All too familiar scenes of chaos engulfed towns scattered across the semi-rural rebel-held area of Ghouta which lies just east of Damascus.
Later in the day, five civilians died when rebels fired shells into government-controlled neighbourhoods in Damascus, including three in the historic Bab Touma district of the Old City, according to the official Syrian news agency SANA.
More than 350 people - including 86 children and 68 women - have been killed in bombardments in Eastern Ghouta alone since December 29, SOHR says.
Syria's multi-sided war has drawn in armies and insurgents from around the world, aggravating a conflict which began as an uprising against Assad's rule.
The call between Putin and Rouhani was also an opportunity for both leaders to highlight their common strategic goals - particularly in Syria, where Russian Federation and Iran remain the principal backers of President Bashar al-Assad's regime.
The UN commission alleges chlorine gas was used in both cases.
On Monday, the opposition Syrian National Coalition condemned what it described as a "barbaric onslaught" by Russian and Syrian forces in Idlib province in recent days and demanded United Nations action.
"There is nowhere left to hide", Ahmed said.
Among them was the young daughter of Abu Raad, a shell-shocked man from Eastern Ghouta.
Eastern Ghouta, where an estimated 400,000 people are living under a crippling government siege, is included in a de-escalation deal agreed past year by rebel ally Turkey and government supporters Iran and Russian Federation.
Instead, the first weeks of 2018 have turned into one of the bloodiest periods of the conflict yet, with hundreds killed in airstrikes, almost 300,000 displaced in northwestern Syria and 400,000 at risk of starvation in a besieged area east of Damascus that has not received food since November. With Idlib now also under siege, it's not clear there's anyplace for the remnants to evacuate to, and the rebels likewise seem to have little interest in negotiating.
"Look, when I saw that Russia's placing military forces, air power, some ground power, and anti-aircraft weapons in Syria, I decided that the wisest thing to do was to go and speak to Mr. Putin directly", Netanyahu said prior to his snap visit to Moscow.
"There is a misperception that the de-escalation areas have resulted in peace and stability", he said.
The US-led coalition battling the Islamic State group said Wednesday it had carried out defensive strikes in the eastern Deir Ezzor region against Syrian pro-regime forces. If anything, there has been a serious escalation.
Around 60 civilians were killed on Tuesday in air strikes and shelling that overwhelmed rescue workers and prompted the United Nations to call call for an immediate cease-fire in order to deliver critical medical care to civilians across the country.
The war in Syria has displaced half the population and killed some 400,000 people, but now the carnage is growing in many places at once.