An injured child following reported bombardment by Syrian and Russian forces in the rebel-held Eastern Ghouta, on January 6, 2018. (via @SiegeWatch)

The fighting in Eastern Ghouta, Syria is exacting a wretched toll on men, women and children living in the enclave besieged by government forces and loyalists and has become a microcosm of the brutality of the seven-year-long war ripping the country apart.

Ghouta, a suburb in Damascus has been under siege since 2013 and has been starved, bombed and become the scene of some of the fiercest fighting between military and paramilitary forces of President Bashar Assad’s and the rebel-jihadist coalition.

Since Russia’s entry into the conflict in 2015, their air force - not dissimilar to its conduct in the Chechen Wars - has been pummelling Ghouta's eastern districts in an effort to crush one of the rebels’ last strongholds in the country.

The use of chemical weapons multiple times including an attack in August 2013, which killed an estimated 280 civilians, has come close to sparking a direct international intervention by the United States and its allies. To this day, chemical attacks continue to be conducted with impunity.

The siege has starved its population with 11 per cent of children of Ghouta’s 393,000 civilians suffering from acute malnutrition and thousands more remaining in need of aid due to shortages in food, medical supplies and water. The number of those affected by trauma has skyrocketed with hundreds of thousands of residents 'battling mental scars of the war and siege.'

In 2018, the situation remains harrowing. The renewed barrage of bombings combined with in-fighting between rebels has left civilians sandwiched between two opposing forces fighting to the death. “The town has become a city of ghosts, and if you walk in it," says Raed Srewel, a journalist based in Douma."It is filled with the smell of death and blood.” Ghouta, like the rest of Syria's war zones, remains hell on earth.