Sunday’s airstrikes on a busy market near Damascus which killed more than 100 civilians and injured nearly 500 were devastating but not in the least surprising.

These attacks on Sahat al-Ghanem market in Douma in Eastern Ghouta are but the latest in a long series carried out by Bashar al-Assad’s regime on opposition-held areas. Time and again, the Syrian government’s Russian-made fighter jets have targeted busy public spaces, including markets or near mosques after prayers, seemingly hell-bent on causing the maximum possible civilian death toll and destruction of the places they frequent.

Only last Wednesday Amnesty International issued a report, ‘Left to Die under Siege’: War crimes and human rights abuses in Eastern Ghouta, Syria’ in which we documented more than a dozen such airstrikes in which the overwhelming number of victims were civilians. With no military targets present or in the vicinity, most attacks appear to have directly targeted civilians: war crimes, of course.

The very same day of the report’s publication, the regime’s aircraft attacked this same market in Douma, as well as the markets in the neighbouring towns of Hamouriya, Kafr Batna and Saqba. There were dozens of casualties. These locations are all in areas under the control of armed groups opposed to the rule of Bashar al-Assad and these patterns of attack indicate that his forces wish to terrorize the local population and make life as painful as possible for everyone living there.

On Sunday, four airstrikes were reported on Douma’s market in the space of 10 minutes. So no sooner did locals and emergency services rush to the scene then they were struck yet again; easy soft targets for the state-of-the-art fighter jets above. Again, a familiar pattern.

...no sooner did locals and emergency services rush to the scene then they were struck yet again; easy soft targets for the state-of-the-art fighter jets above. Neil Sammonds

The local medical facilities are completely overwhelmed. A senior medical worker told Amnesty International that they have a desperate shortage of intensive care equipment, of blood bags, of liquids, antibiotics, anaesthetics and staff. “Most operations are carried out by students,” he said.

One local human rights activist I’ve known and trusted for more than a decade told me that even to send an ambulance to pick up injured people and take them to whichever makeshift field hospital to try to accommodate them needs more fuel than the average resident’s monthly salary could cover.

Douma and Eastern Ghouta have been besieged by government and allied forces for several years, causing severe shortages of basic foods and medicines, with more than 200 people believed to have died as a result. The use of starvation as a weapon is also a war crime.

Yet despite such agonizing widespread suffering and appalling wanton bloodshed, the international community is still hamstrung at the United Nations Security Council and elsewhere. How many more times will mass graves be filled with Douma’s civilians before the world takes meaningful action?

How many more times will mass graves be filled with Douma’s civilians before the world takes meaningful action? Neil Sammonds

The situation in Syria is long overdue for being referred to the prosecutor of the International Criminal Court. In addition, all states should employ universal jurisdiction to apprehend anyone crossing their territories who may be suspected of having committed war crimes and other serious abuses in Syria’s conflict. Russia and Iran must stop fuelling the regime’s atrocities and similarly others must use their influence to rein in abuses by armed groups, including the group calling itself the Islamic State.

Until we see movement in these areas Amnesty International and others will continue to document such horrific war crimes and it gives no comfort at all to say “We told you so”.

Note: This piece also appeared in The Huffington Post.