At least 20 civilians have died in a resumption of bombing on Douma, the largest town in shrinking rebel-controlled pockets of Syria's Eastern Ghouta, a monitor said Monday.
Thirteen were killed late Sunday in air strikes and artillery fire on the battered town, and another seven were killed Monday morning, according to the Syrian Observatory for Human Rights.
The fresh bloodshed came after a week-long lull in the bombardment of Douma after negotiations between rebels and regime-backer Russia allowed medical evacuations from the town.
After the bombing an AFP correspondent saw two rescue workers scouring mountains of rubble in the dark with tiny flashlights, searching for survivors.
A third lifted a wounded person, who was screaming in pain, onto his back.
As morning broke, the sounds of shelling could still be heard across the city. Entire buildings had been gutted by strikes, with a drying rack, glass, and plastic piping spilling out into the streets.
Several members of a single family remained stuck underneath a collapsed building all night, including a handicapped mother, her son, and her grandson, AFP's correspondent said.
Syria's government has pressed a ferocious month-long air and ground on Ghouta in a bid to clear the last rebel bastion on the capital's outskirts.
More than 1,400 civilians including 281 children have been killed, according to the Britain-based Observatory.
Troops have captured more than 80 percent of the enclave and split the remaining rebel territory into three pockets, with Douma in the northernmost zone.
Talks between regime ally Russia and the rebel group which holds Douma, Jaish al-Islam, had resulted in a brief respite for the town.
During the lull, hundreds of people including sick and wounded were evacuated from Douma to government-controlled territory.
Syrian troops and allied militia are also pressing their assault on other parts of the enclave, with government air strikes killing five civilians in another zone on Monday, according to the Observatory.
The deadly raids came as more than 4,000 civilians fled a southern pocket of Ghouta.
The Observatory says nearly 70,000 people have escaped Ghouta in recent days to government-held zones, using "corridors" opened by Syria's army.
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