Most medical facilities in the Eastern Ghouta region outside Damascus have been knocked out of service by the ongoing Syrian regime bombardment that has so far killed more than 420 people, activists and physicians said.

Hospitals and clinics in the besieged opposition enclave have been directly targeted by regime artillery fire and airstrikes that have been pummeling the region for days, they said.

As of Friday (February 23rd) morning, 426 people had been killed since the bombardment began on February 18th, and more than 2,000 have been wounded, AFP reported.

"The death toll is likely to go up, there are many wounded in critical condition and victims trapped in the rubble," said Syrian Observatory for Human Rights director Rami Abdel Rahman.

The situation has become dire for medics operating in the area, due to the repeated targeting of medical facilities, including hospitals, clinics and field hospitals, said Dr. Hanan Ibrahim, who is working in Eastern Ghouta.

"The situation will have very serious consequences due to the high number of casualties from the brutal military offensive against Eastern Ghouta that has been ongoing for a week," she told Diyaruna.

"The number of children and women among the victims of the shelling is very high," she said, with more than 50 children and 100 women killed.

Residential buildings and shelters used by civilians have been targeted, she said, and missiles being used penetrate lower floors and reach the shelters, which explains the killing of entire families.

Hospitals knocked out of service

More than 22 hospitals have been knocked completely out of service, Ibrahim said, among them those that had provided the highest number of medical and surgical services.

These include Saqba Surgical Hospital, Erbin hospital, Jobar hospital, Hazzeh hospital, the tuberculosis hospital in Kafr Batna, al-Marj hospital in the town of al-Shafouniya and al-Quds hospital in Hamouriya, she said.

Also out of service is the medical centre in the town of Jisreen, she said, as well as the medical facility in the town of Madyara, and the medical facility, Mesraba clinics complex and al-Yaman hospital in Douma.

Doctors and paramedics are operating out of basements and shelters, she said, and move "frequently and in secret" to avoid having their work areas targeted.

"It is obvious that medical facilities are being deliberately targeted to increase the number of casualties and ramp up the pressure on civilians," she said.