20 killed in shell attack on Gorazde hospital: Continuing threats of Nato air strikes have failed to curb the Serbian offensive against the Muslims, writes Annika Savill

UP TO 20 patients were killed yesterday as Bosnian Serb forces attacked a medical centre in Gorazde despite threats of further Nato air strikes to halt the Serbian offensive on the Muslim enclave.

The assault brought to at least 47 the number of people killed in Gorazde in 24 hours and to at least 436 the number of dead since the Bosnian Serb forces launched their campaign three weeks ago.

UN sources said a Serbian tank round blew away sandbags around the makeshift clinic, where patients were being treated for shell wounds. The second round exploded inside, killing between 15 and 20, the sources added. The UN was unable to establish exact number of casualties or attend to the wounded because the area was being raked by anti-aircraft fire.

The assault came the day after President Bill Clinton proposed expanding the threat of Nato air strikes to force the Serbs to halt attacks on Gorazde and five other UN-designated 'safe areas'. In response the Bosnian Serb leader, Radovan Karadzic, said yesterday that 'sanctions, threats and bombing do not help the peace process'.

Nato is expected to hold talks today about the practicality of further air strikes. In the Commons, John Major stressed the importance of preserving the possibility of a negotiated peace settlement, while broadly backing the call by the UN Secretary-General for more troops.

President Boris Yeltsin, facing increasing divisions at home over Russian support for the Serbs on the one hand and accommodation of the West on the other, continued to call for a summit with President Clinton and European leaders within a month to co-ordinate international policy. The response in most quarters was lukewarm. A spokesman for Mr Major said: 'We are not sure there is agreement to have a summit. The Russians favour a meeting, but our impression is the Americans, like ourselves, believe that a bit of work needs doing before we are ready.'

President Francois Mitterrand of France urged a meeting of foreign ministers of the European Union, the US and Russia 'in the next few days'. The talks, to be convened by Boutros Boutros-Ghali, the UN chief, should come before Mr Yeltsin's proposed summit.

Mr Clinton's Secretary of State, Warren Christopher, sought to win over US Congressmen who said Mr Clinton's plans would embroil the US in war. 'This is more than a civil war,' Mr Christopher told a Senate committee hearing. 'The aggression of the Serbs, I think, is quite transparent. They have in mind a Greater Serbia. They're looking to the south to Kosovo, possibly to Macedonia. They're moving into Bosnia and perhaps into Croatia . . . it is in those terms that we have to contain the conflict.'

Yesterday's attack came as a convoy of British, French and Ukrainian UN peace-keepers left Sarajevo airport for the enclave.

The convoy, which included a Norwegian army field hospital, was delayed later by a several hundred Serbian demonstrators blocking the road.

(Photograph omitted)