BEIRUT (Reuters) - Dozens of children line up for bread on the side of a road in Eastern Ghouta, a rebel-held area near Damascus. In scenes described by a witness, their belongings are piled up on the gravel -- blankets, old mattresses, sandbags stuffed with clothes -- until the families can figure out their next destination.
They are some of the thousands of people who have fled their homes in recent months, as government forces have steadily encroached on the biggest rebel stronghold near Syria's capital.
Since a ceasefire collapsed last month, international attention has been focused on a major attack by President Bashar al-Assad's government forces and his allies on the northern city of Aleppo.
But hundreds of miles south, the government's gradual, less-publicized advance around Damascus may be of equal importance to course of a war in its sixth year, and is also causing hardship for civilians under siege.
Government troops, backed by Russian air power and Iranian-backed militias, have been snuffing out pockets of rebellion near the capital, notably taking the suburb Daraya after forcing surrender on besieged rebels.
The densely-populated rural area east of Damascus known as the Eastern Ghouta has been besieged since 2013 and is much larger and harder to conquer than Daraya.
Government advances are forcing people to flee deeper into its increasingly overcrowded towns, and the loss of farmland is piling pressure on scarce food supplies.
Several hundred thousand people are believed to be trapped inside the besieged area, similar in scale to the 250,000 civilians under siege in Aleppo.
"People were on top of each other in the trucks and cars," said Maamoun Abu Yasser, 29, recalling how people fled the al-Marj area where he lived earlier this year, as the army captured swathes of farmland.
Abu Yasser said he and a few friends tried to hold out for as long as possible, but the air strikes became unbearable.
"The town was almost empty. I was scared that if we got bombed, there would be nobody to help us," he told Reuters by phone. "We couldn’t sleep much at night. We were afraid we'd fall into the regime's hands. It would probably be better to die in the bombardment."
Since the start of the year, Syrian government forces and their allies, including Lebanese Hezbollah fighters, have moved into Eastern Ghouta from the south, the southwest, and the east, helped by infighting among rebel groups that control the area.
The advances have forced more than 25,000 people to seek shelter in central towns away from approaching frontlines, residents said. Some have set up makeshift homes in the skeletons of unfinished or damaged buildings, aid workers said. Others live in shops and warehouses, or haphazardly erected tents.
The army has made its most significant gains in the area in recent months, according to the Syrian Observatory for Human Rights, which monitors the war. Rebels are still putting up resistance, "but the regime and Hezbollah's continuous advances are a big indicator that they've decided to press on till the end", Observatory Director Rami Abdulrahman said.
Eastern Ghouta was targeted with poison gas in 2013, nearly leading to U.S. air strikes to bring down Assad, who denied blame. President Barack Obama called off military action after Russia brokered an agreement for Assad to give up chemical arms.
The district has regularly been pounded by government air strikes. Insurgents have meanwhile used it as a base to shell Damascus.
Staples such as bread and medicine are unavailable or prohibitively expensive, several residents said.
Once self-sufficient farmers who were forced to abandon their land have become dependent on food from local charities, which Syrian aid workers say are often funded by organizations in Gulf states that support the opposition to Assad.
"Many families ate from their own land ... and they made a living from it," Abu Yasser said. "They were traders ... and now they have to stand in line to get one meal."
The sprawling agricultural area was historically a main food source for much of the capital's eastern countryside. The territory taken by the army in the past six months was full of crops, until fierce battles and air strikes set it ablaze, aid worker Osama Abu Zaid told Reuters from the area.
"Now, compared to the sectors we lost, there are few planted fields left," he said.
Opponents of Assad accuse his government and its Russian allies of relentlessly bombing Eastern Ghouta before ground troops swept in. The Syrian government and Russia say they only target militants.
"It's the scorched earth policy. People were hysterical," Abu Zaid said. "Even if you dug a hole in the ground and sat in it, the chances of surviving would be very, very slim."
Residents have protested over the internecine war among the rebel groups which they blame for the army's gains. Hundreds of people were killed in fighting between the Jaish al-Islam and Failaq al-Rahman factions.
Abu Zaid said the government had been failing for more than a year to capture southern parts of the Ghouta, until the internal fighting allowed for a quick advance.
The waves of displacement mean schools and homes are full in central towns and cities still held by rebels.
"There was a big shock, a huge mass of people migrating at the same time, without any warning, without any capacity to take them in," Malik Shami, an aid worker, said.
"Residents are already unable to get food at such high prices," he said. International aid is insufficient and severely restricted by the Syrian government. "So they rely on local groups... but we can only do basic things, to keep us on our feet," he said. "There will be a big crisis in the winter."
A United Nations report said around 10 aid trucks had entered towns in the area this year.
Amid ongoing battles, the army has escalated its bombing of Eastern Ghouta, and dozens have been killed this month, the Observatory reported. It said the army advanced in the northeast of the area, edging closer to the city of Douma.
"The bombing and the fires, it’s like in the movies," Shami said. "At night, there’s intense panic."
Residents believe the government aims to force them into an eventual surrender through siege and bombardment, the tactic used in Daraya, where a local agreement guaranteed fighters safe passage to other rebel-held parts of the country.
"There are many theories" about what could come next, said Mahmoud al-Sheikh, a health worker. "But in general, there's a lot of mystery about the future, a fear of the unknown."
Additional reporting by Tom Miles in Geneva; editing by Tom Perry and Peter Graff