The cities and villages under siege were Douma, Mesraba, Arbin, Hamouria, Saqba, Modira, Eftreis, Jisrin, as well as suburbs of Damascus Beit Sawa, Harasta, Zamalka, Ein Tarma, Hizzah and Kafr Batna.

United Nations Security Council Resolution 2401, adopted on February 28, 2018, called for a nationwide ceasefire in Syria for 30 days, including Eastern Ghouta, but the Syrian Army continued the offensive.

In March 2018, the Syrian Army split the enclave into three parts, reaching an agreement with the rebels and their families to withdraw to the north, to Idlib.

Prior to the Syrian civil war, the total population of Eastern Ghouta, a collection of farms and cities near Damascus, was around 1.5 million people.

[36] In February 2013, Syrian rebels captured parts of the ring road on the edge of Damascus and entered the Jobar district of the capital city.

[37] Backed by Iran and Hezbollah, the Syrian Arab Army counterattacked and in April 2013 began a siege of Eastern Ghouta, which is just 15 km or a half hour's drive outside the capital Damascus.

The second largest was Faylaq al-Rahman, an official affiliate of the Free Syrian Army (FSA), controlling much of central and western parts of Ghouta, including the Jobar and Ain Terma districts.

The escalation of hostilities led to a United Nations Security Council meeting held on 24 February 2018, voting unanimously in favor of a 30-day cease-fire in Syria, and demanded immediate lifting of the siege of eastern Ghouta.

[50] In mid-late March after a series of negotiations, a deal was finally reached between the Syrian government and rebels that controlled parts of Eastern Ghouta.

[54] The shelling on 8 April 2018, which left several civilians dead, drew allegations of chemical weapons use in Douma, though the UN could not verify the claim initially.

[27] According to local hospital sources, which were cited in the French newspaper Le Monde, approximately 18,000 people were killed in the enclave by October 2017.

[24][44][57][58] According to a 2014 UN report, the denial of food as a military strategy began during July and August 2013: Eastern Ghouta's crops and farms were shelled and burned.

The report also alleged that Syrian forces "blocked access roads and systematically confiscated food, fuel and medicine at checkpoints".

[69] After the end of the siege, tens of thousands of people have been unlawfully interned by the Syrian Government forces in rural Damascus, including Ghouta.

They were known to arrest and torture members of religious minority groups,[24] and regularly fired mortars and rockets from eastern Ghouta at government-held areas.

The final report concluded that evidence suggests that "surface-to-surface rockets containing the nerve agent sarin were used in Ein Tarma, Moadamiyah and Zamalka".

As a consequence, the three states conducted a series of airstrikes targeting sites associated with Syria's chemical weapons capabilities in Damascus and Homs on 14 April 2018.