Elderly Pakistan couple quit Syria's embattled East Ghouta

An elderly Pakistani man and his wife have fled Syria's embattled Eastern Ghouta, it emerged on Thursday, the only known civilians to have left since a "humanitarian pause" took effect.

The rebel enclave outside Damascus has seen some of the worst bombardment and fighting of the Syrian civil war since Russia-backed government forces launched an assault on February 18.

Mohammad Fadhl Akram, 73, and his wife Saghran Bibi, 10 years younger, were evacuated on Wednesday afternoon, a medical source with the Syrian Red Crescent said, but were devastated to be leaving 17 family members behind in the battered region.

Their evacuation comes after a "humanitarian pause" announced by Russia came into effect on Tuesday following days of air strikes and clashes that have killed more than 600 civilians.

"Syria is my home - not Pakistan," Akram told AFP, but added that he now wanted to leave.

"I'm tired of all the bombardment... I'm really tired," he said.

Eastern Ghouta has been under siege by regime forces since 2013, with residents facing severe food and medical shortages even before the latest assault.

The Syrian Observatory for Human Rights, a Britain-based monitor, said the Pakistani couple were the only people among the besieged enclave's 400,000 residents to have left since the "humanitarian pause" started on Tuesday.

Russia this week ordered the daily five-hour pause in the enclave and said it was guaranteeing civilians safe passage to flee.

But Observatory head Rami Abdel Rahman said the Pakistani couple were leaving the enclave not because of this pause but as a result of months of negotiations by their embassy.

Akram, who settled in Syria in 1974, said he and his Pakistani wife were grateful to have been able to flee the embattled Damascus suburbs.

But they were distressed they had to leave two sons, three daughters and 12 grandchildren behind as fighting continues in the rebel-held region.

"I hope God protects them," said Akram, who sported a trimmed white beard.

"I don't want anything else."

He said the embassy told him his children could not leave as, unlike him, they were born in Syria.

Mohamad Azem Rihan, Pakistani charge d'affaires in Damascus, said the couple's papers were being prepared so they could be repatriated.

No other Pakistanis remained in the enclave, he said.

The Russian announcement of a "humanitarian pause" fell far short of a full 30-day ceasefire voted for by the United Nations Security Council last Saturday that has yet to be implemented.

Dozens of trucks loaded with relief supplies have been unable to enter the enclave.

More than 340,000 people have been killed across Syria since its civil war started in 2011 with the brutal repression of anti-government protests.