Syrian regime airstrikes and artillery fire killed at least 23 civilians on Sunday (November 26th) across the opposition-held Eastern Ghouta region outside the capital Damascus, AFP reported.

Eastern Ghouta is already in the grip of a humanitarian crisis caused by a crushing regime siege of the area since 2013 that has caused severe food and medical shortages.

Sunday's airstrikes on the towns of Mesraba and Madira killed 21 civilians, while artillery fire on the town of Douma killed two others, the Syrian Observatory for Human Rights said.

Several people were also wounded in the airstrikes.

Among them was a baby whose head was wrapped in a blood-stained bandage, as well as men and children who sat on the floor as they received first aid.

A small girl cried as a doctor bandaged her head while nearby a man sat against a wall, sobbing silently with his face pressed against his folded arms.

"The toll could rise further because of the number of wounded people in a serious condition," said Observatory director Rami Abdel Rahman.

Among the dead were four children, the Observatory said.

Regime bombardment of Eastern Ghouta in the last two weeks has killed more than 100 people, according to the Observatory.

Number of dead likely to rise

"Eastern Ghouta has been subjected to a real massacre in which dozens of civilians were killed and wounded," activist Mohammed al-Beik of the Eastern Ghouta local co-ordination committee told Diyaruna.

The shelling began shortly after 12 p.m., focusing on the city of Douma, he said, noting that it was accompanied by intensive flights by reconnaissance aircraft and warplanes.

Rocket launchers were also deployed, leading to the spread of massive fires, he said.

"This was followed by airstrikes, which in addition to Douma, targeted the towns of Mesraba and Madira," said al-Beik.

At least 50 civilians were injured in the strikes, he said, noting that the number of dead is likely to rise as a large number of the wounded are in critical condition.

"Also, rubble removal operations have not been completed and a large number of casualties are believed to be under the debris," he said.

The shelling targeted "solely civilian areas and residential buildings that have no military positions in their vicinity", al-Beik said.

Eastern Ghouta falls within a de-escalation zone under a deal between the armed opposition factions and the Syrian government.