Residents of Syria’s Eastern Ghouta District are amid one of the most intense bombardments of the war by pro-government forces on the besieged, rebel-held enclave near Damascus .

At least 310 people have been killed in the district since Sunday night—38 more victims on Wednesday alone —and over 1,550 injured , the British-based Syrian Observatory for Human Rights war monitor said.

The eastern Ghouta, a densely populated agricultural district on the Damascus outskirts, is the last major area near the capital still under rebel control. Home to 400,000 people, it has been besieged by government forces for years.

A massive escalation in the bombardment, including rocket fire , shelling , air strikes , and helicopter-dropped barrel bombs , since Sunday, has become one of the deadliest of the Syrian civil war, now entering its eighth year.

The Syrian government and its ally Russia , which has backed Assad with air power since 2015, say they do not target civilians and point to rebel mortar fire on Damascus.

“Nearly all people living here live in shelters now. There are five or six families in one home. There is no food, no markets,” said Bilal Abu Salah , 22.

An air strike warning system run by the Syrian Civil Defence , a rescue service in opposition areas, was by Wednesday afternoon sending alerts every few minutes, triggered when warplanes are spotted taking off from air bases.

Abdullah Kahala

, a construction worker, was having breakfast with his wife and six children when a huge explosion shattered the wall. “Bombs were falling everywhere near our house. We have been spending the last week digging into the rubble of nearby areas with our bare hands,” he said.

The United Nations has denounced the bombardment, which has struck hospitals and other civilian infrastructure, saying such attacks could be war crimes.

On Wednesday, U.N. Secretary-General António Guterres appealed for an “immediate suspension of all war activities in eastern Ghouta”. Speaking to the U.N. Security Council Guterres said residents were living in “hell on earth.”

While the International Committee of the Red Cross ( ICRC ) called for humanitarian access to Ghouta to reach wounded people in critical need of treatment.

“The fighting appears likely to cause much more suffering in the days and weeks ahead,” said Marianne Gasser , ICRC’s Head of Delegation in Syria . “This is madness and it has to stop.”

The pace of the strikes appeared to slacken overnight, only to intensify again later on Wednesday morning, the Observatory said. Pro-government forces fired hundreds of rockets and dropped barrel bombs from helicopters on the district’s towns and villages.

Medical charity Médecins Sans Frontières said 13 hospitals had been hit and damaged or destroyed in the past three days.

Damascus denies using the inaccurate explosive barrel bombs dropped from helicopters whose use has been condemned by the United Nations.

Eastern Ghouta is one of a group of “ de-escalation zones ” under a diplomatic ceasefire initiative agreed by Assad’s allies Russia and Iran with Turkey which has backed the rebels. But a rebel group formerly affiliated with al Qaeda is not included in the truces and it has a small presence there.

Conditions in eastern Ghouta, besieged since 2013, had increasingly alarmed aid agencies even before the latest assault, as shortages of food , medicine , and other basic necessities caused suffering and illness.

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