Families in southern Turkey and Syria spent a second night in the freezing cold on Wednesday as overwhelmed rescuers raced to pull people from the rubble two days after a massive earthquake that killed more than 9,600 people.
In Turkey, dozens of bodies, some covered in blankets and sheets and others in body bags, were lined up on the ground outside a hospital in Hatay province.
Many in the disaster zone had slept in their cars or in the streets under blankets, fearful of going back into buildings shaken by the 7.8 magnitude tremor - already Turkey's deadliest since 1999 - that hit in the early hours of Monday.
Rescuers there and in neighboring Syria warned that the death toll would keep rising as some survivors said help had yet to arrive.
"Where are the tents, where are food trucks?" said Melek, 64, in the southern Turkish city of Antakya, adding that she had not seen any rescue teams.
"We haven't seen any food distribution here, unlike previous disasters in our country. We survived the earthquake, but we will die here due to hunger or cold here."
With the scale of the disaster becoming ever more apparent, the death toll rose above 7,100 in Turkey.
In Syria, already devastated by 11 years of war, the confirmed toll climbed to more than 2,500 overnight, according to the Syrian government and a rescue service operating in the rebel-held northwest.
Turkish President Tayyip Erdogan has declared a state of emergency in 10 provinces. But residents in several damaged Turkish cities have voiced anger and despair at what they said was a slow and inadequate response by the authorities.
Erdogan, facing a close-fought election in May, is expected to visit some of the affected areas on Wednesday.
The initial quake, followed hours later by a second one almost as powerful, struck just after 4 a.m. on Monday, giving the sleeping population little chance to react.
It toppled thousands of buildings including hospitals, schools, and apartment blocks, injured tens of thousands, and left countless people homeless in Turkey and northern Syria.
Turkish authorities say some 13.5 million people were affected in an area spanning roughly 450 km (280 miles) from Adana in the west to Diyarbakir in the east - broader than the distance between Boston and Philadelphia, or Amsterdam and Paris.
In Syria, it killed people as far south as Hama, some 100km from the epicenter.
Turkey's disaster management agency said the number of injured was above 38,000.
'UNDER THE RUBBLE'
In the town of Jandaris in northern Syria, rescue workers and residents said dozens of buildings had collapsed.
Standing around the wreckage of what had been a 32-apartment building, relatives of people who had lived there said they had seen no one removed alive. A lack of heavy equipment to remove large concrete slabs was impeding rescue efforts.
Rescue workers have struggled to reach some of the worst-hit areas, held back by destroyed roads, poor weather, and a lack of resources and heavy equipment. Some areas are without fuel and electricity.
Aid officials voiced particular concern about the situation in Syria, where humanitarian needs were already greater than at any point since the eruption of a conflict that has partitioned the nation and is complicating relief efforts.
The head of the World Health Organization has said the rescue efforts face a race against time, with the chances of finding survivors alive slipping away with every minute and hour.
In Syria, a rescue service operating in the insurgent-held northwest said the number of dead had climbed to more than 1,280, and more than 2,600 were injured.
"The number is expected to rise significantly due to the presence of hundreds of families under the rubble, more than 50 hours after the earthquake," the rescue service said on Twitter.
Overnight, the Syrian health minister said the number of dead in government-held areas rose to 1,250, the state-run al-Ikhbariya news outlet reported on its Telegram feed. The number of wounded was 2,054, he said.
Turkey's deadliest earthquake in a generation has handed Erdogan a huge rescue and reconstruction challenge, which will overshadow the run-up to the May elections already set to be the toughest of his two decades in power.
The vote, too close to call according to polls before the quake, will determine how Turkey is governed, where its economy is headed, and what role the regional power and NATO member may play to ease conflict in Ukraine and the Middle East.
Heartrending scenes of a newborn plucked alive from the rubble and a broken father clutching his dead daughter's hand have laid bare the human cost of violent earthquakes in Syria and Turkey.
For two days and nights since the 7.8 magnitude quake, an impromptu army of rescuers have worked in freezing temperatures to find those still entombed among ruins that pockmark several cities on either side of the border.
For Mesut Hancer -- a resident of the Turkish city Kahramanmaras, near the epicenter -- it is already too late.
He sat on the freezing rubble, too grief-stricken to speak, refusing to let go of his 15-year-old daughter Irmak's hand as her body lay lifeless among the slabs of concrete and strands of twisted rebar.
- 'Children are freezing' -
Even for survivors, the future seems bleak.
Many have taken refuge from relentless aftershocks, cold rain, and snow in mosques, schools, and even bus shelters -- burning debris to stay alive.
Frustration is growing that help has been slow to arrive.
"I can't get my brother back from the ruins. I can't get my nephew back. Look around here. There is no state official here, for God's sake," said Ali Sagiroglu in Kahramanmaras.
"For two days we haven't seen the state around here... Children are freezing from the cold," he said.
In nearby Gaziantep, shops are closed, there is no heat because gas lines have been cut to avoid explosions, and finding petrol is tough.
Sixty-one-year-old resident Celal Deniz said the police had to intervene when impatient crowds waiting for rescue teams "revolted".
About 100 others wrapped in blankets slept in the lounge of an airport terminal normally used to welcome Turkish politicians and celebrities.
"We saw the buildings collapse so we know we are lucky to be alive," said Zahide Sutcu, who went to the airport with her two small children.
"But now our lives have so much uncertainty. How will I look after these children?"
Across the border in northern Syria, a decade of civil war and Syrian-Russian aerial bombardment had already destroyed hospitals, collapsed the economy and prompted electricity, fuel, and water shortages.
In the rebel-controlled town of Jindayris, even the joy of rescuing a newborn baby was tainted with sadness.
She was still tethered to her mother who was killed in the disaster.
"We heard a voice while we were digging," Khalil al-Suwadi, a relative, told AFP.
"We cleared the dust and found the baby with the umbilical cord (intact) so we cut it and my cousin took her to the hospital."
The infant faces a difficult future as the sole survivor among her immediate family. The rest were buried together in a mass grave on Tuesday.
- International response -
Dozens of nations including the United States, China, and the Gulf States have pledged to help, and search teams, as well as relief supplies, have begun to arrive by air.
A winter storm has compounded the misery by rendering many roads -- some of them damaged by the quake -- almost impassable, resulting in traffic jams that stretch for kilometers in some regions.
Turkish President Recep Tayyip Erdogan has declared a three-month state of emergency in 10 southeastern provinces.
The World Health Organization has warned that up to 23 million people could be affected by the massive earthquake and urged nations to rush help to the disaster zone.
The Syrian Red Crescent appealed to Western countries to lift sanctions and provide aid as President Bashar al-Assad's government remains a pariah in the West, complicating international relief efforts.
Secretary of State Antony Blinken said the United States would not work with the Damascus government.
"These funds, of course, go to the Syrian people -- not to the regime. That won't change," he said.
Aid agencies have also asked the Syrian government to allow border crossings to be reopened to bring help to rebel-held areas.
The Turkey-Syria border is one of the world's most active earthquake zones.
Monday's earthquake was the largest Turkey has seen since 1939, when 33,000 people died in the eastern Erzincan province.
In 1999, a 7.4-magnitude earthquake killed more than 17,000.
Experts have long warned a large quake could devastate Istanbul, a megalopolis of 16 million people filled with rickety homes.
'EVERY MINUTE, EVERY HOUR
Turkish authorities say some 13.5 million people were affected in an area spanning roughly 450 km (280 miles) from Adana in the west to Diyarbakir in the east, and 300 km from Malatya in the north to Hatay in the south. Syrian authorities have reported deaths as far south as Hama, some 250 km from the epicenter. "It's now a race against time," World Health Organization Director-General Tedros Adhanom Ghebreyesus said in Geneva. "Every minute, every hour that passes, the chances of finding survivors alive diminishes." Across the region, rescuers toiled night and day as people waited in anguish by mounds of rubble clinging to the hope that friends, relatives, and neighbors might be found alive In Antakya, the capital of Hatay province bordering Syria, rescue teams were thin on the ground and residents picked through debris themselves. People pleaded for helmets, hammers, iron rods, and rope. One woman, aged 54 and named Gulumser, was pulled alive from an eight-story building 32 hours after the quake.
Another woman then shouted at the rescue workers: "My father was just behind that room she was in. Please save him." The workers explained they could not reach the room from the front and needed an excavator to remove the wall first. More than 12,000 Turkish searches and rescue personnel are working in the affected areas, along with 9,000 troops. More than 70 countries offered rescue teams and other aid. But the sheer scale of the disaster is daunting.
"The area is enormous. I haven't seen anything like this before," said Johannes Gust, from Germany's fire and rescue service, as he loaded equipment onto a truck at Adana airport. Turkey's Disaster and Emergency Management Authority said 5,775 buildings had been destroyed in the quake and that 20,426 people had been injured. Two U.S. Agency for International Development teams with 80 people each and 12 dogs are set to arrive Wednesday morning in Turkey and head to the southeastern province of Adiyaman to focus on urban search and rescue. UNICEF spokesperson James Elder told reporters in Geneva that the earthquake "may have killed thousands of children."
Syrian refugees in northwest Syria and in Turkey were among the most vulnerable people affected, Elder said. In the Syrian city of Hama, Abdallah al Dahan said funerals for several families were taking place on Tuesday. "It's a terrifying scene in every sense," said Dahan, contacted by phone. "In my whole life, I haven't seen anything like this, despite everything that has happened to us." Mosques opened their doors to families whose homes were damaged.
The Syrian state news agency SANA said at least 812 people were killed in the government-held provinces of Aleppo, Latakia, Hama, Idlib, and Tartous. At least 1,120 people were killed in Syria's opposition-held northwest with the toll expected to "rise dramatically", the White Helmets rescue team said.
"There are a lot of efforts by our teams, but they are unable to respond to the catastrophe and a large number of collapsed buildings," group head Raed al-Saleh said. A U.N. humanitarian official in Syria said fuel shortages and the harsh weather were creating obstacles.
"The infrastructure is damaged, the roads that we used to use for humanitarian work are damaged," U.N. resident coordinator El-Mostafa Benlamlih told Reuters from Damascus. In Malatya, Turkey, locals with no specialist equipment or even gloves tried to pick through the wreckage of homes crumpled by the force of the earthquake. "My in-laws' grandchildren are there. We have been here for two days. We are devastated," said Sabiha Alinak.
"Where is the state? We are begging them. Let us do it, we can rescue them. We can do it with our means."