Human rights monitor Syrian Observatory for Human Rights said on Tuesday that 194 civilians had been killed and 850 injured in Eastern Ghouta region since Sunday night, BBC reported. Fresh strikes on Tuesday led to a rise in the toll after government forces trying recapture the rebel-held region bombed the area.

Of these, 127 were killed on Monday. First responders from the Syria Civil Defence, a rescue services organisation, said air and artillery strikes on the town of Marj left 24 people dead on Tuesday. Another 10 civilians died in air strikes on Arbin and Misraba, the group said.

More than 20 children have also died in the bombing of Eastern Ghouta, which is home to 4,00,000 people and the last opposition-held enclave near Damascus. On Tuesday, the United Nations Children’s Fund issued a blank statement in protest against the child casualties.

Over 300 civilians have been injured in air raids and artillery firing on Monday, the Syrian Observatory for Human Rights said earlier on Tuesday. Medical organisations said at least four clinics and hospitals, including a maternity centre, were bombed, The Guardian reported.

While the Syrian military has not commented, the government said it only targets militants. “The heavy shelling targeted mainly residential areas in Eastern Ghouta,” Rami Abdel Rahman, head of the Syrian Observatory for Human Rights, told the dpa news agency.

Ahmed al-Dbis, a security official at the Union of Medical and Relief Organisations called the bombing “hysterical”. “It is a humanitarian catastrophe in every sense of the word,” he added.

United Nations Regional Coordinator Panos Moumtzis said the humanitarian crisis in East was out of hands now. “Many residents have little choice but to take shelter in basements and underground bunkers with their children.”

He added that it was imperative to end “this senseless human suffering” immediately. “Such targeting of innocent civilians and infrastructure must stop now,” he said, according to Al Jazeera.

The Syrian government and its allies Russia, Iran and Turkey classified Eastern Ghouta as a de-escalation zone in 2017, but strikes in the region have continued.