BEIRUT -- Syrian government and Russian airstrikes killed at least 46 people in a besieged town outside of Damascus on Friday, while Turkish shelling and attacks on a Kurdish-held town in northern Syria left at least 22 dead there, monitors and officials said.
The staggering death toll, at least 68 civilians killed, came a day after Syria passed the seven-year mark in its relentless civil war.
In Damascus' rebel-held enclave of eastern Ghouta, Syrian and Russian jets struck the town of Kafr Batna with cluster bombs, napalm-like incendiary weapons, and conventional explosives, the Syrian Observatory for Human Rights said.
The assault was part of an indiscriminate campaign by President Bashar Assad's forces to retake the town and the rest of the enclave from the rebels.
A medical charity supporting hospitals in the Ghouta region, the Syrian American Medical Society, said doctors in Kafr Batna were treating patients for severe burn wounds. The charity said it recorded 40 casualties Friday. The Syrian Civil Defense search-and-rescue group said it identified 42 bodies so far.
Oways al-Shami, a spokesman for Syrian Civil Defense, also known as the White Helmets, said he expected the toll to rise further. "Most of the (bodies) were charred," he said.
Exhausted and shell-shocked civilians streamed out of eastern Ghouta for the second consecutive day to buses arranged by the government to take them to a center for identification and relief.
A man interviewed on state-affiliated al-Ikhbariya TV said he had gone two days without food. Others said rebels hoarded food and humiliated civilians, even shooting people trying to leave.
The U.N. has warned of a malnutrition crisis in eastern Ghouta, which human rights groups have blamed on the government's strangling blockade.
Russia's Defense Ministry said close to 5,000 civilians have been evacuated Friday, after more than 10,000 left the enclave the day before.
The assault on eastern Ghouta has devastated towns across the region and damaged and destroyed over a dozen hospitals. At least 1,300 civilians have been killed under shelling and airstrikes.
Russia's Foreign Minister Sergey Lavrov said the Russian military and the Syrian government would extend a "cease-fire" in Damascus' rebel-held suburbs as long as it takes to allow all the civilians to leave the area.
In northern Syria, where Kurdish officials Turkish shelling and airstrikes killed at least 22 civilians Friday in the town of Afrin, the Turkish military urged civilians to leave and the Syrian Kurdish militiamen to surrender to besieging Turkish forces.
The media office for the Syrian Democratic Forces, a Kurdish-led and U.S.-backed force operating in the Kurdish autonomous region in the north, said also that at least 30 were wounded in Friday's attacks.
Victims lay dead in the streets in pools of blood, according to a video from the Observatory, which monitors Syria's seven-year civil war and which put the death toll at 18. Different casualty tolls are common in the immediate aftermath of big attacks.
Since their January offensive began, Turkish forces have nearly encircled Afrin in an effort to drive the Syrian Kurdish fighters from the town and the surrounding region. Residents say they are facing bread, water, and electricity shortages.
The Observatory and activists reported seeing hundreds of civilians filing out of Afrin to neighboring villages on Thursday and Friday, looking for relief. Tens of thousands of civilians are believed to still be inside.
Earlier Friday, Turkish aircraft dropped flyers in Arabic and Kurdish on Afrin, asking residents to stay away from "terrorist positions" -- a reference to the Syrian Kurdish fighters -- and to not let themselves be used as "human shields." The leaflets claimed civilians desiring to flee Afrin would be guaranteed safety by the Turkish military and urged Syrian Kurdish fighters to "trust the hand we extend to you."
Thursday saw the largest single-day exodus of civilians in Syria's civil war. The government offensive has pushed farther into eastern Ghouta, chipping away at one of the largest and most significant opposition bastions since the early days of the rebellion -- communities where some 400,000 people are estimated to be holed up.
Since mid-February, Syrian troops have targeted Damascus' sprawling suburbs with shells, airstrikes and, at times, even toxic gas, according to opposition medics. They are now in control of the majority of the enclave that had been in rebel hands since 2012.
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