ISTANBUL — As temperatures dipped below freezing, rescue crews raced Tuesday to free those trapped under the thousands of buildings that collapsed in the magnitude 7.8 earthquake that rocked southern Turkey and northern Syria, even as the death toll rose past 7,200.
Rescue workers scrabbled frantically at mounds of rubble, alert for the cries of still-conscious survivors. Aftershocks, including a strong jolt of magnitude 5.7 on Tuesday, added to the difficulty and fear. Trained emergency personnel and heavy equipment were in short supply as affected areas waited for domestic and international aid to arrive, held up in some cases by harsh weather conditions that snarled airports.
The full scale of the devastation left by the massive temblor — one of the most powerful to hit the region in more than a century — still has yet to become clear. But on Tuesday evening, Turkey's disaster management agency said that at least 4,500 people had died. President Recep Tayyip Erdogan said earlier that more than 22,000 others were injured, and he declared a three-month state of emergency in 10 provinces affected by the earthquake.
In Syria, which has been racked by a 12-year civil war, officials were quoted in state media as saying that 812 people had died since Monday in areas controlled by the government of President Bashar Assad. In opposition-held enclaves of northwest Syria, the White Helmets, a civil defense volunteer group, said the number of dead exceeded 790, adding that it was likely an underestimate.
The World Health Organization warned that a staggering 23 million people, 1.4 million of them children, could be exposed to the elements.
"It's now a race against time," said Tedros Adhanom Ghebreyesus, the WHO's director general. "Every minute, every hour that passes, the chances of finding survivors alive diminishes."
In Gaziantep, a provincial Turkish capital close to the quake's epicenter, rescue crews searched through the rock-strewn remains of one of the city's many leveled buildings, shouting for silence from onlookers. A crew member sat atop a concrete slab that had once been the building's roof, pressing his ear to the masonry to pick up sounds of distress beneath the wreckage.
In the crowd, some people lifted their heads, others bowed them, as they strained to listen as one.
Minutes passed.
Nothing.
That doleful scene was replicated across the region Tuesday. There were some heartening successes — about 8,000 people have been rescued so far in Turkey, Erdogan said — but the sheer scale of the task facing emergency responders is daunting, compounded by the frigid temperatures, inclement weather and the hundreds of aftershocks.
"Now, on the second day, the disaster is revealing itself to be larger than we first thought," said Ammar Selmo, a volunteer with the White Helmets.
The organization has become a fixture in rebel-held parts of war-torn Syria for more than a decade, with crews in white hard hats known for running into still-smoldering husks of bombed buildings to fish out survivors. But the earthquake's aftermath is unprecedented for the group, Selmo said.
"We're always ready to respond, but normally it's three or four homes we have to deal with. Now there are 400, with hundreds of families under the ground," he said, adding that his organization is short of "vehicles, fuel and money."
The harsh weather conditions that have battered the region for weeks are hampering the rescue efforts and the arrival of assistance promised by a host of countries, including Britain, members of the European Union, India, Pakistan, Qatar, South Korea and the U.S. Los Angeles County is sending dozens of specially trained firefighters; Fairfax County in Virginia is also dispatching a crew.
Even Greece, which has strained relations with Turkey, said it would send a military transport aircraft with rescue dogs.
Nations were less forthcoming with offers of assistance to Syria, whether because of downgraded relations with Assad's government or because of U.S. and EU sanctions that have kept donors away. Russia and Iran, staunch allies of the Syrian government, have sent hundreds of troops and engineering specialists to assist rescue efforts.
In the Turkish city of Antakya, the capital of Hatay province, resident Nurgul Atay told the Associated Press that she could hear her mother's cries from beneath the rubble of a flattened building. But she and others were unable to reach the trapped woman by themselves, and trained rescue crews and heavy equipment were unavailable.
"If only we could lift the concrete slab, we'd be able to reach her," Atay said. "My mother is 70 years old. She won't be able to withstand this for long."
Along with rescue crews, medical facilities have been overwhelmed as well, and also subject to the disruption and tension of aftershocks. That's especially true on the Syrian side of the border, where the merciless civil war has hollowed out many of the country's institutions and much of its infrastructure.
The rebel-held northern regions, backed by Turkish forces, are home to millions of Syrians displaced by the war, who are now experiencing even greater misery. The area has relied on routes through southern Turkey for goods and supplies. The United Nations has for years dispatched aid via those routes rather than through the Syrian capital, Damascus.
But the earthquake has upended those arrangements. Madevi Sun-Suon, spokesperson for the U.N.'s humanitarian agency, said aid would be disrupted because of the damaged roads.
"We are exploring all avenues to reach people in need and conducting assessments on feasibility," Sun-Suon told CNN. "We do have aid, but this road issue is a big challenge."
Turkey's Iskenderun port also appears to have suffered a blow. Danish shipping company A.P. Moller - Maersk said Tuesday that the port had suffered "severe structural damage, leading to a complete stop of all operations until further notice." The statement added that roads were also heavily affected and that the company would divert containers to other transshipment hubs.
