The effects, and images below, are shocking.
Casualties who made it to a hospital found a system pushed to breaking point. Doctors Without Borders said Wednesday that 13 of its medical facilities have been damaged since Sunday.
“There have been many massacres,” said Huda Kyayati, a relief worker with the Syrian nonprofit group Women Now for Development. “I cannot handle the idea of going down to the basement, because I cannot imagine what it would mean to be bombed and die under the rubble.”
Across much of Syria, this is no longer a civil war. As the conflict escalates, international powers, including the United States, Russia, Turkey and Iran, are scrambling for influence, clashing in the skies and on the ground. But in Eastern Ghouta, the final pocket of rebel territory around the capital, it is just the Syrian government that is clashing with the country’s armed opposition.
Trapped in the middle are as many as 400,000 people, most civilians.
Syrian troops laid siege to Eastern Ghouta in April 2013, sending prices soaring and causing dozens of deaths related to a lack of essentials.
The price of bread has risen to 1,500 Syrian pounds, according to monitoring groups. A few miles away in parts of the Syrian capital controlled by the government, it costs less than 100.
As the pace of death accelerates in Eastern Ghouta, so do preparations. Pathologists and gravediggers in the enclave said before the violence accelerated that they had 20 to 50 graves on standby at any given time. This week, they said that was not enough.
“We are overwhelmed. We are throwing body parts in mass graves. It’s all we can do,” said one man, speaking on the condition of anonymity because he feared retribution from the government in the event that it took full control of the area.
Medics across the enclave described grueling surgeries. One said he had removed a child’s eyes after they were shredded in an airstrike. Another said a colleague had found their nephew on the operating table.
Unlike previous government attacks on the area, Tuesday’s bombardment did not target any specific neighborhood, according to the White Helmets.
As warplanes circled in the sky past midnight Tuesday, another volunteer for a Syrian nonprofit group, speaking on the condition of anonymity out of fears for his family's safety, said he had still not dared to take his children to the basement. “We might die here, but at least it won't be the darkness,” he said.
Zakaria Zakaria in Istanbul and Carol Morello in Washington contributed to this report.