Frame grab shows a Russian military jet dropping bombs during airstrikes carried out by the country’s air force near Idlib on Oct. 5.

A wave of Russian air strikes in western Syria on Wednesday was being accompanied by a ground assault on at least four insurgent positions, a group monitoring the war said.

The ground attacks were being carried out by “regime forces” the Syrian Observatory for Human Rights said, a term it uses broadly to describe the Syrian military and allied local and foreign militia.

The Syrian Observatory for Human Rights said there were also heavy surface-to-surface missile bombardments.

Russia has courted controversy since their first wave of airstrikes hit Syria as they have been accused of attacking moderate rebels and civilians instead of fighting Islamic State of Iraq and Syria (ISIS) militants.

At least 39 civilians, including eight children and eight women, have been killed in Russian air strikes in Syria during the first few days of when strikes were deployed.

Russia, a top ally of Syrian President Bashar al-Assad, started carrying out air strikes in Syria last week, saying they were targeting hardline Islamic State militants.

Russia’s Wednesday strikes targeted the towns of Kafr Zita, Kafr Nabudah, al-Sayyad and the village of al-Lataminah in Hama province and the towns of Khan Shaykhun and Alhbit in Idlib, the Observatory said.

Most of Idlib province is held by an insurgent alliance that includes al-Qaeda’s Syria wing Nusra Front and other factions and that has put pressure on the Syrian military.