DUBAI -- Twenty-two regime fighters and extremists were killed in clashes in northwest Syria on Sunday in the highest such death toll since the start of a two-month-old ceasefire there, a monitor said.

A truce since March 6 had largely stemmed fighting in Syria’s last major opposition bastion of Idlib after a months-long regime assault that killed hundreds of civilians and forced almost a million to flee.

But before dawn on Sunday position fighters attacked the positions of pro-regime fighters on the western flank of the extremist-dominated region, the Syrian Observatory for Human Rights.

The clashes in the Sahl Al-Ghab area killed 15 regime fighters as well as seven extremists including from the Al-Qaeda-affiliated Hurras Al-Deen group, the Britain-based monitor said.

“It’s the highest death toll for fighters since the truce came into force,” said observatory chief Rami Abdel Rahman, who relies on sources inside Syria.

“There had been intermittent clashes and mutual bombardment between both sides before, but this is the most violent attack yet.”

The Idlib region of some three million people is dominated by the Hayat Tahrir Al-Sham group led by Syria’s former Al-Qaeda affiliate, but other extremists such as Hurras Al-Deen and rebel groups are also present.

The truce brokered by regime ally Russia and Turkey has kept Syrian and Russian warplanes out of the region’s skies, and largely held despite sporadic clashes or rocket fire.

Tens of thousands have returned to their hometowns. Hundreds of thousands of others remain in crowded displacement camps or in temporary shelters near the Turkish border.

Aid groups have warned that any outbreak of the novel coronavirus there would be devastating.

Syria’s war has killed more than 380,000 people and displaced millions since starting in 2011 with the brutal repression of anti-government protests. - Al Arabiya English/Agencies