A fourth consecutive day of heavy regime air strikes on the militia-held enclave of Eastern Ghouta near Damascus killed 40 people and injuring 125 more, on Thursday, the Syrian Observatory for Human Rights, a Britain-based war monitoring group, reported.
The head of the Britain-based Syrian Observatory for Human Rights, Rami Abdel Rahman, said the strikes hit at least six different locations in the besieged district.
The observatory reported 200 dead as toll kept rising over four days of raids on Ghouta.
The highest toll was in the town of Jisreen, where eight civilians were killed.
Two children and a woman were killed in the town of Saqba, the war monitor said.
In the aftermath of the raid on Saqba, an AFP correspondent saw damaged storefronts and streets littered with human remains and destroyed cars.
A man carrying his young daughter was screaming for an ambulance to take her to the nearest makeshift clinic.
Eastern Ghouta, which lies just east of the capital Damascus, is controlled by militant factions including Islamists.
An estimated 400,000 people live under a suffocating government-imposed siege, which has made food and medicine nearly impossible to access.
Syrian government warplanes have ratcheted up their bombardment of Eastern Ghouta this week, leaving dozens dead and hundreds in need of medical care.
Regime bombing raids left 38 civilians dead on Wednesday, the Observatory said in a new toll.
It came on the heels of the bloodiest day in months for Eastern Ghouta on Tuesday, when 80 civilians were killed in strikes.
In apparent retaliation, one person was killed in rebel mortar fire on the regime-controlled part of the town of Harasta, according to state news agency SANA.