Four nurses and paramedics have been killed in an air strike on a medical facility in Syria, a relief group has said.

The International Union of Medical Care and Relief Organisations said the new strike in northern Syria levelled a medical triage point in rebel-held town of Khan Touman, south of Aleppo.

The Britain-based Syrian Observatory for Human Rights put the toll at 13 dead including nine rebel fighters, some of them belonging to the al Qaida-linked Fatah al-Sham Front.

The new air strike came as the US blamed Russia for an attack on an aid convoy in Uram al-Kubra, west of Aleppo, that killed 20 civilians and an aid worker.

It happened as a week-long ceasefire agreement appeared to unravel, with Syria's military declaring the truce to be over.

The UN has suspended overland deliveries in Syria in response, jeopardising food and medical supplies for millions of besieged and hard-to-reach civilians.

Confusion continued about who struck the convoy, but the White House insisted it was either Russia or Syria.