The Turkish president, Recep Tayyip Erdoğan, met with his Russian counterpart, Vladimir Putin, for their first face-to-face talks since the pandemic in which they discussed the future of the last pocket of Syria outside regime control. The leaders met in in the Russian Black Sea resort town of Sochi for Wednesday’s summit. Erdoğan sought to shore up a March 2020 ceasefire deal which ended a bruising assault by Bashar al-Assad and his Russian allies on Turkish-backed fighters in north-west Syria. The fighting last year brought Ankara and Moscow close to direct confrontation and threatened Turkey – which is already home to about 4 million Syrians – with a new wave of refugees. Although ground positions for the most part remain stalemated, the truce has been ruptured repeatedly in the last 18 months, with a significant uptick in regime airstrikes and shelling since June. Ahead of this week’s summit, first responders in the Idlib area said Syrian air force bombing has again intensified, and the Turkish military has deployed extra troops to the region as a deterrent. “The steps we take together regarding Syria carry great importance. The peace there is dependent on Turkey-Russia ties,” Erdoğan said at the start of Wednesday’s talks. Putin, who made only a passing reference to Syria in his opening comments, said that “negotiations with Turkey are sometimes difficult” but that the two countries had learned “how to find compromises that are beneficial to both sides”. The relationship between the regional powers is awkward, but the two countries have grown closer in recent years as tensions with the west have built in both Moscow and Ankara. While they back opposing sides in wars across the Middle East and the Caucasus, Turkey and Russia enjoy strong trade and energy links, and millions of Russian tourists who visit Turkey every year represent a significant source of hard currency for the struggling Turkish economy. Turkey is also understood to have pressed on Wednesday for Russian help in removing western-backed Syrian Kurdish forces on its border, and last week signalled it is open to acquiring more Russian-made military hardware. Ankara’s 2019 delivery of the S-400 air defence system from Russia alarmed Nato allies, triggered US sanctions and led to Turkey’s removal from the F-35 fighter jet programme. The cautious but constructive tone from the two leaders suggests they are willing, at least in the short term, to curb violence in north-west Syria and work together to neutralise radical groups – a stipulation of the 2020 agreement which Moscow says Turkey has so far failed to deliver. But for civilians in Idlib province and the surrounding countryside, compromises hashed out by foreign leaders on the shores of the Black Sea feel divorced from the day-to-day impact of Assad’s war of attrition. About three-quarters of the area’s estimated population of 3.5 million fled to the north-west to escape fighting in other parts of Syria: caught between religious extremist groups and the regime, living conditions are dire, and have worsened since last year’s collapse of the Syrian currency and the emergence of Covid-19. The north-west is in the grips of a deadly second wave of the virus, which is pushing the already struggling healthcare system to the limit. “We have just 157 ventilators in the whole region and every day more than 2,000 cases,” said Dr Moustafa Aleado, who leads a medical team trying to provide at-home care for coronavirus patients in order to ease the pressure on overwhelmed hospitals. “The WHO [World Health Organization] and other donors haven’t responded at all to this new wave … We have only had 158,000 vaccine doses so far and the Delta variant is attacking everyone, not just old people, but young people and children. We desperately need more vaccines,” he said. Covid-19 is exacerbating the already urgent humanitarian crisis caused by the fighting, said Amina al-Besh, a civil service volunteer in the frontline village of Shenan. “People are scared of the virus, but they are more scared of Assad bombs. The families who stayed here in southern Idlib and didn’t flee, it’s because they couldn’t afford to. People are exhausted from years of bombing and displacement, and they fear if Assad advances, they’ll have to escape and end up in a tent.” Syria’s 10-year-old civil war has left hundreds of thousands dead and displaced more than half of the prewar population. Yet with significant military activity now confined to the north-west and Assad firmly in control, some of Damascus’s neighbours – including Lebanon, Jordan, Egypt and the Gulf monarchies – now appear to be pushing for the Syrian regime’s rehabilitation. Ranim Ahmed, senior communications officer at the Syria Campaign, said: “Russia’s escalation of attacks in breach of the ceasefire amid a Covid-19 surge has been disastrous for civilians and health workers in north-west Syria. The international community must pressure Russia to cease those brutal attacks on civilians including children and first responders at homes, camps, schools and hospitals. As Turkey and Russia meet today, they need to restore the ceasefire that gave residents a much-needed respite.”