The UN has suspended all aid convoys in Syria after a devastating air attack on its lorries near Aleppo on Monday.
The strikes destroyed 18 of the 31 lorries, which were bringing wheat, clothes and medical kit to the area.
A senior local official of the Syrian Arab Red Crescent was among about 20 civilians killed, aid officials said.
The convoy had received proper permits, and all warring parties - including Russia and the US - had been notified, a UN spokesman said.
The President of the International Committee of the Red Cross, Peter Maurer, has denounced the attack as a "flagrant violation of international humanitarian law".
Syrian Red Crescent president Abdulrahman Attar said: "It is totally unacceptable that our staff and volunteers continue to pay such a high price because of the ongoing fighting."
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The US has expressed its "outrage" over the attack, which took place in the town of Urum al-Kubra hours after the Syrian army declared a US-Russian brokered truce over.
Washington has said it will "reassess the future prospects for co-operation" with Russia - an ally of Syria's government.
Aid deliveries to besieged areas had been a key part of the cessation of hostilities deal brokered last week.
A media activist who witnessed the attack told the BBC Arabic service that Russian reconnaissance planes had been spotted, apparently filming the passage of the convoy.
He said the first strike came at about 19:00 local time on Monday, when a helicopter dropped several barrel bombs. This was followed by rocket and machine-gun fire from aircraft, he said.
Russia's defence ministry has denied accusations that its aircraft, or those of the Syrian government, were involved, the privately owned Russian news agency Interfax has said.
The convoy was being unloaded at a Red Crescent warehouse when the attacks began. The aid had been due to be delivered to 78,000 people in rebel-held areas around Urum al-Kubra, who were last supplied in mid-July.
The UN said the aid included:
- Blankets
- Winter clothes
- Education and nutrition items
- Nine tonnes of medical supplies including trauma kits, burn treatments, IV kits and fluids, medication for chronic conditions such as diabetes, high blood pressure and cardiological conditions
- Vitamins
- Wheat
A health clinic near the warehouse was also badly damaged.
"The destination of this convoy was known to the Syrian regime and the Russian Federation," state department spokesman John Kirby said.
"And yet these aid workers were killed in their attempt to provide relief to the Syrian people," he added.
The attack appeared to signal the collapse of the latest effort by the US, which backs the rebels, and Russia to halt the violence in Syria, with the army there saying the deal was over.
"We don't know if it can be salvaged," a senior US official told journalists on condition of anonymity.
"At this point the Russians have to demonstrate very quickly their seriousness of purpose because otherwise there will be nothing to extend and nothing to salvage."
Russian presidential press secretary Dmitry Peskov said the chance of renewing the ceasefire was "very weak", Interfax has reported.
In other comments, reported by Reuters, Mr Peskov said: "Unfortunately, we can state... that our American colleagues have failed to separate terrorists from the so-called moderate opposition."
After the army announcement, activists said Aleppo and the surrounding area had been targeted.
A member of the White Helmets group that helps civilians caught in the violence said there had been "heavy bombing on many neighbourhoods" of Aleppo, causing multiple casualties.
"Our rescue teams are now trying to get people from under the rubble," Ismail told the BBC's Newsday programme. "The situation has changed completely. Before the sky was clear. Now I hear warplanes."
He said people risked dying "in two ways - from bombing, and the lack of food, the lack of basic needs", and appealed for renewed international efforts.
"Do something to save these kids who do not know what this war is."
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