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President Donald Trump on Sunday condemned a “mindless CHEMICAL attack” in Syria that killed women and children, called Syrian President Bashar Assad an “animal” and delivered a rare personal criticism of Russian President Vladimir Putin for supporting the Damascus government.

As Washington worked to verify the claim by Syrian opposition activists and rescuers that poison gas was used, Trump said there would be a “big price to pay” for resorting to outlawed weapons of mass destruction. A top White House aide, asked about the possibility of a U.S. missile strike in response, said, “I wouldn’t take anything off the table.”

Just over a year ago, Trump ordered dozens of cruise missiles to be fired at a Syrian air base after declaring there was no doubt Assad had “choked out the lives of helpless” civilians in an attack that used banned gases. White House advisers said at the time that images of hurt children helped spur the president to launch that air strike, and television new shows on Sunday aired similar depictions of suffering young Syrians.

“Many dead, including women and children, in mindless CHEMICAL attack in Syria,” Trump tweeted. “Area of atrocity is in lockdown and encircled by Syrian Army, making it completely inaccessible to outside world. President Putin, Russia and Iran are responsible for backing Animal Assad. Big price to pay. Open area immediately for medical help and verification. Another humanitarian disaster for no reason whatsoever. SICK!”

Saturday’s attack took place in a rebel-held town near Damascus amid a resumed offensive by Syrian government forces after the collapse of a truce. Syrian activists, rescuers and medics said a poison gas attack in Douma killed at least 40 people, with families found suffocated in their houses and shelters. The reports could not immediately be independently verified.

The developments come as Trump has moved to dramatically scale back U.S. goals in Syria, pushing for a quick military withdrawal despite resistance from many of his national security advisers. Trump has given no formal order to pull out the 2,000 U.S. troops in Syria or offered a public timetable other than to say the U.S. will withdraw as soon as the remaining Islamic State fighters can be vanquished.

But Trump has signaled to his advisers that, ideally, he wants all troops out within six months.

Images released by the Syrian Civil Defense White Helmets, a volunteer organization, show children lying on the ground motionless and foaming at the mouth. The Assad government, in a statement posted on the state-run news agency SANA, denied responsibility.