WASHINGTON – A Russian-ordered daily cease fire to allow delivery of humanitarian aid appears to be having little benefit, as Syrian President Bashar al-Assad’s forces began ground attacks against rebel forces on Wednesday in the Damascus suburb of Eastern Ghouta.

The Syrian Observatory for Human Rights, a United Kingdom pro-opposition organization, said that the Assad regime continued its bombing and missile attacks on the final rebel-held enclave in Syria, immediately preceding the times established for the ceasefire.

The daily pauses are part of an order that came Monday from Russian President Vladimir Putin—who has supported the Assad regime since 2015. The Russian order called for a cessation of military action in most cases between 9 a.m. and 2 p.m. daily so humanitarian aid can be delivered and civilians who have been trapped by the fighting can be evacuated.

This order came on the heels of United Nations Security Council action last Saturday calling for a 30-day ceasefire. However, despite unanimous passage of the resolution, fighting and mass killings have continued in Eastern Ghouta.

Russia and the Syrian government insist the continued attacks are against terrorist organizations that have infiltrated the area, and not against rebel forces. A provision in the UNSC resolution specifically allows for continued operations against terrorist groups like ISIS and al-Qaida, which greatly complicates any effort to end hostilities.

There was no break in fighting on Tuesday, the first day the Russian’s five-hour pause. The Syrian human rights organization said that, along with the continued airstrikes before and after the five-hour ceasefire, Assad forces began ground attacks against rebel forces Wednesday.

Because of the ongoing fighting, no aid has been delivered to Eastern Ghouta and no civilians have been evacuated as of Wednesday, according to an Associated Press report.

Jens Laerke, spokesperson for the UN’s Office for the Coordination of Humanitarian Affairs, said Tuesday that the area was still too dangerous for humanitarian organizations to enter.

“The UN is ready to move convoys into East Ghouta, and to evacuate hundreds of casualties, as soon as security conditions permit,” Laerke said. “In the current situation, that is not possible.”

Laerke stressed the importance of “immediate implementation” of the UNSC resolution and cooperation by all sides in its enforcement. Eastern Ghouta was facing extreme food shortages and sharp increase in food prices even before the most recent bombings began because of an almost total lack of aid delivery.

There has been only one delivery of humanitarian aid to the area since November 2017, according to the UN.

Nearly two week ago, UN officials began warning of dire threats to civilians in the region, particularly in Eastern Ghouta, as Syrian forces stepped up air strikes.

“What is happening in Eastern Ghouta is not simply a humanitarian crisis because aid is denied, these sieges involve the international crimes of indiscriminate bombardment and deliberate starvation of the civilian population,” Paulo Pinheiro, chair of a UN commission focused on Syria, said in a Feb. 6 report.

Eastern Ghouta sits just outside of Syria’s capital city of Damascus and is one of the final areas in all of Syria that the rebel’s control. It is home to around 393,000 people and has been besieged by the Assad regime since 2013.

Despite fighting that has gone on in the area in the past—it was the victim of a chemical weapons attack by Assad forces in 2013—the most recent bombings began Feb. 18.

According to SOHR, the death toll over the last 11 days has risen to 588 citizens—including 146 children and 88 women. Along with the death of civilians, hospitals and medical sites have been destroyed from the bombings and the UN is investigating the use of chemical weapons by the Assad regime during the current air campaign.

The White House has criticized the attacks by the Assad regime and the State Department has said that Syria’s main ally, Russia, must take responsibility for what is happening to Syrian civilians; however, there has been no direct intervention yet taken by the United States.

Randa Slim, the Director of Conflict Resolution and Track II Dialogues Program at the Middle East Institute, said that, much like the Obama administration, President Donald Trump does not highly prioritize a solution in Syria. A diplomatic solution may not be possible after Assad has regained so much control over the country, he said.

“These massacres are not new and we have seen the U.S. not stepping up to the plate again and I am not expecting this to change,” Slim said, adding that the current situation stems from inaction against the Assad regime in the past seven years of the war.