Beirut: Pro-government forces pounded the rebel-held district of eastern Ghouta outside the Syrian capital Damascus on Tuesday, in a surge of violence that a war monitor said had killed at least 250 people since Sunday night.

The Britain-based Syrian Observatory for Human Rights said it was the highest 48-hour death toll in the Syria conflict since a 2013 chemical attack on eastern Ghouta, the last major rebel bastion located near the capital.

The wave of air strikes, rocket fire and shelling has sparked international condemnation. France, a permanent member of the UN Security Council, described the bombardment as a serious violation of international humanitarian law.

There was no immediate comment from the Syrian military. Damascus says it only targets militants.

Recent violence in the besieged suburb is part of a wider surge in fighting on several fronts as President Bashar al-Assad’s military pushes to end the seven-year rebellion against him.

The Observatory said the bombardment had killed more than 106 adults and children in eastern Ghouta on Tuesday alone.

Panos Moumtzis, the United Nations’ humanitarian coordinator for Syria, on Tuesday condemned the bombing of five hospitals in eastern Ghouta and said intentional attacks on medical facilities ‘may amount to war crimes’.

US State Department spokeswoman Heather Nauert said Washington was ‘deeply concerned’ by the rising violence in Ghouta. ‘The Assad regime’s siege and starve tactics are ... adding to the humanitarian disaster there,’ she said.

Nauert said the United States supported a UN call for a month-long cessation of hostilities to allow for the delivery of aid and an emergency medical evacuation of civilians. She urged Russia to stop supporting the Assad government.

In Brussels, Syrian opposition leader Nasr al-Hariri - a delegation head at stalled UN peace talks - pleaded for more international pressure on Assad to stop.

In Geneva, the UN children’s agency expressed outrage at the casualties among the enclave’s children, saying it had run out of words.

Those killed since the escalation began on Sunday include 58 children. Another 1,200 people have been injured in the bombardment, the Observatory said.

Warplanes in the sky

Rescuers said the air raids created ‘a state of terror’ among residents in eastern Ghouta, where the UN says nearly 400,000 people live. The pocket of satellite towns and farms has been under government siege since 2013.

Factions in Ghouta fired mortars at Damascus on Tuesday, killing six people and injuring 28, Syrian state TV said. The army retaliated and pounded militant targets, according to the state news agency SANA.

The Syrian foreign ministry accused militants in Ghouta of targeting Damascus and using people as ‘human shields’. It said in a letter of complaint to the United Nations that some Western officials were denying the government’s right to defend itself.

The Civil Defence in eastern Ghouta, a rescue service that operates in rebel territory, said jets battered Kafr Batna, Saqba, Hammouriyeh and several other towns on Tuesday.

‘The warplanes are not leaving the sky at all,’ said Siraj Mahmoud, a civil defence spokesman in Ghouta, as the sound of explosions rang out in the background.

Mahmoud said that government forces bombed houses, schools and medical facilities, and that rescuers had found more than 100 people dead ‘in one day alone’ on Monday.

Reuters photos showed bandaged people waiting at a medical point in the town of Douma, some of them with blood streaming down their faces and their skin caked in dust.

Bombs struck five hospitals in the enclave on Monday, said the UOSSM group of aid agencies that funds medical facilities in opposition parts of Syria.