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A rocket fired by Syrian rebels killed 35 people in a Damascus shopping district Tuesday, in one of the deadliest rebel attacks on the Syrian capital.

The rocket attack came as heavy bombardment killed 38 civilians in the shrinking rebel enclave of Eastern Ghouta east of Damascus.

State media said the opposition fire hit the area of Jaramana, which residents said was full of shoppers - including some buying presents ahead of Mother's Day.

A taxi driver, who asked not to give his name, said he was nearby when the rocket hit a street known for its cheap clothes and food shops.

"The place was full of people buying presents for Mother's Day," the 41-year-old said.

A nurse in her 30s, who asked not to be named, said the projectile hit a shopping area "next to a security checkpoint".

"The intensity of the blast was terrifying," she said.

Syrian President Bashar al-Assad has brought swathes of territory back under his control since the war started in 2011, with help from Russia and allied forces, including Iran-backed Lebanese Hizballah militia.

He has recently focused efforts on flushing out the last pockets that escape government control in and around the capital, the largest of them being Eastern Ghouta.

'Loved one' in a sack

A month-long air and ground assault on the area, which was home to around 400,000 residents, has left more than 1,400 dead.

Regime and allied forces have retaken more than 80 percent of Eastern Ghouta and splintered the rump of the enclave into three pockets, each controlled by different rebel groups.

In images broadcast on Sunday, Assad congratulated soldiers in Ghouta, and told them Damascenes would "maybe tell their children in the coming decades how you saved the capital".

	Smoke rises at a factory after Assad Regime forces carried out airstrikes in Eastern Ghouta's Douma town that killed at least 29 civilians [Getty]

Clashes shook the various zones on Tuesday, with bombardment by the regime and its Russian ally killing at least 29 civilians in the main town of Douma, the Syrian Observatory for Human Rights said. Another nine civilians were killed in bombardment in other areas of the enclave, the Britain-based monitor said.

Washington has voiced concern that the chaos in Syria could allow a revival of the Islamic State (IS) group, whose "caliphate" collapsed late last year after three years of international military operations.

IS militants launched a surprise nighttime attack in a southern Damascus neighbourhood of Qadam, which it managed to seize control of, the Observatory said.

Observatory chief Rami Abdel Rahman said the regime was sending reinforcements to retake Qadam, which was attacked from the adjacent IS-controlled neighbourhood of Hajar al-Aswad.

The extremist group also have a presence in the nearby Palestinian refugee camp of Yarmouk.

Heavy bombardment was reported in Douma, Eastern Ghouta's largest town, through the night from Monday to Tuesday that left ambulances struggling to reach the wounded.

At the town's main hospital, a man walked the facility's halls with a sack. Medics said it held the human remains of a loved one killed in raids.

'War crimes'

After a seventh day of medical evacuations on Tuesday, some 1,800 civilians including 375 patients had crossed over into government-held territory, a medical source said.

Tens of thousands of civilians have fled both the intense bombardment of Ghouta and the deprivations of a siege that lasted five years.

The ramifications are catastrophic, the UN's High Commissioner for Human Rights Zeid Ra'ad Al-Hussein told the Security Council, accusing the Damascus regime of "war crimes" in Eastern Ghouta.

But Hussein also warned of another humanitarian catastrophe unfolding hundreds of kilometres to the north in the Syrian border enclave of Afrin.

The Turkish army and its Syrian proxies - a motley assortment of extremist fighters, former rebels and members of other armed groups - seized Afrin from Kurdish forces on Sunday.

Turkish military police deployed across the city on Tuesday, as some civilians tried to return to homes and shops looted by Ankara's Syrian proxies.

The two-month offensive has displaced around 100,000 people, most of them to the town of Tal Rifaat further east, the UN has said.

On Tuesday, a convoy carrying food, blankets, and other aid was being delivered to thousands of families seeking refuge in Tal Rifaat, according to the International Committee of the Red Cross.

The capture of Afrin, one the cantons in the self-proclaimed autonomous administration run by Syria's Kurds, has been a huge blow to the minority.