Two weeks ago, Mouaz Khaboutily, a Syrian photographer who works with an anti-government group, called me from the rebel-controlled Damascus suburb of eastern Ghouta. Khaboutily had sheltered in a bunker as Syrian and Russian forces launched an offensive to retake the enclave of nearly four hundred thousand people. During what he hoped was a pause in the fighting, he risked a trip to the street in order to find Internet access and see if the U.N. Security Council had brokered a ceasefire. “I’d be a liar if I said this is not dangerous,” the twenty-eight-year-old told me over WhatsApp. As he stood on the street, warplanes began flying overhead. After two minutes, we agreed that he should hang up and find shelter. The warplanes had dropped bombs four times while he was on the phone—one, he estimated, was just two hundred yards away.

In the last two weeks, one thousand and forty-two people, including about a hundred and fifty-six children, have been killed in eastern Ghouta, in what human-rights groups fear is a final, all-out offensive to retake one of the few remaining rebel-held enclaves in the country. Bombings by Syrian and Russian planes have been indiscriminate, killing civilians, levelling homes, and destroying medical facilities. Bashar al-Assad’s regime—with the full support of Vladimir Putin and the Russian military—have flouted calls for a complete ceasefire.

More than thirty medical facilities in eastern Ghouta and other parts of the country have been struck by Syrian and Russian air strikes since mid-February, and many of them are no longer functioning, according to Violations Documentation Center, a human-rights organization founded by opposition activists in Syria. “They’re using weapons that are guided, unlike barrel bombs,” Mona Zeineddine, a London-based spokeswoman for the group, told me. “If a town or village loses its hospital, and given how hard it is to commute between towns, it’s devastating to the people.”

A thirty-eight-year-old school teacher, who asked to be called Sarah, said that, in the initial days of the bombardments, she and ten members of her family, including five children, lived in one room in their house. At first, they prepared to live in the basement of their building, filling it with clothes, papers, shoes, and food. On February 24th, the U.N. Security Council passed a resolution that called for a thirty-day ceasefire. At 11 A.M. the next day, Sarah heard the sound of a plane. “It was obvious that ceasefire is a big lie,” she later wrote to me, in an e-mail. “The planes hit a village . . . . We knew they would return to hit other cities in Ghouta.”

When night fell, Sarah and her family decided to flee to a nearby basement that they hoped would be safer. To ensure the survival of some family members, they divided into three teams taking separate routes. When one missile fell, and then another, and another, they took shelter. “A missile hit the roof of the building where we were hiding, and the children cried more and more,” she wrote. “We decided to run: whatever happens, never stop . . . . We ran, missiles came again, a child fell down. I carried her and kept running.”

They finally made it to the basement, but it reminded her of one of “the regime’s prisons.” “There were about a hundred persons in a 150-square meter basement,” Sarah wrote. “No lighting, no water, no food, even no place to have a nap.”

One day, a local organization came to offer food to the people inside. They brought cooked rice—a total of one and a half kilos. “I looked at the man in charge of distribution and said there are a hundred people inside,” she wrote. The man told her to distribute the rice to the fifty children. Sarah gave each of them three small spoonfuls of rice. “They were waiting for food, and when they discovered the real amount, they couldn’t help their tears.”

Seven years ago, the towns of Douma, Kafr Batna, Saqba, and Harasta, in eastern Ghouta, were the sites of some of the first mass protests against Assad. The regime gradually lost control of the area in 2012, and civilians created local councils that provided municipal services. The following year, the Syrian regime began blocking the flow of food, medicine, and aid to the region. Hundreds died from lack of medical care or malnutrition, and those that survived paid exorbitant prices for rice, wheat, and other necessities. In August, 2013, in one of the most brutal acts of the war, the government attacked the suburb with sarin gas, killing an estimated fifteen hundred people. Popular support for the insurgent groups operating inside the area grew. Jaish al-Islam, an Islamist group, and Failaq al-Rahman, an offshoot of the Free Syrian Army, eventually emerged as the two most powerful opposition factions, and now rule most of eastern Ghouta.

Bayan Rehan, a member of a local council in the besieged city of Douma, told me in a recent phone interview that she had not eaten for sixteen hours. “Life has stopped,” she said. “Nobody dares walk on the street. It’s raining rockets.” Venturing onto the streets to find food, she said, was “a suicide mission.” That day, no wheat was available in the local market. Aid groups say the cost of a kilo of flour in eastern Ghouta is two thousand per cent higher than in government-controlled Damascus.

On February 25th, Rehan and other opposition officials rushed to Douma’s local-council office after a suspected chlorine attack. A man had brought the body of his young son, who had died from suffocation. “I was shocked when I saw the dead body covered with a silk blanket,” she wrote. “The shrouds have run out in a city where we bury lots of people every day.” Rehan asked the father to give testimony about what happened, but he refused. He was in the office only to get help finding other members of his family, who were in a shelter. He wanted the boy’s mother to be able to say goodbye to her son before he was buried.

On Monday, Syrian officials allowed an aid convoy to enter eastern Ghouta for the first time since the offensive began. At a checkpoint along the way, government officials confiscated medical supplies, insulin, and surgical equipment from the trucks. After the convoy arrived, U.N. officials were given only a few hours to unload the forty-six trucks, before being ordered to leave. Nine of the trucks returned full. During and after the delivery, the bombing of opposition areas continued, according to Rehan, who accompanied the U.N. convoy in Douma. “The shelling in the cities was more intense than ever,” she said. By the end of the day, attacks by Syrian and Russian forces had killed nearly a hundred people.