Syrian regime air strikes and artillery fire hit the rebel-held enclave of Eastern Ghouta for a sixth straight day yesterday killing 32 civilians, as the European Union joined a host of other countries to stop the carnage, saying “massacre must stop now”.

More than 450 civilians, including over 100 children, have been killed in nearly a week of bombardment that has been one of the seven-year Syrian conflict's bloodiest episodes -- and rescuers were searching for more bodies buried in the rubble.

The leaders of France and Germany urged Russian President Vladimir Putin, whose airforce is also striking Eastern Ghouta near Damascus, to back a 30-day truce at a UN Security Council vote.

The council delayed the crunch vote by over three hours to 1930 GMT, as negotiations went into high gear to avoid a veto from Syrian regime ally Moscow, which has been calling for "guarantees" that the ceasefire would be respected by rebel fighters.

"We are still working on the language, on some of the paragraphs, but we are almost there," said Kuwait's Ambassador Mansour al-Otaibi, who holds the presidency this month.

Few of Eastern Ghouta's nearly 400,000 residents -- mostly living in a scattering of towns across the semi-rural area east of the capital -- ventured out yesterday.

An AFP correspondent in Douma, the enclave's main town, saw a handful of people stealthily crossing rubble-strewn streets to assess damage to their property or look for food and water.

He said rescuers carried a young boy wounded in the eye, blood trickling down his face, to one of the town's hospitals. "Will I see again?," he asked a doctor.

Death has fallen from the sky relentlessly since government and allied forces intensified their bombardment on Sunday and rocket fire soon forced everybody to run for cover.

Exhausted and famished families cowered in cramped and damp basements, exchanging information on the latest casualties of the government's blitz.

Some of the only people braving the threat of more bombardment were medical staff in those hospitals still standing and rescuers sifting through the wreckage of levelled buildings.

Fresh strikes yesterday, by the Syria regime and its Russian ally, killed at least 32 civilians, including six children, the Syrian Observatory for Human Rights said.

Rami Abdel Rahman, head of the Britain-based war monitor, said the strikes targeted different areas of Eastern Ghouta.

The latest deaths brought to 468 the number of people killed -- including 103 children -- since the regime and Russia intensified their bombardment of the besieged area on February 18.

More than 2,000 people have been wounded.

Rebels have been firing back into the capital Damascus, where a hospital was hit yesterday, the official Syrian news agency SANA said.

Diplomats at the United Nations failed to clinch Russian approval late Thursday on a resolution calling for a 30-day truce to allow for humanitarian aid and medical evacuations.

They then announced that a vote would take place a later, but it was delayed twice amid staunch Russian resistance.

Negotiations were continuing to avoid a Russia veto of the text that would establish a truce to allow humanitarian aid deliveries and medical evacuations.

German Chancellor Angela Merkel and French President Emmanuel Macron wrote to Putin to ask him to back the ceasefire.

The latest text softens language in a key provision to say that the council "demands" a ceasefire instead of "decides".

It also specifies that the ceasefire will not apply to "individuals, groups, undertakings and entities associated" with al-Qaeda and the Islamic State group. A previous version simply mentioned the two groups.

World leaders have expressed outrage at the plight of civilians in Eastern Ghouta, which UN chief Antonio Guterres called "hell on earth", but have so far been powerless to halt the bloodshed.

"The UN says it is concerned and calls for a ceasefire, France condemns, but they have given us nothing," said Abu Mustafa, one of the few civilians on the streets of Douma yesterday morning.

"Every day we have strikes, destruction. This would draw tears from a rock," said the 50-year-old, who was escorting a wounded person to hospital.

The enclave has been controlled by Islamist and jihadist groups since 2012.

The main rebel groups in Eastern Ghouta yesterday rejected any deal that would see them or other residents relocated.

"We categorically reject any initiative providing for inhabitants to leave their homes and be transferred towards any other location," they said in a letter addressed to Guterres.

The area is completely surrounded by government-controlled territory and residents are unwilling or unable to flee the deadly siege.

The dire images of civilian victims bleeding to death in understaffed hospitals and the scope of the urban destruction have shocked the world and drawn comparisons with the devastating 2016 battle for Aleppo.

The aid community has voiced its frustration at being prevented from assisting civilians in Eastern Ghouta, which has been under government siege since 2013.

Government forces have this month reinforced their deployment around the enclave in preparation for a ground offensive.