António Guterres. Picture: REUTERS
António Guterres. Picture: REUTERS

Douma, Syria — The Syrian regime rained rockets and bombs on Eastern Ghouta on Thursday, killing 19 civilians as international pressure mounted to stop the carnage in the rebel-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, António Guterres, 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. Small pools of blood dotted the way to the hospital, where most of the victims of the sustained rocket fire unleashed by government troops on Thursday were taken.

"The rocket fire hasn’t stopped this morning. Around 200 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 Eastern 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 ahead of a likely ground offensive to flush out Islamist and jihadist groups.

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 properties or inquire about their relatives and neighbours.

In the town of Hammuriyeh, a queue had formed outside a shop as hungry 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.

The indiscriminate bombardment and the strikes on medical facilities sparked global outrage but few concrete options emerged to stop the bloodletting.