AMMAN: Pro-government airstrikes and artillery fire on the rebel-held East Ghouta suburbs of Damascus left at least six hospitals “out of service” over the past 48 hours, as doctors say they are struggling to handle an influx of wounded residents.

At least one East Ghouta hospital was struck by missiles on Tuesday in the town of Zamalka, Dr. Waleed Awatah, the hospital’s director, told Syria Direct. The bombing destroyed part of the hospital, he said.

The previous day, pro-government airstrikes and artillery fire hit at least five other hospitals across the encircled enclave, according to reports by the Syrian American Medical Society (SAMS) and the France-based Union of Medical Care and Relief Organizations (UOSSM).

One anesthesia technician and a patient were killed on Monday when three airstrikes struck a hospital in East Ghouta’s Marj region, UOSSM reported.

A doctor and hospital administrator in East Ghouta described to Syria Direct how patients and medical staff were evacuated to basement shelters just “moments before a bombing” hit on Monday. He and other doctors asked that the names and locations of their hospitals not be published for fear that they could be targeted again.

Aftermath of bombing in Kafr Batna on Tuesday. Photo courtesy of Syrian Civil Defense-Outer Damascus.

As bombardment knocks medical facilities out of service, “there is more pressure on the remaining hospitals,” another doctor in East Ghouta, who also requested anonymity, told Syria Direct on Tuesday. “It is difficult to confirm the numbers [of extra patients], but today we are suffering from more pressure.”

A statement released by the opposition-run Outer Damascus Health Directorate called on East Ghouta residents to stay in basement shelters, now ubiquitous throughout the pocket, in order to avoid injury and “reduce pressure” on remaining medical staff and first responders.

At least 100 people were killed and hundreds of others wounded in East Ghouta on Monday alone, Siraj Mahmoud, a Civil Defense spokesman in East Ghouta told Syria Direct on Tuesday.

Heavy airstrikes and shelling were “ongoing” throughout the day on Tuesday, said Mahmoud. The spokesman accused pro-government forces of “systematically targeting” residential neighborhoods and hospitals.

Updated Civil Defense statistics for Tuesday’s airstrikes are not yet available, but the UK-based Syrian Organization for Human Rights (SOHR) reported that 194 people were killed in East Ghouta over the past two days.

In response to the carnage in East Ghouta, UNICEF released a mostly blank statement on Tuesday, with empty quotations. “No words will do justice to the children killed, their mothers, their fathers and their loved ones,” a brief explanation read.

Doctors treat a wounded child in Arbin on Monday. Photo courtesy of SAMS.

The bombardment on Monday and Tuesday is part of an intensification of a weeks-long pro-government airstrike and artillery campaign on East Ghouta. The bombing also comes as pro-government forces reportedly amass troops for a potential ground fight in the encircled enclave.

Social media posts by rebel groups inside East Ghouta reported “attempted attacks” by pro-government forces on the encircled enclave on Monday and Tuesday.

When asked for confirmation, spokesmen from the Jaish al-Islam and Failaq a-Rahman rebel militias said their forces had not engaged in direct ground battles with pro-government fighters.

Over the weekend, the Tiger Forces, an elite unit of the Syrian Arab Army (SAA), announced via Facebook it had amassed troops and weaponry in the Damascus suburbs, in preparation for the “largest military campaign” yet against rebels in East Ghouta.

By Tuesday afternoon, the Tiger Forces were reportedly shooting “artillery fire and missiles” on “terrorist positions” within East Ghouta, the unit said in a statement posted on Facebook.

Syria Direct reached out to the Tiger Forces via social media on Tuesday but received no comment by time of publication.