There has been a heartsinking familiarity to the scenes witnessed in Idlib over the last few days. As regime forces unleashed a wave of airstrikes on civilian targets, the death toll crept up; first in the single figures, then into double digits.
By the time the Syrian regime is done with Idlib, that figure will no doubt have climbed into the hundreds, then thousands.
Over the course of the seven-year conflict, the northwestern province of Idlib has absorbed many of the six million internally displaced Syrians fleeing regime offensives in Eastern Ghouta, Homs and Aleppo.
Wave after wave of the desperate and starving have arrived, some bussed in by the regime amid promises of "reconciliation", others fleeing for their lives.
They have been rounded up and herded in like cattle to what has been termed a “dumping ground” for the displaced and dispossessed so that the regime and its supporters can unleash its very worst, crushing and pounding the very last rebel stronghold into the ground.
This is the template that has been moulded and replicated to devastating effect: siege, starve and wait for surrender.
The forces of Bashar Al Assad care little that among Idlib's terrified population of 2.5 million are more than one million children, described by Unicef as "exhausted of war and fearful".
They are, as far as he is concerned, collateral damage as he ploughs on relentlessly towards his end goal of obliterating any dissent.
We saw similar scenes in Eastern Ghouta, where, after a three-year siege, the Assad regime bombarded the area earlier this year with barrel bombs and chemical attacks, decimating the region over a month and killing 1,600 men, women and children.
Idlib is next in its sights and Mr Al Assad, backed by his Russian sponsors, is showing no mercy. For months, observers have been talking about the endgame and the final battleground; of how Idlib, the scene of the first chemical attack in 2012, will be the battle to end the war for good.
But there will be no sense of resolution among its population, where food, water and medicine are already scarce. Nor will Mr Al Assad’s planes dropping bombs on towns from Khan Sheikhoun to Alteh distinguish between rebel fighters and innocent civilians; all are fair game for the planes pounding from the skies.
On the ground, different factions are at war with each other, as well as with the regime, each with different allegiances, which threaten to pit Turkish-backed fighters against Russian and Syrian.
There is a grave danger of clashes driving an explosive wedge in this trifecta of tenuous alliances. Recep Tayyip Erdogan’s woes at home as the lira plummets to an all-time low could distract him from carving out a sphere of influence in Idlib, as was previously feared.
But for civilians who might have hoped for Turkish protection from the onslaught, it is quickly becoming apparent that any forces present in Idlib are only interested in serving their own purposes.
There is a horrifying inevitability to the humanitarian disaster that is about to unfold, with one key difference: Mr Al Assad is confident he will be the last man standing, whatever the cost.