The death toll from a string of tornadoes that hit the US state of Missouri rose to 89 early Monday, with officials warning the death toll will likely rise, DPA reported.
People could be heard calling for help from beneath the wreckage in Joplin, which bore the brunt of the storm, even as rescue workers spread out to find and aid survivors, reported broadcaster ABC.
Search and rescue efforts were being hampered by poor weather and high winds. But bodies were also being pulled out into the streets of Joplin, about 250 kilometres south of Kansas City, so that loved ones could identify them.
The tornado that struck the city late Sunday was reportedly more than 1.6 kilometres wide with gusts reaching 320 kilometres per hour. Authorities estimated that between 25-30 per cent of the city had been destroyed, reported ABC. At least 2,000 buildings were levelled.
The website of the local Joplin Globe newspaper had not been updated since Sunday, though a feed of Facebook postings issued directions to volunteers and survivors about the best places to go, including a reference to an aid shelter possibly being set up where the Home Depot, a chain of big box retail hardware stores, "was."
There were also fears that broken gas lines could be leaking, raising the danger of accidental fires.
The News-Leader newspaper of nearby Springfield, Missouri, reported that Joplin's St John's Regional Medical Center took a "direct hit" from the storm, requiring at least 100 patients to be transferred to safety.
ABC reported that the hospital's roof had been torn off and that every window in the building had shattered. Deaths had also been reported at a local nursing home.
Missouri Governor Jay Nixon declared a state of emergency on Sunday, called out the National Guard to support local emergency services and mobilized other state agencies to assist.
The storm struck with multiple funnel clouds in the south part of Joplin about 5:45 pm (2245 GMT) Sunday, according to the National Weather Service.
The tornado was one of 70 produced by a storm system since Friday, with more than 47 tornadoes reported across the central United States on Sunday alone.