At least 100 civilians, including 20 children, were killed in massive fighting in Syria’s rebel-held Eastern Ghouta, evidence of major escalations on the part of dictator Bashar Assad’s regime.

The area has been held by rebels for the last five years.

The United Nations issued a warning that Assad’s targeting of civilians with airstrikes, missile fire and artillery in the area “must stop now.”

The town of Douma also experienced shelling, with journalists reporting young children being rushed to the hospital.

Estimates from last year placed the total deaths from the Syrian civil war from between 350,000 to 480,000 since 2011, following protests against Assad’s government that ended in arrests and killings.

Over the past five years, Israel has admitted some 4,071 Syrians affected by the war to Israeli hospitals for free treatment. In the last year, Israel has treated more than 1,000 Syrian children.