Warplanes pounded Syria's Eastern Ghouta on Friday as Islamist groups tried to resist an advance by Russian-backed regime forces and civilians looked for cracks through which to flee the five-year-old siege.
At least 57 civilians were killed as the toll for the month-old assault near Damascus continued to mount and world powers remained unable to stop one of the seven-year conflict's worst crises.
The war entered its eighth year with another deadly assault unfolding in the north, where Turkish-led forces pressed an operation to seize the Kurdish-majority region of Afrin, sending thousands more civilians on to the roads.
Turkish artillery fire killed 18 civilians on Friday in the city of Afrin, where remaining residents were stocking up on food in preparation for a fully-fledged siege.
On the edge of Ghouta, a sprawling semi-rural area within mortar range of central Damascus, hundreds of civilians were still streaming out of destroyed towns, carrying scant belongings in bags and bundles.
Exhausted and distraught, the estimated 12,000 people who poured out of Ghouta on Thursday had harrowing tales of life in fear and deprivation, trapped for weeks in their cellars as regime and Russian jets rained bombs.
"We were around 66 families in the basement, with seven people per family," Hussein Samid told AFP, pausing on the roadside to smoke a cigarette.
"Those of us who were in the cellar got together and decided to leave, whatever the cost," the 40-year-old said.
Hundreds of them were crammed in a centre on the edge of Eastern Ghouta on Friday, unsure what the next step would be after walking straight into the arms of the forces that have relentlessly pounded their homes for weeks.
They were sitting on the ground and had little access to sanitation as the sudden exodus appeared to have caught the government flat-footed.
Despite mild temperatures, most of them were wearing several layers of heavy winter clothes, the same they had kept on for weeks in their freezing basements.
The ground offensive pressed by Syrian troops and allied militia has splintered Eastern Ghouta into three pockets.
Most of the civilians fleeing since Thursday have left from the town of Hammuriyeh, in the south of Eastern Ghouta.
The Islamist and jihadist groups which have dominated this area of the enclave over the past few years retook much of the town they had almost lost a day earlier, the Syrian Observatory for Human Rights said.
"Hayat Tahrir al-Sham and Faylaq al-Rahman have almost completely retaken the town but fighting continues on the outskirts," the Britain-based monitoring group said.
Few residents remain in Hammuriyeh itself but tens of thousands of others were still scattered across the southwestern pocket, the largest of three still in rebel hands.
President of the International Committee of the Red Cross Peter Maurer, who was inside rebel-held Ghouta on Thursday when food aid was brought in, voiced his exasperation with the continued bloodshed.
"I am myself with many humanitarian workers on the ground both exhausted and fed up with the blind justification of gross violations against civilians," he said in a statement.
The Observatory said at least 57 civilians were killed in Russian air strikes on Kfar Batna and Saqba, in the southwestern Ghouta pocket on Friday.
The latest deaths brought to more than 1,300 the number of civilians killed since the start of the ground and air offensive on the enclave on February 18, around a fifth of them children.
Syrian President Bashar al-Assad has in recent months recovered swathes of territory lost at the beginning of the conflict and Ghouta was one of his key remaining targets.
No deal has been reached with the rebel fighters inside Ghouta, some of whom are jihadists and ex-members of a former Al-Qaeda affiliate.
An exodus of similar proportions was under way hundreds of kilometres (miles) to the north near the border with Turkey, as civilians tried to escape a looming siege of the city of Afrin.
The Observatory said on Thursday that more than 30,000 people had fled the city of Afrin in 24 hours and civilians were still trying to slip out on Friday before Turkish-led forces cut the last exit road.
"Since midnight (2200 GMT Thursday), 18 civilians, including five children, were killed by Turkish artillery fire on the city of Afrin," it said.
On January 20, Turkey and Syrian Arab rebel proxies launched an air and ground offensive on the Afrin region, which is controlled by the US-backed Kurdish People's Protection Units (YPG).
Ankara has consistently denied targeting civilian infrastructure but the Observatory said at least 245 civilians, including 41 children, have been killed in less than two months.
In seven years, more than half of Syria's pre-war population of 20 million has been displaced.