Eastern Ghouta witnessed the bloodiest day in months on Tuesday when 80 civilians were killed in strikes
A fourth consecutive day of heavy government air strikes on neighbourhoods across Eastern Ghouta near Damascus killed at least 58 civilians, including 15 children, on Thursday, a monitor said.
Since Monday, at least 170 have been killed by Russian and Syrian warplanes in eastern Ghouta.
The head of the British-based Syrian Observatory for Human Rights (SOHR), Rami Abdel Rahman, said the strikes hit at least six different locations in the besieged district.
There were 125 people injured in the latest round of attacks on the rebel enclave, according to SOHR.
"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 told AFP.
"From 2011 until now, there has never been the level of bombardment we've seen in the last 96 hours."
We're rushing, doing the work that we're doing, but we can't get to everything
- Abu Mohammed Omar, Syrian Civil Defence Forces
The highest toll on Thursday was in the town of Jisreen, a neighbourhood in the enclave, where eight civilians were killed.
Two children and a woman were killed in the town of Saqba, the war monitor said.
In the aftermath of the raid on Saqba, an AFP correspondent saw damaged storefronts and streets littered with human remains and destroyed cars.
A man carrying his young daughter was screaming for an ambulance to take her to the nearest makeshift clinic.
Rescue volunteers were struggling to cope with back to back searches, after four days of consecutive air strikes.
Syrian rescue workers Abu Mohammad Omar told AFP the many volunteers were exhausted and overstretched after the continued bombardment of neighbourhoods across eastern Ghouta.
"We're rushing, doing the work that we're doing, but we can't get to everything," Omar told AFP.
"We can't keep up. We're trying as much as we can."
Eastern Ghouta, which lies just east of the capital Damascus, is controlled by rebel factions including Islamists.
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An estimated 400,000 people live under a government-imposed siege, which has made food and medicine nearly impossible to access.
Syrian government warplanes have ratcheted up their bombardment of Eastern Ghouta this week, leaving dozens dead and hundreds in need of medical care.
Wednesday's deaths followed the bloodiest day in months for Eastern Ghouta on Tuesday, when 80 civilians were killed in strikes.
In apparent retaliation, one person was killed in rebel mortar fire on the government-controlled part of the town of Harasta, according to state news agency SANA.