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Secretary of State John Kerry on Wednesday threatened to end all cooperation between the United States and Russia to stop Syria's civil war, unless Russian and Syrian government attacks on Aleppo end.
Kerry's warning came in a telephone call on Wednesday to Russian Foreign Minister Sergey Lavrov, the State Department said, describing the latest US ultimatum in Syria's 5½-year conflict.
Many have gone unfulfilled, including President Barack Obama's declaration that the US would take military action if Syrian President Bashar Assad crossed the "red line" of using chemical weapons.
It was unclear what effect Kerry's words would have.
Government shelling and airstrikes landed near a bread distribution center and two hospitals in Aleppo on Wednesday. Activists and medics reported several people killed. They said at least one of the medical facilities was no longer operable, leaving the country's biggest city with only six functioning hospitals.
The Syrian government and its ally Russia have been accused of intentionally targeting medical facilities in rebel-held areas. The US-based Physicians for Human Rights has recorded 382 such attacks throughout Syria since the conflict started in 2011. The group says government forces carried out 293 of the attacks; Russian warplanes conducted 16.
Despite Moscow's military engagement in the war alongside Assad's government, Washington has been working with its former Cold War foe in hopes of securing a ceasefire and a peace process. The latest effort collapsed last week after several days of reduced violence, but the US and Russia have been discussing ways to revive it.
The Obama administration had hoped the promise of the new US-Russian alliance against the Islamic State group and Al-Qaeda affiliates would be enough to get Moscow to ground Assad's forces.
Current coordination to ensure US and Russian planes stay out of each other's way will continue no matter what, the Pentagon said. The US and its coalition partners are flying missions in Syria against IS; the US also has a small contingent of special forces on the ground.
Kerry's threat aside, the US has few other options beyond engaging Moscow to end the fighting between Assad's forces and rebels.
Obama has made clear he won't authorise military action against Syria and the presence of Russian air assets alongside Syrian forces makes such a scenario all the more unlikely. The US is similarly uncomfortable ramping up military support for anti-Assad rebels given the close ties even the so-called "moderate" groups maintain with Al-Qaeda-linked militants.
"The secretary made clear the United States and its partners hold Russia responsible for this situation, including the use of incendiary and bunker buster bombs in an urban environment, a drastic escalation that puts civilians at great risk."
Russia's Foreign Ministry presented a different version of the call, making no reference to the US ultimatum.
It focused on Lavrov's demand that the US compel opposition forces to separate themselves from extremist groups. He told Kerry that many US-backed groups have merged with the Al-Qaeda-linked Nusra Front and said Nusra was getting US weaponry that way.
Nevertheless, Lavrov and Kerry discussed ways to "normalize" the situation in Aleppo and "return to the basic principles" of the 9 September ceasefire, the ministry said.
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