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Syrian regime forces and rebel fighters traded salvos of rockets and mortar bombs Thursday in and around Damascus, killing over 70 people, The Daily Star reported, citing news agencies.

Outside observers said anti-government forces struck first, after a rebel commander vowed to hit government-held areas of the capital to avenge the past week’s strikes by government warplanes on opposition-held suburbs.

That commander, Zahran Alloush of the Islam Army rebel group, said in a tweet that his forces would keep firing mortars and rockets “until the capital is cleansed.”

The state-run SANA news agency reported that at least six people were killed in the rebels’ barrage. The British-based Syrian Observatory for Human Rights put the death toll at nine, and said rebels fired at least 60 mortar bombs toward the city.

Later, government batteries rained shells and rockets on to rebel-held districts outside the city, including the suburb of Douma, a power base for the Army of Islam. Government forces have targeted that area heavily over the past week, including the use of barrel-sized bombs that are dumped from helicopters.

The Observatory said at least 66 people were killed in regime strikes.

The Local Coordinating Committees, a Syria-based network of anti-regime activists, said the deadliest strikes targeted Douma, killing 25 people, while 27 others perished in the town of Kafr Batna.

An activist in Douma, Hasan Taqulden, said the town suffered at least 38 hits from mortar shells or aircraft munitions. “This is the worst we’ve seen,” he added.

AFP photographer Abd Doumany said the assault caused chaos. “The situation in the hospitals is very bad. There are shortages of everything.”

He said medics had been wounded in the shelling and residents were hiding in basements.

Local field hospitals were overwhelmed by arrivals, some of whom lay on the floor to receive treatment.