The guns didn’t fall silent in Eastern Ghouta on Wednesday—despite a five-hour pause ordered by the Russian government to allow medical and humanitarian-aid deliveries into the rebel-held area outside Damascus, the Syrian capital. It was the second day the besieged area was supposed to experience such a brief pause, but the continuing violence and the condition of the roads means that little to no aid is getting in.

More than 500 people have been killed in a little more than a week in Eastern Ghouta, and thousands have been injured by the forces of Syrian President Bashar al-Assad, who are operating with Russian and Iranian support. Residents have dug underground shelters to escape the bombardment, and according to a spokeswoman for an aid group with local contacts, some of them have been there for up to nine days, sharing the spaces with dozens of other people. There are no toilets in these facilities, and no mattresses.

The area, which has a population of 400,000, was once an agricultural hub and part of Syria’s breadbasket. Residents were mostly wheat farmers who raised livestock, and lived in homes that had been in their families for generations. Eastern Ghouta is also one of the last major rebel strongholds in Syria, and among those fighters are Islamists that Syria and Russia say have ties to al-Qaeda. The area has been besieged by the government for roughly five years. Supplies have been taken in only three times in that period, most recently last November.

The UN Security Council voted Saturday to approve a resolution that called for a 30-day ceasefire across the country. But that ceasefire did not include ISIS and Jabhat Fateh al-Sham, the group previously known as al-Nusra Front, a militant group that has ties to al-Qaeda. And because the Syrian government and its Russian allies maintain that those groups are active in Eastern Ghouta—where the carnage of the past week is what prompted the Security Council to act in the first place—they apparently don’t recognize the ceasefire there, only “pauses” in the fighting. Russia maintains the rebels are responsible for any violations of those pauses. The rebels have denied this claim.

“We’re trying to take advantage of this month—the reduction in violence—to get clean water, to get supplies to people,” Christy Delafield, a spokeswoman for MercyCorps, a humanitarian group that operates in Syria, told me. “But what happens tomorrow? The ceasefire must be respected—and we need to have safe routes opened up so we can have more goods come into the city and to the region. I think it’s the most important thing to remember: that there are people at the heart of it.”

“The way this works is the Russians say the bombardments are directed against terrorists and that other people are getting caught in the crossfire,” Andrew Tabler, an expert on Syria at the Washington Institute, told me. “The problem is, of course, that the real goal is not to kill terrorists—the real goal is to knock out opponents of Assad. It’s not about counterterrorism.”

The same thing has played out in Syria before—in Aleppo, which was once the country’s largest city.

Two years ago, Assad’s forces, then as now backed by Russia and Iran, besieged the eastern part of Aleppo, a section of the historic city that was then home to about 200,000 people. They bombarded it, destroyed it, and seized it from the rebels in December 2016. Those rebels, Islamist groups and others, including those backed by the U.S., blended among the civilian population who were the vast majority of the residents. They ultimately agreed to withdraw from the eastern part of the city to other rebel-held areas in Syria. Many Syrians have returned to the area since then, according to the UN.

But unlike in Eastern Ghouta for the past five years, supply trucks were able to enter Aleppo even in the last months before it fell, Delafield said. “It was very dangerous, but the last road didn’t really close until ... over the summer.” The siege that began then ended in December, after a long few months. “People were worried about where food was coming from,” Delafield said. “But people had been stockpiling food because they’d been thinking about it; they’d been worried about it.”

Some of Eastern Aleppo’s residents tried to flee amid the bloody fighting during the siege. Water and food were scarce. Hospitals were targeted for bombardment. The UN called the situation a “complete meltdown of humanity.” Syrian government-backed fighters and their allies were accused of slaughtering civilians trying to flee.

“Aleppo will join the ranks of those events in world history that define modern evil, that stain our conscience decades later,” Samantha Power, who at the time was the U.S. ambassador to the UN, said. When she spoke, more than 460 people had died in the fighting in Aleppo in the preceding few weeks. “Halabja, Rwanda, Srebrenica, and now Aleppo.” (Halabja was the site of massacre of Kurds carried out by Saddam Hussein in 1998; the 1994 Rwandan genocide is estimated to have killed about 800,000 people in a matter of three months;  the Srebrenica massacre involved the killing of more than 8,000 Bosnian Muslims in 1995 in the ethnic cleaning that accompanied the breakup of Yugoslavia.)

There are signs that the siege of Eastern Ghouta, and the ongoing fighting there, could take an even worse human toll than the fighting in Aleppo.

“You can’t quantify pain and suffering; you can’t measure that—but eastern Ghouta has been under siege since 2013,” Delafield said. “The malnutrition rates are much higher; wondering where your next meal is coming from: That question has been on people's minds for a very long time. This is winter after winter of burning everything that burns in your house to try to keep your family warm.”

But the Syrian government’s motivation remains the same as it was in Aleppo. “They just want to pound them into submission, and get them to run away, so that they can take over the area without much effort,” Tabler said. “And that’s what they are doing at the moment.”