BEIRUT — No civilians exited the rebel-held Syria region near the capital Damascus on Wednesday, the second day of a Russia-ordered brief daily humanitarian pause amid reports of ground battles as government troops attempted to push their way into the area.

The Syrian Observatory for Human Rights said the five-hour pause in eastern Ghouta was preceded by a barrage of airstrikes in the towns of Harasta and Douma, where Syrian troops and allied militia trying to push ahead with a ground offensive on a number of fronts from the east and west clashed with local insurgent groups.

The Observatory said government shelling and limited clashes were reported on three fronts since the pause began: near Douma, in Harasta Farms, and near Shifouniyah.

Russia has ordered a five-hour daily humanitarian pause to allow civilians to exit the region that started Tuesday. But no humanitarian aid has gone in and no civilians have left. Residents said they do not trust the truce and the U.N. and aid agencies criticized the unilateral arrangement, saying it gave no guarantees of safety for residents wishing to leave.

The limited pause came after a U.N. Security Council resolution that called for a nationwide 30-day cease-fire that failed to take hold. While the relentless bombing has somewhat subsided in the region, home to around 400,000 civilians, the Syrian government’s push to squeeze the insurgents out of the region continued. Commentators on pro-Syrian government TV cheered the Syrian troops, saying there can be no going back on bringing the region under control.

In the period of a week, more than 500 civilians were killed in the violence and the region’s medical facilities were targeted, and rescuers overwhelmed. On the first day of the pause, activists reported around 20 civilians were killed, including several pulled from under the rubble from previous bombings.

Bassam Abu Bashir, an anaesthetist in a hospital in eastern Ghouta, said the shelling continued Monday and Tuesday but has largely spared his central hometown of Saqba and he had to deal with fewer injuries than in the past week. He said the violence was now closer to the ground offensive areas. Abu Bashir said the shelling still struck civilians living in villages near the clashes.

“Even in areas that are calmer, there is still no truce. There are still jets flying over our heads and areas where there are gatherings that get targeted,” Abu Bashir said. “There are still injured coming in but not as many as before.”

He said rescuers are also finding time to pull dead bodies from under the rubble of destroyed buildings.

Eastern Ghouta, adjacent to the Syrian capital, came under opposition control in the early days of the revolt against the Syrian government, threatening President Bashar Assad’s seat of power. Under a siege since 2013, the region relied on tunnels and smuggling for supplies and movement. But these tunnels have been controlled by the government in the past months, tightening the siege on the region amid an escalating government offensive.

State-run al-Ikhbariya TV broadcast Wednesday from the deserted corridor as ambulance workers milled around near parked vans. State media said the rebels inside Ghouta are preventing civilians from leaving, a charge they deny. The State news agency SANA said shells fell near the corridor, but no injuries were reported.

The TV presenter said government fliers have been dropped in eastern Ghouta indicating to civilians the route to the corridor and how to proceed if they want to leave the area.

“A message from the Syrian army: because of the terrorists, thousands have died and live in shelters. We hope that you don’t cooperate with the terrorists,” the presenter reading from the flier said.

Albert Aji in Damascus, Syria, contributed reporting.