On Wednesday, the rebel-held Eastern Aleppo was attacked again by bombings that has left at least 32 dead. An emergency worker said that the attacks have been around a children’s hospital, where the neighborhood is already battered from previous air strikes.

Air raids led to part of a larger military escalation from the Syrian government and their allies, including Russia. On Tuesday, volleys of missiles were fired at the rebels, and the government used their only aircraft carrier for the first time. According to a Britain-based war monitor, the Syrian Observatory for Human Rights, at least 21 people were killed from Wednesday’s air strikes against Eastern Aleppo. The 21 deaths included five children and one emergency worker. Syrian and Russian warplanes were used to carry out the civilians that were killed.

Reports say that Moscow was a part of the wave of bombardment, but Moscow denies the allegations and said that they remain moratorium on Aleppo air strikes. After the bombings on Tuesday, it was declared that the pause, which was established by Russia on October 18th, had ended. The residents of the city and the Observatory said that the attacks on the city were barrel bombs dropped from helicopters, artillery from government forces, and rockets fired from jets. A civil defense worker in Aleppo, Bebars Mishal told Reuters, “The helicopters won’t stop for a single moment. Right now, the bombing won’t let up.”

Prior to the war, Aleppo was the largest city and commercial hub in Syria. The city has received a lot of support from a volunteer rescue service called, Civil Defence, which operates out of rebel-controlled areas throughout Syria. It was reported that two ambulances had been destroyed from the air strikes. A nurse that works in the Eastern Aleppo said, “We woke up to the bombing, and until now, the warplanes and helicopters are running.”