Four days of ferocious Syrian government raids on the rebel-held enclave of Eastern Ghouta have killed more than 200 civilians, a war monitor said on Thursday.
Syrian government troops have since Monday waged an intense air campaign on Eastern Ghouta, the only significant opposition pocket near the capital Damascus.
Bombardment on Thursday alone killed 58 civilians including 15 children, according to the Britain-based Syrian Observatory for Human Rights.
The deadliest strikes hit a market in the town of Erbin and killed 21 civilians including nine children.
"These are the worst four days that Eastern Ghouta has ever gone through," said Hamza, an overwhelmed doctor at the local Erbin clinic who was treating wounded patients.
"From 2011 until now, there has never been the level of bombardment we've seen in the last 96 hours."
He described seeing shell-shocked children brought in to the clinic, sitting in silence even though they were badly wounded.
"As a doctor, the hardest thing you can do is to treat your loved ones, your colleagues, your neighbours, your relatives," Hamza said, breaking down.
Syrian government warplanes have ratcheted up their bombardment of Eastern Ghouta this week, leaving dozens dead and hundreds in need of medical care.
Regime bombing raids left 38 civilians dead on Wednesday, the Observatory said in a new toll.
It came on the heels of the bloodiest day in months for Eastern Ghouta on Tuesday, when 80 civilians were killed in strikes.
Jisreen was also hit heavily, with 17 civilians killed on Thursday.
An AFP correspondent there said the strikes hit near a school, a market and a mosque, leaving vegetable stalls overturned and damaged.
Rescue teams rushed to Jisreen and pulled three children and a woman out of the rubble.
Moayad al-Hafi, a rescue worker, said his team was hit in a double-tap strike as they were pulling bodies out in Jisreen, which is near Erbin.
"As we were pulling out the children and the dead from under the rubble, they targeted us with five rockets -- directly targeting us," said Hafi, 24.
Eastern Ghouta, which lies just east of the capital Damascus, is controlled by rebel factions including Islamists.
An estimated 400,000 people live under a suffocating government-imposed siege, which has made food and medicine nearly impossible to access.
In apparent retaliation, one person was killed and five people wounded in rebel mortar fire on the regime-controlled part of the town of Harasta, according to state news agency SANA.
Most of the other rebel-controlled territory surrounding Damascus has been recaptured by government forces either through military operations or local truce agreements.
Eastern Ghouta is ostensibly included in a "de-escalation" deal that is meant to tamp down violence in a handful of areas across the country, but the bloodshed has escalated dramatically this week.