#Douma three days ago Searching for survivors under rubble after several airstrikes on #EasternGhouta #WhiteHelmet: image via Mohammed Badra @badramamet, 9 February 2018

#Now Assad's warplanes targeted civilians by several air raids on the #EasternGhouta near #Damascus #IsraelF16Fall: image via Amer_almohibany @amer_almohibany, 10 February 2018

Plumes of smoke billow over the rebel-held Syrian town of Erbin on February 7, 2018 as air strikes pummel the Eastern Ghouta enclave: photo via AFP News, 9 February 2018

Air strikes batter Syria rebel enclave for fifth day: Hasan Mohammed with Maya Gebeily in Beirut, AFP News, 9 February 2018

Fresh bombardment hit the Syrian rebel enclave of Eastern Ghouta on Friday, AFP correspondents reported, the fifth straight day of a bombing campaign that has killed more than 240 civilians.

Syrian warplanes and artillery have battered the enclave's towns since Monday, trapping thousands of families in makeshift bomb shelters and overwhelming rescue workers.

World powers failed to back an appeal by UN officials for a month-long ceasefire to allow for desperately needed aid deliveries and medical evacuations.

Bombardment resumed on several Eastern Ghouta towns on Friday morning, killing 13 civilians, according to the Syrian Observatory for Human Rights, a Britain-based war monitor.

At least six were killed in Douma, including two children.

"There were eight families living in this neighbourhood," said Abu Ezzo, a 29-year-old resident of Douma.

"The airplane hit the houses, and every single resident came out either wounded or dead," he said.

One of the raids hit Douma's local civilian council, starting a fire on the upper levels.

Multiple strikes also killed seven civilians in Erbin, where medics reported being overwhelmed by the relentless bombardment.

Friday's toll was less than on previous bloody days, but it put the week's deaths at more than 240 including 60 children, according to the Observatory.

Aid workers 'all alone'

Eastern Ghouta is home to an estimated 400,000 people who have lived under crippling government siege since 2013.

More than 4,000 families live in basements and bunkers for fear of air strikes.

Relief organisations on Friday warned that the intensity of the air strikes was hampering life-saving aid operations.

"Our partners are having a hard time moving around, so how can they reach vulnerable people?" asked Joelle Bassoul, CARE International's communications director for Syria.

"If there is no ceasefire, if this is all left unheard, we cannot imagine the scale of the humanitarian disaster," she said.

Mercy Corps said members of its local relief partners have been killed in bombardment in recent months.

"People are dying and aid workers trying to help them are dying also. These Syrian aid workers are all alone -- they are the only ones trying to help their communities," said senior communications officer Christy Delafield.

"This is a de-escalation area, but this is some of the worst violence we've seen in what's now going on eight years of conflict," she told AFP.

Eastern Ghouta is ostensibly included in a "de-escalation" deal reached last year in an attempt to reduce the bloodshed.

UN aid officials appealed this week for a month-long humanitarian truce to allow aid to be delivered and the sick and wounded brought out for treatment.

But the Security Council on Thursday failed to support the proposal, with long-time regime ally Moscow dismissing it as "not realistic".

Russia says the rebels in Eastern Ghouta are "terrorists", and has previously backed Syrian government offensives against them.

'Unbearable deterioration'

On Friday, French President Emmanuel Macron asked his Russian counterpart Vladimir Putin to help ease civilian suffering in the enclave.

Macron urged Putin "to do everything so that the Syrian regime puts an end to the unbearable deterioration in the humanitarian situation in Eastern Ghouta", a statement said.

As it is last rebel-held district on the capital's doorstep, the government is more determined than ever to clear Eastern Ghouta, said Nick Heras, an analyst at the Center for New American Security.

"This strategy of laying siege to the Ghouta is at its basic element a strategy of collective punishment, of making the entire population of the area suffer for its choice to rebel against Bashar al-Assad and his regime," he told AFP.

Syria's conflict began with widespread protests against Assad's rule in 2011, but a crackdown on demonstrations paved the way for a complex war drawing in world powers.

The US-led coalition on Thursday said it hit forces allied to the Damascus regime in eastern Syria and that at least 100 pro-regime fighters were killed.

US Defence Secretary Jim Mattis said the coalition acted in self-defence after pro-Damascus forces moved on an area under the control of the US-backed Syrian Democratic Forces.

The Syrian foreign ministry condemned the bombardment as a "war crime" against its forces fighting the Islamic State (IS) group, an accusation echoed by the Russian ambassador to the UN.

Eastern Ghouta. Map of Damascus locating areas of the besieged rebel enclave in Eastern Ghouta hit by regime strikes since February 1.: image via AFP News, 9 February 2018

A family runs for cover through the dust cloud kicked by an air strike on the rebel-held Syrian town of Jisreen, on February 8, 2018: image via AFP News, 9 February 2018

Wounded pro-regime fighters receive treatment in the Syrian city of Deir Ezzor on February 8, 2018 after US-led air strikes which Russia described as "criminal".: photo by AFP, 8 February 2018

3 Russian airstrikes have completely destroyed my warm childhood house: image via Firas Abdullah @firasabdullah, 10 February 2018

We (people live in #EasternGhouta) say to world: Any interference in the holocaust is welcome. #SaveGhouta @amer_almohibany: image via Amer_almohibany @amer_almohibany, 10 February 2018

Assad's wife (asmaa assad) published pictures of rockets that kill our children in the #EasternGhouta and wrote : "be safe our country's guards". This is shameful. #syria: image via Amer_almohibany @amer_almohibany, 10 February 2018

#Israel reiterates demand that #Iran troops and allied fighters like Hizbullah should not be close to its border - Israel ambassador to Russia said: they should withdraw from deescalation zone in southern #Syria: image via Amer_almohibany @amer_almohibany, 10 February 2018

One outcome of the #Israeli attack against Assad earlier this morning, that No airstrikes have hit #EasternGhouta today so far - I’d pray that Israel do more - despite they are war criminals as well - But this is having effect on Syrian lives - at least for today.: tweet via Zouhir_AlShimale @ZouhirAlShimale, 10 February 2018

The #Russians who are number one ally of #Israel and who supported Assad regime with S-400 Air system have allowed Assad to hit their ally (Israel)!!!! for what sake!? Is Assad priority for Russians more than Israel - Of course not. What a show seriously! #F-16: tweet via Zouhir_AlShimale @ZouhirAlShimale, 10 February 2018

Today's escalation between the #Israeli army and the Syrian army of civilians may have saved hundreds of children in the #EasternGhouta from daily death under rubble by airstrikes of the Assad regime warplanes. #Syria #IsraeliF16Fall: image via Amer_almohibany @amer_almohibany, 10 February 2018

The Israeli army: The raids targeted 3 Syrian air defense batteries and 4 Iranian targets near #Damascus #IsraeliF16Fall.The report came after the Israeli military said one of its fighter jets had crashed during strikes against "Iranian targets" in Syria after intercepting a drone.: image via Amer_almohibany @amer_almohibany, 10 February 2018

Again, Israeli airstrikes on a military factory in Aleppo countryside. It seems it's going to escalate between Assad and Israel if Russia will not manage it.: tweet via Amer_almohibany @amer_almohibany, 10 February 2018

More than 235 people got killed in #EasternGhouta since the beginning of this month injured #Children receive first aid in a hospital after a bombing in #Douma, #EasternGhouta @epaphotos @Guardian: image via Mohammed Badra @badramamet, 10 February 2018

6 yr old Yehya who was injured after a cluster bomb exploded near him a day earlier, lies in a hospital in rebel-held #Douma #Syria Photo @badramamet @epahotos: image via Sunday Times Pictures @STPictures, 2 February 2018

An ambulance from the Damascus countryside field hospital brought in dozens of women and children wounded in today's bombing of Douma, with injuries ranging from severe to moderate to be transferred to surgical departments and intensive care #RevolutionSyria #Syria #Damascus #Douma: image via Douma Medical @Doumamedical, 9 February 2018