The pro-regime fighters came under bombardment from Turkey after entering the northern Afrin region, escalating a month-long offensive by Ankara in another major twist for Syria's complex near-seven-year war.
To the south on the outskirts of Damascus, air strikes and rocket and artillery fire have battered the Eastern Ghouta enclave since Sunday in apparent preparation for a government ground assault on the besieged region.
On yesterday alone, 127 civilians, including 39 children, were killed in the bombardment - the single bloodiest day for Eastern Ghouta in four years.
Air strikes today morning killed at least 66 civilians, including 15 children, the Britain-based war monitor said.
Held by rebels since 2012, Eastern Ghouta is the last opposition pocket around Damascus and President Bashar al-Assad is keen to retake it with an apparently imminent ground assault.
The UN's regional humanitarian coordinator for Syria, Panos Moumtzis, said the targeting of civilians in the enclave "must stop now".
The UN has repeatedly called for a month-long ceasefire across Syria's front lines, from Eastern Ghouta to the Kurdish enclave of Afrin in the northwest, which Turkey threatened today to lay siege to in the coming days.
"February 19 was the one of the worst days that we've ever had in the history of this crisis," said an exhausted doctor in a hospital in Eastern Ghouta.
Identifying himself as Abu al-Yasar, he described treating a one-year-old brought into the Arbin hospital with blue skin and a faint pulse, rescued from under the rubble.
He pulled out the dirt as fast as possible, put in the breathing tube and managed to save the baby's life.
"This is just one story from among hundreds of wounded."
The bloodshed prompted the UN children's agency UNICEF to issue a largely blank statement today saying it "we no longer have the words to describe children's suffering."
Syria's main opposition group condemned the government onslaught as a "bloodbath" and a "war crime", saying it may pull out of UN-backed peace talks in protest.
Eastern Ghouta is mostly held by two hardline rebel groups - Jaish al-Islam and Faylaq al-Rahman - though jihadists have a smaller foothold.
The factions often fire rockets and mortar rounds into residential neighbourhoods of east Damascus.
Today, at least four people were killed and 15 wounded by rebel fire on the capital, state television reported.
Al-Watan newspaper, which is close to the government, said today that the bombing campaign "comes ahead of a vast operation on Ghouta, which may start on the ground at any moment."
But the escalating bombardment suggests the regime will likely opt for a ground assault.
It already waged a ferocious five-day air assault on Eastern Ghouta earlier this month that left around 250 civilians dead and hundreds wounded.
More than 340,000 people have been killed since the civil war erupted in 2011 when protests against Assad's government were brutally crushed.
An array of rebels, some of them jihadist, have since carved out zones of control as have the Kurdish minority, and the government and its allies.
Hundreds of Syrian pro-government forces entered the region for the first time since 2012 to face off against Turkey alongside Kurdish forces that Ankara views as an offshoot of its own internal insurgency.
But they quickly came under shelling by Turkish forces, who said they had fired "warning shots" at the "pro-regime terrorist groups".
In a statement today, YPG spokesman Nuri Mahmud said the Kurdish forces had called on the Damascus government to help fend off Turkey's assault.
Turkish President Recep Tayyip Erdogan on Tuesday defended the operation's slow progress, telling parliament that Syrian rebel allies would lay siege to the town of Afrin "in the coming days.
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