'This is a war of extermination' - violence surges in Syria as families take to basements in attempt to survive
After 48 relentless hours of air strikes and artillery shells, Bassem made the reluctant decision to move his family into the basement of their building, even though he knew it could not protect them.
His baby son was two weeks old and his wife too weak and malnourished to breastfeed him. Bassem, a 33-year-old anaesthetist at one of eastern Ghouta's few beleaguered hospitals, worried about their health in the poorly ventilated basement.
Deep down, he knew the makeshift shelter would not hold if it sustained a direct hit with a barrel bomb or rocket.
"It is not a good place for them. It is not healthy, it is not equipped, it is too cold.
"And I know it isn't safe if it is hit by a missile. But what else can we do?" Bassem said. "This is a war of extermination."
Around 400,000 people - half of them children - are trapped in eastern Ghouta as the regime and its Russian allies intensify their air strikes in preparation for what many expect will be a final assault in the coming weeks.
More than 200 civilians have been killed since Sunday in the most intense bombardment in years, according to the Syrian Observatory of Human Rights.
At least 57 children are among the dead, the group said, including 15 who were killed yesterday alone.
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Amnesty International has said "war crimes on an epic scale" are being committed in the rebel-held suburb of Damascus, while the Syrian opposition called the offensive "a bloodbath of innocent women and children".
In the northern district of Douma, a weary doctor described the frantic effort to treat a seemingly endless stream of bomb victims. A desperate shortage of supplies meant he and other medics reuse disposable medical equipment and dispense expired medicine.
"There are cases where we find someone we thought was dead and they turned out to be alive," the doctor said, speaking on the condition of anonymity.
"A baby of 20 months was brought in after an air strike. He was blue and he wasn't breathing but his heart was working.
"I opened his mouth and I found his throat was completely full of sand, back to his tonsils."
The doctor scooped sand from the infant's mouth until there was space in his throat for a respirator. The boy began to breathe but it is still not clear if he will survive. The air strike killed his mother and two siblings.
As a coalition of Islamist rebels fight to repel the advance of regime fighters and Iranian-backed militias, thousands of families are sheltering in basements. Their makeshift bomb shelters usually have no electricity nor running water.
When a bomb falls nearby, a volunteer must venture on to the street to clear rubble from the pipes which provide ventilation. Often dozens of people share a few buckets as lavatories.
Abu Abdelrahman moved his family into one of the basements 16 days ago after their home was destroyed.
He is responsible for his wife and three children but also his brother's widow and son, after his brother was killed in a regime prison at the start of the war.
"I feel suffocated down here but we are lucky because some people have no basement to hide in," said Mr Abdelrahman.
"We're just breathing but this is not living. The situation is worse than your imagination."
Even amid the horror of the bombardment and the darkness of the basements, children in eastern Ghouta, many of whom have never known life outside the siege, still laugh and shout and play games and cling to life.
A video from one shelter showed a little boy clutching a red balloon that he had found somewhere in the ruined city. His friend made faces at the camera.
As the bombs and rockets fell outside, a man named Haitham held his four-year-old son Elias close and whispered stories to try to ease his fear.
"You would think I'd tell him about Laila the Wolf or Sleeping Beauty," he said. "But I tell him stories about how bananas taste, or what a playground looks like, or how we used to go to restaurants just a few kilometres from here in Damascus.
"Our children were born into this situation.
"They have never known anything but bombardment and starvation and destruction and murder."