In remarks carried by Russian news agencies, Medvedev said he has delivered this message to Syrian President Bashar Assad.

An offensive by Syrian forces against anti-government dissent in the city of Hama, backed by tanks and snipers, has killed scores of people since Sunday.

“Regrettably, large numbers of people are dying there. That causes us grave concern,” Medvedev was quoted as saying.

“That’s why both on a personal level and in the letters I sent to him (Assad) I have emphasized that it’s necessary to urgently conduct reforms, negotiate with the opposition, restore civil peace, and create a modern state.”

“If he fails to do that, he will face a sad fate. And in the end we will also have to make some decisions. We are watching how the situation is developing. It’s changing, and our approach is changing as well.”

Medvedev and Russia’s most powerful politician, Prime Minister Vladimir Putin, have long urged Assad to find a compromise with the opposition. In June, Putin warned Assad against using “political instruments of 40 years ago.” But at the same time, Moscow had warned the West against interfering with Syrian affairs and objected to a UN resolution.

US and European members of the UN Security Council had been pressing for months for a legally binding resolution that would strongly condemn Syria.

Russia — which has had close political ties with Syria since Soviet times and provided it with weapons — had urged Assad to find a compromise with the opposition but warned that the West shouldn’t interfere in Syrian affairs with such a resolution.

But on Wednesday, after Russia and other countries dropped their long-standing opposition, the UN Security Council finally responded to the escalating violence in Syria by condemning Assad’s forces for attacking civilians and committing human rights violations.

The presidential statement adopted by the council, which is weaker than a legally binding resolution, urges Syrian authorities to immediately end all violence and launch an inclusive political process that will allow the Syrian people to fully exercise “fundamental freedoms ... including that of expression and peaceful assembly.”

Germany’s Foreign Minister Guido Westerwelle on Thursday called for a special UN envoy on Syria to be named and immediately dispatched “to bring the clear message of the international community to Damascus.”

Amnesty International criticized the UN Security Council for not being tougher.

Jose Luis Diaz, the human rights group’s UN representative, called the council statement “completely inadequate,” saying members should have adopted a legally binding resolution imposing an arms embargo on Syria, freezing Assad’s assets and referring the crackdown against protesters to the International Criminal Court.

Diaz also criticized the council for failing to support a UN Human Rights Council fact-finding mission to Syria to investigate the violence. Syrian authorities have refused to allow the UN delegation into the country.

In a lonely show of support for Damascus, Cuba’s Foreign Ministry on Thursday accused the West of pressuring the UN into adopting decisions against the Syrian government.

“Cuba reiterates its confidence in the ability of the Syrian people and government to resolve their internal problems with no foreign interference,” the statement said.