The Syrian Observatory for Human Rights said at least six children were among those killed in nearly 40 air raids on parts of Eastern Ghouta in Damascus province.
The Britain-based group said at least 140 people were wounded, adding that government forces had also fired surface-to-surface missiles at the area.
The assault came after rebels fired at least 70 rockets and mortar rounds at the capital, killing seven people, including a policeman.
"Within minutes, our busy street was empty," said a resident of the Baramkeh neighbourhood, adding that the headteacher of a local school had been forced to take her students to a shelter.
The middle class district is home to several university buildings, as well as the headquarters of state news agency SANA.
In the city centre, traffic was light and many people stayed home from work.
Rebel group Jaysh al-Islam (Army of Islam) warned two days ago that it would launch a barrage of missiles at the capital in response to deadly air strikes on rebel-held Douma in Eastern Ghouta.
The group has carried out such barrages before, including on January 25, when it fired dozens of rockets after a similar warning, killing six.
In Douma, the government air strikes brought chaos, with an AFP photographer reporting civilians streaming into a makeshift clinic.
Medics, overwhelmed by the number of arrivals, were forced to treat some on the floor.
Among them was an infant, his red and white striped sweater lifted up to allow medics to apply a defibrillator to his bloodied chest.
More than 200,000 people have died in the conflict, which began with anti-government protests in March 2011 and escalated into a civil war that brought jihadists streaming into the country.
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