Ayad Saryoul has spent most of the past month in an underground shelter he shares with his family and 40 other people. Sometimes spending 18 hours straight underground, he passes the time by counting the number of rockets and shells that fall on the besieged Eastern Ghouta suburbs of Damascus.

"There's nothing else to do here," says the 27-year-old resident of Eastern Ghouta. "We're waiting for death to come at any moment. Either by way of shelling or disease."

Hundreds of thousands of people have gone underground to take shelter from relentless government attacks on the last rebel enclave near the Syrian capital. Many are living in makeshift collective shelters or basements.

Since government forces stepped up attacks on Feb. 18, more than 1,500 people have been killed and more than 45,000 displaced from their homes. Prior to the offensive, the UN Refugee Agency (UNHCR) estimated that some 350,000 civilians were trapped in the area, which has been under siege for more than four years.

Although largely safer than above ground shelters, makeshift bunkers are not impenetrable. Government airstrikes and artillery attacks have regularly killed civilians hiding underground. On Monday, 15 children and two women hiding in a school basement in the town of Arbin were killed in government shelling. It took rescue workers more than two days to recover the corpses from under the rubble.

"Does the world hate us?"

Syria Deeply spoke to a number of residents who have sought safety in bunkers and collective shelters. They describe dark, claustrophobic, humid and dingy spaces that sometimes accommodate up to 200 people. Saryoul has seen "little children clinging to the bodies of their parents' inside the shelters after airstrikes and mortar attacks.

Their stories shed light on the plight of those who remain in Eastern Ghouta, which the UN has described as a "hell on earth." But they show the resilience of residents who have survived these past years.

Destruction above-ground forces in people Eastern Ghouta to seek shelter below the surface — Photo: Mouneb Taim/ZUMA

"The basement floor is filled with dirt. There are no toilets or any other facilities," says Nivin Al-Houtari, a 38-year-old mother of two, who lives in an underground shelter with her husband, children and some 30 other people. Many shelters in Eastern Ghouta are even more crowded, with upwards of 100 people. Families separate their living spaces with cloth or curtains, she explains.

There is a great deal of cooperation between the many families living in the tight quarters, especially in terms of cooking, sharing and distributing food, Al-Houtari says. "Some families brought food supplies such as bulgur, rice or lentils, and they cook them inside the basement," she says. "There is an understanding between us because we are aware that this is an exceptional circumstance and we must bear with it."

Al-Houtari says she never leaves the underground shelter. To pass the time, she gossips with other women in the bunker, or reads or tells stories to her children, who have no room to either play or breath while living underground. "Sometimes we tell them heroic stories about the triumph of good over evil, which they like and enjoy a lot," she says. At other times, children are given coloring books and drawing material to help them pass the time.

"I am living inside death itself."

Still, it's a challenge to try to keep the kids from running outside, and to distract them from the sound of heavy shelling, Al-Houtari acknowledges. It's even more of a challenge trying to explain to them why they have to live this way. "My three-year-old daughter Maya always asks me: Why are we dying? Does the world hate us?" she says. "And I have no answer for her because I can't convey to her the abstract idea that we are dying for freedom."

Trapped and hungry

Hussam, 27, lives in an underground bunker with 70 people, including eight different families. He does not have a family of his own, but he does have a fiancee — living outside Syria — and it's the thought of her, he says, that keeps him going in these difficult times.

"Dana always speaks to me when the shelling is violent, so I quickly text her "shelling" and she texts back "hide." And when the bombing ends, I text her again "I am fine" and she responds by telling me a joke," Hussam explains.

Dana's support during these difficult times gives him a lot of "hope," he says. "I am living inside death itself. But I feel like I am the embodiment of life for someone else. This gives me the drive to persevere."

When he is not texting his distant bride-to-be — and when the bombardments are fewer and farther between — Hussam helps local groups deliver food and water to families in shelters. He said both are hard to come by, especially since it is often too dangerous to go above ground. Sometimes families can go up to 48 hours without any food.

Aid agencies have also warned of the deteriorating humanitarian conditions in Eastern Ghouta. Andrej Mahecic, a spokesman for the UNHCR, told reporters on Tuesday that thousands of civilians in Eastern Ghouta were "trapped and in dire need of aid."

Living with limited access to food and water is difficult, but for Hussam, one of the hardest parts of living in shelters is witnessing the suffering of children, he says. "I once asked one girl to draw a picture for me, so she drew a basement with many children in it," he says. "It is very painful to see that the ceiling of our children's imagination is just a small breathing space."