Fresh air strikes hit the Syrian rebel enclave of Eastern Ghouta on Tuesday killing at least 50 civilians as a ferocious regime bombing campaign entered its third day, a monitor said.
Twelve children were among the dead, said the Syrian Observatory for Human Rights, a Britain-based monitor of the war.
Tuesday's raids followed Eastern Ghouta's bloodiest day in three years.
At least 128 civilians, among them 39 children, were killed by air strikes or rocket or artillery fire on Monday, the Observatory said.
Held by rebels since 2012, Eastern Ghouta is the last opposition pocket around Damascus and President Bashar al-Assad is keen to retake it with an apparently imminent ground assault.
Al-Watan newspaper, which is close to the government, said on Tuesday that the bombing campaign "comes ahead of a vast operation on Ghouta, which may start on the ground at any moment."
Rebels based in the enclave often fire rockets and mortar rounds into residential neighbourhoods of east Damascus.
MORE THAN 700 KILLED OR INJURED NEAR DAMASCUS IN 36 HOURS
Over 700 civilians have been killed or injured in the last 36 hours in Syrian government shelling targeting the rebel-held Eastern Ghouta region - the highest toll since 2015 - a monitoring group said on Tuesday.
So far, "128 people have been killed, including 39 children, since the hysteric shelling started on Eastern Ghouta region," the Britain-based Syrian Observatory for Human Rights said.
Some 610 were injured, the watchdog added, saying it was the highest toll since 2015 in the rebel-held stronghold, located at the outskirts of the capital Damascus.
"I can tell you this was hell. We saw children dying in our hands due to serious wounds as they arrived late in the hospital," Mohammed, a doctor at one of the hospital inside Eastern Ghouta, told dpa.
He said at least four hospitals in the area were targeted on Monday evening.
"Why is the world still silent? This is not a film, this is reality," the doctor screamed, begging for help from the international community.
The area has been the target of weeks of strikes by government forces. It is one of the last remaining areas under rebel control and has been under siege by Syrian President Bashar al-Assad's forces for more than four years.
A total of 400,000 people in the region have been largely cut off from humanitarian aid and activists have warned that the situation is drastic, with food and medical supplies running out.
