Rescue volunteers from the Syrian Civil Defence Forces (SCD), also known as the White Helmets, told MEE that the Syrian government continued to launch air strikes and shell the rebel enclave for "30 hours straight".
Forty-five civilians, including 12 children, were killed by air strikes and shelling from the Syrian government on Tuesday morning, according to the UK-based Syrian Observatory for Human Rights.
Four people were also killed in ground attacks in Saqba town, while three others were killed in an airstrike in Cisrin town, the sources added on condition of anonymity due to safety concerns.
Ghouta has not seen a single humanitarian aid convoy for two months.
An estimated 350,000-400,000 people live in Eastern Ghouta, including 1,000 in urgent need of medical treatment.
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Turkey warned that it would open fire on regime forces if they sided with the Kurds, raising the prospect of the most direct confrontation between Turkish and Syrian troops since the start of Syria's war in 2011.
Eastern Ghouta falls under ceasefire plans for rebel territory that Russian Federation has brokered with the help of Turkey and Iran.
"The humanitarian situation of civilians in East Ghouta is spiraling out of control".
Since anti-government and fundamentalist fighters occupying Damascus suburbs have reached such agreements and been transported to Idlib, the government's objective is to exert military pressure on Eastern Ghouta's holdouts to follow their example. They said that events in their suburb are playing out similarly to the 2016 offensive in Aleppo, when rebels and ISIS militants were expelled by a government offensive that reduced much of the city to rubble. "The sheer intensity of airstrikes is leveling the city, and killing civilians without any regard or mercy", Zedoun Al Zoebi, CEO of the Union of Medical Care and Relief Organizations, said in a statement Monday. As many as 5.4 million Syrians have left their country, the UN Refugee Agency said, and 6.1 million are displaced from their homes but still inside Syria.
The area is made up of 22 communities.
"Today is truly a nightmare for the people of Eastern Ghouta".