More than 400 people have been killed in Eastern Ghouta, a monitoring group said, as Syrian government forces backed by Russian warplanes continued their aerial bombardment of the rebel-held area.

The Syrian Observatory for Human Rights said on Thursday that at least 403 people were killed in the "hysterical attack" that began on Sunday, including 150 children. Almost 2,120 others were wounded.

UN special envoy for Syria, Staffan de Mistura, stressed the urgent need for a ceasefire in comments made before Thursday's UN Security Council meeting.

"The humanitarian situation in Eastern Ghouta is appalling and, therefore, we need a ceasefire that stops both the horrific heavy bombardment of Eastern Ghouta and the indiscriminate mortar shelling on Damascus," he said.

He added the ceasefire needs to be followed by immediate, unhindered humanitarian access and a facilitated evacuation of wounded people out of Eastern Ghouta and warned against this being a repeat of Aleppo.

Living under bombardment

Residents of Eastern Ghouta, the majority of whom are internally displaced, say there is nothing they can do and nowhere to hide.

Rafat al-Abram lives in Douma and is a car mechanic. The air attacks over the last few days have disrupted his job as the street he works on was destroyed by two raids.

"I managed to get some of my tools and equipment out, and fix cars whenever I can," he told Al Jazeera.

"Sometimes I also fix the ambulances of the civil defence, which break down often because of their constant use."

His wife and two teenage daughters, Khadija, 17, and Ola, 15, remain at home. They start their day by sitting together before al-Abram visits his neighbours to get the latest grim news.

"Sometimes a bombing takes place near where I am working, which means I have to stop and hurry to help the civil defence pull victims from the rubble," he said.

After al-Abram returns home, he says he is haunted by the unbearable scenes he witnessed during the day.

"Seeing a father or mother wailing and crying over their dead children, or a father carrying his son who has one leg amputated, or another screaming at God and then at people to help save his family who are all lying under the rubble of a building … I try to comfort them even though I want to sit and cry with them from the horror of what is happening all around us," he said.

'Survive or die together'

Rebel-controlled Eastern Ghouta, a mostly rural area on the outskirts of the capital Damascus, has been under government siege since 2013. About 400,000 Syrians live there. The siege has resulted in huge inflation of the cost of basic foodstuffs, a bag of bread now costs the equivalent of $5.

Malnutrition rates have reached unprecedented levels, according to the UN Office for the Coordination of Humanitarian Affairs, with 11.9 percent of children under the age of five acutely malnourished.

Only one aid convoy was permitted inside the area in February, to the town of Nashabieh, but none were allowed in January and December.

Nisma al-Hatri told Al Jazeera her husband and 10-year-old daughter Sara wake up to the sound of warplanes.

"Every day goes like this: bombings, then I clean the house from the effect of the nearby shelling, then we hide in one room, attempting to survive or die together," Hatri said.

"My daughter Sara and I wake up with our arms around each other from the night before," al-Hatmi continued. "We all sleep on one mattress. She hugs me and asks me why she can't go out to play, or to school or to see her friends. I cannot answer her."

The 32-year-old used to be a teacher, but schools were shut down a month ago because the situation grew too dangerous to go outside. Nevertheless, Hatmi still gives lessons to Sara and other neighbourhood children on an almost daily basis.

Her husband goes out every morning for several hours and returns with barley, which Hatmi cooks with rice for their breakfast and dinner. Some days her husband returns empty-handed.

'War against civilians'

Mahmood Adam, a member of the Syrian Civil Defence, described to Al Jazeera the reality of Eastern Ghouta as "disastrous".

"We are talking about a systematic targeting of civilians in their homes, schools, medical centres, marketplaces, and civil defence sites," he said. "This is an extermination of the society in this area."

"There are families who have been hiding in basements and underground shelters who haven't seen the sun in days for fear of the brutality of the regime and the Russian warplanes," he continued.

"We don't know whether we will be alive to tell the world what is happening in the next hour or day. The rocket launchers are relentless, and the warplanes have not left the skies of Eastern Ghouta since Sunday.

"Everyone here knows this is a slaughter and a crime against humanity," he added. "This is a war against civilians."

Targeting medical centres

Speaking from the Turkish border city of Gaziantep, Al Jazeera's Osama Bin Javaid said doctors in Eastern Ghouta are saying the circumstances are "beyond words".

"What they see is body after body arriving in makeshift clinics," Bin Javaid said. "[They are] trying to give medical aid to the people who are in their hundreds being wounded in a relentless barrage of rockets, shells, and air raids.

"They are running out of medical assistance and places to put these people because at least 22 facilities, according to the Syrian American Medical Society, have been targeted since Sunday," he said.

Ahmed al-Masri, spokesman for the Union of Free Syrian Doctors, told Al Jazeera that government forces are attempting to destroy "every aspect of civilian life".

"The regime's forces are using the most ferocious means of bombardment," he said. "As a result, many of the hospitals and medical facilities in Eastern Ghouta were directly hit and destroyed.

"Three of our medical centres were shelled and destroyed, and one of our crews was killed and three others wounded."

No consensus on ceasefire

Meanwhile, the UN Security Council failed to reach an agreement on a resolution put forward by Sweden and Kuwait that called for a 30-day cessation of hostilities to allow aid delivery and the evacuation of civilians from besieged Eastern Ghouta.

Russian UN ambassador Vassily Nebenzya said there was "no agreement" and presented amendments to the draft resolution "for it to be realistic". He also accused the Syrian Civil Defence, also known as the White Helmets, of being "closely affiliated with terrorist groups".

The Syrian ambassador to the UN, Basher al-Jaafari, accused the UN and mainstream media of backing "terrorists recruited by the US from all over the world" to fight in Syria.

Al Jazeera's diplomatic correspondent James Bays said Jaafari's comments were typical of a man who has "stoutly defended his government and whatever it does".

"He is representing a government that is breaching international law - effectively many would say carrying out war crimes," Bays said, speaking from the UN headquarters in New York.

"He's very much supported diplomatically by Russia. They helped the Syrian government turn the tide of the war in the last two years, and they are now helping do whatever it takes to win the war."



