Photos: Pain, anguish, death, devastation and rubble everywhere after massive quake hits Turkey-Syria

People try to reach people trapped under the debris of a collapsed building in Malatya, Turkey.

A man reacts at the site of a collapsed building in the aftermath of a deadly earthquake in Diyarbakir, Turkey.

View of heavily damaged buildings after an earthquake as rescue operations continue in Jandaris, Syria.

Civilians look for survivors under the rubble of collapsed buildings in Kahramanmaras.

People sit amid rubble following an earthquake in Hatay, Turkey.

A girl reacts following an earthquake, in rebel-held town of Jandaris, Syria.

A doll lies on the ground near the site of a collapsed mosque, following an earthquake in Hatay, Turkey.

View of temporary shelters set up after an earthquake struck the region in Kobani, Syria.

A woman is rescued after surviving the earthquake in Hatay, the day after a 7.8-magnitude earthquake struck the country's southeast on February 7, 2023. - Rescuers in Turkey and Syria braved frigid weather, aftershocks and collapsing buildings, as they dug for survivors buried by an earthquake that killed more than 5,000 people. Up to 23 million people could be affected by the massive earthquake that has killed thousands in Turkey and Syria, the WHO warned on Tuesday, promising long-term assistance.

An aerial view shows collapsed and damaged buildings after an earthquake in Hatay, Turkey.

Rescuers in Turkey and Syria dug with their bare hands through the freezing night Tuesday hunting for survivors among the rubble of thousands of buildings felled in a series of violent earthquakes. The confirmed death toll across the two countries has soared above 4,300 after a swarm of strong tremors near the Turkey-Syria border - the largest of which measured at a massive 7.8-magnitude.

Turkish and Syrian disaster response teams report more than 5,600 buildings have been flattened across several cities, including many multi-storey apartment blocks that were filled with sleeping residents when the first quake struck.

In the city of Kahramanmaras in southeastern Turkey, eyewitnesses struggled to comprehend the scale of the disaster. "We thought it was the apocalypse," said Melisa Salman, a 23-year-old reporter. "That was the first time we have ever experienced anything like that."

Turkey's relief agency AFAD on Tuesday said there were now 2,921 deaths in that country alone, bringing the confirmed tally to 4,365. There are fears that toll will rise inexorably, with World Health Organization officials estimating up to 20,000 may have died.

In Gaziantep, a Turkish city home to countless refugees from Syria's decade-old civil war, rescuers picking through the rubble screamed, cried and clamoured for safety as another building collapsed nearby without warning. The initial earthquake was so large it was felt as far away as Greenland, and the impact is big enough to have sparked a global response.

In the southeastern Turkish city of Sanliurfa, rescuers were working into the night to try and pull survivors from the wreckage of a seven-storey building that had collapsed. "There is a family I know under the rubble," said 20-year-old Syrian student Omer El Cuneyd. "Until 11:00 am or noon, my friend was still answering the phone. But she no longer answers. She is down there."

Despite freezing temperatures outside, terrified residents spent the night on the streets, huddling around fires for warmth. Mustafa Koyuncu packed his wife and their five children into their car, too scared to move. "We can't go home," the 55-year-old told AFP. "Everyone is afraid."

Some of the heaviest devastation occurred near the quake's epicentre between Kahramanmaras and Gaziantep, where entire city blocks lay in ruins under gathering snow.

President Joe Biden promised his Turkish counterpart Recep Tayyip Erdogan that the United States will send "any and all" aid needed to help recover from a devastating earthquake. Ukrainian President Volodymyr Zelensky also offered to provide "the necessary assistance" to Turkey, whose combat drones are helping Kyiv fight the Russian invasion. Turkey is in one of the world's most active earthquake zones.

A winter blizzard has covered major roads into the area in ice and snow.

Monday's first earthquake struck at 4:17am (0117 GMT) at a depth of about 18 kilometres (11 miles) near the Turkish city of Gaziantep, which is home to around two million people, the US Geological Survey said. More than 14,000 people have so far been reported injured in Turkey, the disaster management agency said, while Syria said at least 3,411 people were injured.