Heavy Syrian military airstrikes and rocket attacks on a Damascus suburb have killed nearly 100 people and wounded close to 500 since Sunday, a Syrian monitoring group says.

The Syrian Observatory for Human Rights says a large number of civilians, including children, are among the victims in eastern Ghouta.

The Syrian military has launched an all-out operation to retake eastern Ghouta. It is one of the last areas near Damascus still in the hands of rebels and Islamic militants looking to topple the Assad government.

The observatory says the air operation is aimed at paving the way for a ground offensive.

The fighting in eastern Ghouta was supposed to have de-escalated under a ceasefire brokered between Russia, Turkey and Syria. 

Instead, the region is seeing what U.N. official Panos Moumtzis calls an “extreme escalation of hostilities.”

“The humanitarian situation of civilians in east Ghouta is spiraling out of control. Many residents have little choice but to take shelter in basements and underground bunkers with their children.”

Residents and aid workers say almost no food and relief is getting through.

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