The Syrian regime rained rockets and bombs on Eastern Ghouta Thursday (February 22nd), killing another 19 civilians as international pressure mounted to stop the carnage in the opposition-held enclave.
Calls for a humanitarian truce in one of the bloodiest episodes of Syria's seven-year-old conflict went unheeded as the death toll for Damascus's five-day blitz rose to 368.
The UN chief said the bloodshed wreaked by the aerial campaign had turned Eastern Ghouta into "hell on earth", while German Chancellor Angela Merkel called for an end to the "massacre".
Residents huddled in basements as government forces pounded the besieged enclave with rockets and bombs, turning towns into fields of ruins and even hitting hospitals.
According to Doctors Without Borders, 13 of the facilities it supports in Eastern Ghouta were damaged or destroyed in three days, leaving remaining staff with very little to save the hundreds of wounded brought to them every day.
In the hospital mortuary in Douma, the main town in the enclave just east of Damascus, bodies wrapped in white shrouds were already lining up on the floor, two of them children.
"The rocket fire has not stopped this morning. Around 200 ground-to-ground rockets struck Douma alone," said Rami Abdel Rahman, head of the Syrian Observatory for Human Rights.
Morning rain appeared to initially keep warplanes away but the sky cleared by midday and jets, some of them Russian according to the Observatory, soon returned.
Russia has so far denied direct involvement in the assault on Ghouta but the pro-government Syrian newspaper al-Watan reported on Thursday that Russian warplanes and advisers had joined the battle.
Regime and allied forces have been massing around the enclave, in which an estimated 400,000 people live, ahead of a likely ground offensive.
The brief respite provided by the rain on Thursday encouraged some residents to venture out of their basements and shelters, to buy food, check on their property or enquire about their relatives and neighbours.
In the town of Hammuriyeh, a queue had formed outside a shop as starving residents tried to stock up but another rocket sowed panic and sent everybody back to their shelters.
In Douma, a young boy tried to peddle lighters on the street but rocket fire quickly forced him to scamper back to cover.
An AFP correspondent saw rescuers known as the "White Helmets" forced to stop their efforts to retrieve a wounded woman from the rubble of a collapsed home when airstrikes resumed.
When they ventured back to the site, the woman was dead.
The indiscriminate bombardment and the strikes on medical facilities sparked global outrage.
"The killing of children, the destruction of hospitals -- all that amounts to a massacre that must be condemned and which must be countered with a clear no," Merkel said.
Russia has asked for a special meeting of the UN Security Council and the Red Cross has demanded it be allowed to enter the besieged enclave to help overwhelmed doctors and nurses to treat the wounded.
Gulf states urge end to violence
Gulf states on Thursday urged an end to the deadly assault on Eastern Ghouta and called for an immediate truce.
Saudi Arabia demanded an end to the violence, appealing to Damascus to adhere to UN Security Council resolution 2254, which calls for a nationwide ceasefire and a political transition.
"We stress the need for the Syrian regime to stop the violence, to allow in humanitarian aid, and to take seriously the path of a political solution to the crisis," the Saudi foreign ministry said on Twitter.
The UAE expressed concern at the escalation of violence and called for an "immediate truce" to halt the bloodshed and protect civilians. It also called for allowing humanitarian and medical aid to civilians.
Qatar slammed the assault as an outright "massacre".
"The State of Qatar expresses its strong... condemnation of the massacres and intensive aerial bombardments," read a statement released by Qatar's foreign ministry.