Many Syrians took to social media to voice their anger over the lack of action to help eastern Ghouta's 400,000 residents who have lived under the regime siege since 2013 and are facing severe shortages in food and medicine.
A government source said on Sunday that regime forces had seized a number of districts including Al-Nashabiyeh and Otaya, and had "eradicated terrorist groups" on the eastern outskirts of Damascus.
Regime backer Russian Federation last week announced daily five-hour "humanitarian pauses" in Eastern Ghouta. Fighting has intensified in Beit Sawa between government forces and the Islamist faction Jaysh al-Islam.
Syrian government forces claimed about 25 percent of the rebel-held enclave of Eastern Ghouta on Sunday after advancing from several fronts to gain control of farms and villages.
The Observatory said some 2,000 civilians had fled government shelling and clashes in eastern parts of the enclave.
"This is the same combination of lies and indiscriminate force that Russian Federation and the Syrian regime used to isolate and destroy Aleppo in 2016, where thousands of civilians were killed", the USA statement said.
The death toll in the region may rise as the attacks are still ongoing. The first aid convoy, which consists of 46 trucks, is slated to enter Douma on Monday morning, led by Ali al-Za'atri, the UN's resident humanitarian coordinator in Syria.
Pro-government forces now control 10% of the rebel-dominated enclave, according to the Syrian Human Rights Watch.
In a statement, Macron's office said the president and Rouhani had agreed to work together in the coming days to deliver the necessary assistance to civilians and implement the UN-sponsored ceasefire.
"The operation in Ghouta is a continuation of combating terrorism in different places", Assad said in comments broadcast on state television, adding that the offensive did not contradict the proposed truce.
According to the SANA report, the rebel group had fired over 300 mortar shells and rockets on neighboring Damascus, killing and injuring scores of civilians.
"Instead of a much-needed reprieve, we continue to see more fighting, more death, and more disturbing reports of hunger and hospitals being bombed", United Nations regional humanitarian co-ordinator Panos Moumtzis said on Sunday.
Rahman also said 26 of the people killed were in Ghouta's main town of Douma and its eastern suburb.
A United Nations humanitarian official said people in eastern Ghouta were being subjected to unacceptable "collective punishment", which is illegal under the Geneva Conventions.
"Instead of a much-needed reprieve, we continue to see more fighting, more death, and more disturbing reports of hunger and hospitals being bombed", Moumtzis said in a statement. The reporter said the Syrian troops had crossed a "moat" and seized around 12 square kilometres (4.6 square miles).