State Department spokeswoman Heather Nauert blamed the Assad regime's "siege and starve tactics" for adding to the humanitarian disaster in the Damascus district, and endorsed the United Nations' call for a month long halt to violence.
"The United States is deeply concerned by the escalating violence in the Damascus suburb of Eastern Ghouta," Nauert told reporters. "The escalation is exacerbating the already grave human suffering of nearly 400,000 people.
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"The cessation of violence must begin now, and those needing emergency assistance should be allowed to evacuate immediately," she added.
Eastern Ghouta is home to more than 400,000 people living under crippling government siege, with little access to food or medical resources.
Syrian and Russian air strikes slammed the area earlier, adding 100 civilian deaths to the toll since Sunday and putting another hospital out of service.
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The rebel-held district is nominally included in a "de-escalation" deal meant to tamp down violence, but President Bashar al-Assad is apparently preparing troops for an imminent ground assault to retake the area.
Nauert compared the assault on Eastern Ghouta to the 2016 siege of East Aleppo, when the Assad regime with Russian support laid waste to a heavily civilian populated district of the city in its push to eliminate Islamic State fighters.
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"The horrors of East Aleppo are being repeated in East Ghouta with the on-going slaughter of trapped civilians and woefully inadequate access for humanitarian actors," she said.
"We call on all parties to commit to the unconditional de-escalation of violence. Russia must end its support of the Assad regime and its allies. They are responsible for the attacks, for the dire humanitarian situation in East Ghouta and for the horrendous civilian death toll."
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