Image copyright AFPAn air strike on a clinic near Aleppo has killed four employees of an international medical aid agency, the group says.
The Paris-based Union of Medical Care and Relief Organizations (UOSSM) said the strike appeared to be targeted.
At least nine rebel fighters were also killed, the Syrian Observatory for Human Rights monitoring group said.
The attack came a day after an aid convoy was targeted in a deadly attack nearby.
The US said it holds Russia responsible for Monday"s attack, which destroyed 18 lorries, killed about 20 civilians and has been described as a possible war crime.
But Russia strongly denied involvement of its own or Syrian planes, and said the incident was caused by fire on the ground and not by an air strike.
The two successive attacks were "not a coincidence," UOSSM CEO Dr Zaydoun al Zoubi told the BBC.
"Somebody is trying to tell us humanitarian workers are not welcome in Syria, that we are a target, that we will be killed," he said.
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Separately, a Syrian warplane has crashed north of Damascus, the UK-based Syrian Observatory says. The so-called Islamic State group said the plane had been bombing its positions but did not claim they shot it down.
Buried under rubble
It is unclear who carried out the attack on the medical centre in the rebel-held town of Khan Touman late Tuesday night local time.
The Syrian Observatory said either Syrian or Russian warplanes were responsible, Reuters news agency reports.
The strike hit a medical triage point, and killed two ambulance drivers and two nurses who had arrived to transport wounded patients to a more advanced medical facility, UOSSM said in a statement (in French).
Another nurse remains in a critical condition and the medical centre was completely destroyed. More victims are feared buried under the rubble.
The rebels killed were from Jaish al-Fatah, an Islamist group not officially part of the Western-backed alliance but one that works alongside the Free Syrian Army, the BBC"s James Longman in Beirut reports.
Blame game
Speaking earlier about Monday"s attack on the aid convoy, unnamed US officials said two Russian SU-24 attack aircraft were in the sky above the convoy at the precise moment it was hit in Urum al-Kubra.
The strike, they added, was too sophisticated to have been carried out by the Syrian army.
White House spokesman Ben Rhodes later said: "There only could have been two entities responsible, either the Syrian regime or the Russian government.
"In any event, we hold the Russian government responsible for airstrikes in this space."
Russia"s foreign ministry spokeswoman said the US government had "no facts" to support its claim.
"There are no craters and the exterior of the vehicles do not have the kind of damage consistent with blasts caused by bombs dropped from the air," a statement from the defence ministry said.
The UN had earlier said it was "not in a position to determine whether these were in fact air strikes".
"Deal not dead"
Monday"s attack prompted the UN to suspend all aid convoys in Syria.
The president of the International Committee of the Red Cross, Peter Maurer, denounced it as a "flagrant violation of international humanitarian law" and said it could amount to a war crime.
It occurred hours after the Syrian military declared the end of a week-long truce agreed by the US and Russia.
But US Secretary of State John Kerry, speaking alongside his Russian counterpart Sergei Lavrov in New York, insisted the cessation of hostilities deal was "not dead", following talks with delegates of the Syria Support Group.
They are to meet again on Friday. And the UN Security Council is due to hold a high-level meeting on Syria on Wednesday.
"Blood on their hands"
Outgoing UN chief Ban Ki-moon on Tuesday launched a stinging attack on Syria"s government, saying it has killed the most civilians in the five-year civil war and continues "to barrel bomb neighbourhoods and systematically torture thousands of detainees".
Using unusually blunt language in his final address to the UN General Assembly, Mr Ban also said those who supported the opposing sides in the conflict had "blood on their hands".
Syria"s foreign ministry responded by accusing Mr Ban of flouting the UN charter.
Syria conflict: Air strike kills four medical workers
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