The attack in the town of Khan Sheikhun left dozens suffering respiratory problems and symptoms including vomiting, fainting and foaming at the mouth, the Britain-based Syrian Observatory for Human Rights said.
A hospital in the town where doctors were treating victims of the attack was also bombarded, an AFP correspondent said.
The entrance of the building was hit, bringing down rubble on top of medics who had earlier been seen dousing a steady stream of arrivals to wash away chemical residue.
The Observatory said the attack on a residential part of Khan Sheikhun came in the early hours of Tuesday, when a warplane carried out strikes that released "toxic gas".
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It said 11 children were among the dead, with at least 160 injured, and that many people were dying even after arriving at medical facilities.
The monitor could not confirm the nature of the gas or whether the strikes were carried out by Syrian warplanes or those of government ally Russia.
An AFP journalist in Khan Sheikun saw a young girl, a woman and two elderly people dead at the hospital prior to the bombardment, all with foam still visible around their mouths.
Doctors at the facility had been using basic equipment, some not even wearing lab coats, and attempting to revive patients who were not breathing.
The town is in Syria's Idlib province, which is largely controlled by an alliance of rebels including former Al-Qaeda affiliate Fateh al-Sham Front.
Syria's leading opposition group, the National Coalition, accused the "regime of the criminal Bashar" of being behind the attack.
It called on the UN Security Council to convene an emergency session, "open an immediate investigation and take the necessary measures to ensure the officials, perpetrators and supporters are held accountable."
"Failure to do so will be understood as a message of blessing to the regime for its actions," the statement added.
But there have been repeated allegations of chemical weapons use by the government since then, with a UN-led investigation pointing the finger at the regime for at least three chlorine attacks in 2014 and 2015.