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Rescue workers in quake-devastated Turkey and northern Syria struggled on Tuesday to reach some of the worst-hit areas, held back by destroyed roads, poor weather and a lack of resources and heavy equipment and confronted by angry survivors.
Turkish authorities say more than 12,000 search and rescue personnel and 9,000 troops are working in the affected areas. President Tayyip Erdogan called a state of emergency on Tuesday to bolster the responses.
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But a major challenge is the sheer scale of the disaster over a large area, requiring a huge mobilisation of resources to help look for survivors. Scant information has come out of some places, raising concern about the extent of the devastation that could yet be discovered.
With little immediate help at hand, residents picked through rubble sometimes without even basic tools in a desperate hunt for survivors trapped under thousands of collapsed buildings a day after the earthquake struck.
People in the southern Turkish city of Antakya were asking each other for helmets, hammers, iron rods and strong rope to lift debris as they waited for reinforcements to arrive.
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Their frustration already prompted scuffles between residents and rescue workers, with people pleading with rescuers to save their loved ones. In Antakya's Kavasli neighbourhood, one woman, aged 54 and named Gulumser, was pulled alive from an 8-storey 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 rescue workers explained they could not reach the room from the front and needed an excavator to remove the wall first.
Elsewhere, drone footage showed a lone man on top of a collapsed building, hammering at debris while others stood around him.
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"I see people here complain about the scarcity of rescue efforts, but maybe it is because there are 10 cities affected by the quake and many, many rescue teams are needed," a rescue worker from Istanbul, who declined to be named, told Reuters.
"But we are doing our best, trying to save people."
To aid rescue efforts, volunteers poured into the rebel-held Syrian town of Jandaris in Aleppo province.
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"We are here to help. There is no state, no equipment to help people, there are no excavators, or hard equipment. Everything is done by our hands," said volunteer Abu Malik al Hamawi.
"Whole families are still trapped under buildings."
SLOW PROGRESS
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 100 km from the epicentre.
"The area is enormous. I haven't seen anything like this before," said Johannes Gust, a worker from Germany's fire and rescue service, while loading equipment onto a truck at Turkey's Adana airport.
Another challenge is reaching the afflicted areas by road, Jens Laerke, Deputy Spokesperson of the United Nations Office for the Coordination of Humanitarian Affairs, told a UN briefing in Geneva.
"It is a disaster zone, if I ever saw one. Of course access by road is a challenge. There is a shortage of trucks to transport international teams to work on site," he said.
A senior official at the International Federation of Red Cross and Red Crescent Societies said reaching remote, rural parts of Syria was proving especially difficult.
"What is missing from the rescue effort at the minute is there are certain types of machinery that would help in terms of trying to help people that are trapped in rubble," Xavier Castellanos Mosquera told Reuters in an interview.
The Turkish authorities are using the airport in Adana as a logistics base. The airport became so congested that for example a team from Taiwan's fire service, consisting of 40 people and three search and rescue dogs, was stranded in Istanbul for hours on Tuesday waiting to take off.
Rescue workers told Reuters there were 14 separate sites they were working on to try to extract people from under the rubble in Adana.
The city has comparably better conditions than other places but resources were stretched thin. A makeshift shelter in a school was sheltering survivors but the young volunteers staffing it looked haggard and told Reuters they were exhausted and had little to work with. They were distributing sandwiches and making instant coffee as fast as they could for the groups of people flowing in to find a corner to sleep in.
Emrah Delinkanli, who sells women's clothing, was standing in the yard of a damaged building in Adana looking on as a crane moved slabs of concrete from a pile of rubble where half a building had collapsed, looking like it had been sheared off.
"My colleague Ibrahim is under there. He lived on the second floor and there are 12 floors above him. You think he could have survived that? There is no way," said Delinkanli, adding he believed Ibrahim was trapped with his two daughters.
Back in Antakya in the Hatay province, frustration was mounting.
"No aid, no electricity, no phone, no food since the quake rescue team just arrived this morning," said a woman called Kubra. "There used to be a cliché in Turkey 'Where is the state?' We are living this cliché now."
(Additional reporting by Gabrielle Tétrault-Farber, Ben Blanchard, Kate Holton; Writing by Matthias Williams; Editing by Jonathan Spicer, William Maclean)