pablo Marco, Medecins Sans Frontieres
"We have sent teams to assess the health and water and sanitation conditions in displaced people's camps, and are preparing a mass distribution of essential aid items. MSF's hospital in Azaz district remains open and is receiving wounded."
Turkish border posts have been closed, likely due to EU pressure to curb the flow of refugees into Europe.
Now the thousands on the border are sitting ducks for war planes.
Given the shelling of refugee camps in Latakia and the heavy bombing of the frontier region, this is not an impossible scenario to imagine.
In the south, around 100,000 have also been made homeless due to Russian bombing and another regime offensive.
"It's certainly a strategy where they are trying to twin up Russian bombardments with a major offensive on the ground. So far it hasn't been very successful but things are changing," said Leila al-Shami, a British-Syrian writer and co-author of Burning Country: Syrians in Revolution and War.
Shami said that such mass displacements had been common when the regime captured rebel-held territories.
It is also something that is altering the demographics of Syria, which will likely have tragic repercusions in the future.
"There is a fear that Aleppo will be encircled and besieged. Hundreds of thousands of people are living in there… it is going to be a hunded times worse [than Madaya] if it happens in Aleppo," she said.
|This is just the beginning of the refugee crisis. We are going to see waves and waves of people fleeing the areas if this continues.
- Leila al-Shami, British-Syrian writer
Shami said there was an absolute fear among civilians in Aleppo of sectarian militias advancing on opposition areas. There is also a fear of being stuck behind a regime cordon with no food or fuel.
"This is just the beginning of the refugee crisis. We are going to see waves and waves of people fleeing the areas if this continues."
In northern Aleppo, the last functioning hospital was bombed last week, and the heavy bombing likely caused mass injuries and trauma among those families now heading north.
For neighbouring host countries, the pressure of looking after hundreds of thousands of refugees will also bite as the regime continues its scorched earth strategy.
With the few roads available north packed with refugees fleeing the regime advance, we are witnessing another human catastrophe in Syrian which will have implications way beyond its border.
"NGOs are stretched at breaking point," said Shami.
"I don't know what will happen to these people or how they are expected to survive - it's not a situation that is going to disapear, it's going to continue."