The victims in the Eastern Ghouta include 121 children, says the Syrian Observatory for Human Rights, a UK-based group monitoring the conflict.
Syrian government forces backed by Russia have been pounding the area since last Sunday.

The UN Security Council is struggling to agree on a ceasefire resolution.
A vote has been delayed several times since Thursday, and is now due to be held later on Saturday.

How bad is the situation in the Eastern Ghouta?

On Saturday, the Syrian Observatory said at least 29 civilians were killed, including 17 in the main town, Douma - bringing the total to over 500 for the week.
The group said the strikes were being carried out by both Syrian and Russian planes - although Russia denies direct involvement.

Barrel bombs and shell fire have been dropped on the area, where some 393,000 people remain trapped.
Aid groups report several hospitals being put out of action since Sunday.

The Syrian government has denied targeting civilians and said it is trying to liberate the Eastern Ghouta from "terrorists" - a term it has used to describe both the jihadist militants and the mainstream rebel groups that hold the enclave.

The plight of civilians in the area has alarmed world leaders. Conditions there have been described as "hell on earth" by UN Secretary General Antonio Guterres.

Who are the rebels?

The rebels in Eastern Ghouta are not one cohesive group. They encompass multiple factions, including jihadists, and in-fighting between them has led to past loses of ground to the Syrian government.
The two biggest groups in the area are Jaish al-Islam and its rival Faylaq al-Rahman.

The latter has in the past fought alongside the jihadist group Hayat Tahrir al-Sham - an alliance of factions led by the Nusra Front, which sprung from al-Qaeda.
The Syrian government is desperate to regain the territory, because it says the rebels are directly endangering the capital.

Eastern Ghouta is so close that it is possible for rebels to fire mortars into the heart of Damascus, which has also led to civilian deaths.
Syrian state media said rebels have killed at least 16 civilians in eastern districts of the city since Sunday.