ANTAKYA, Turkey - Thousands who lost their homes in a catastrophic earthquake huddled around campfires and clamored for food and water in the bitter cold, three days after the temblor and a series of aftershocks hit Turkey and Syria, killing more than 19,300.
Emergency crews used pick axes, shovels and jackhammers to dig through twisted metal and concrete — and occasionally still pulled survivors out. But in some places, they switched the focus to demolishing unsteady buildings.
At least three American citizens are among the dead, a U.S. State Department spokesperson told Fox News.
While stories of miraculous rescues briefly buoyed spirits, the grim reality of the hardship facing tens of thousands who survived the disaster cast a pall. The number of deaths has surpassed the toll in a 2011 earthquake off Japan that triggered a tsunami, killing more than 18,400 people.
In northwest Syria, the first U.N. aid trucks to enter the rebel-controlled area from Turkey since the quake arrived — underscoring the difficulty of getting help to people in the country riven by civil war. In the Turkish city of Antakya, meanwhile, dozens of people scrambled for aid in front of a truck distributing children's coats and other supplies.
One survivor, Ahmet Tokgoz, called for the government to evacuate people from the devastated region. While many of the tens of thousands who have lost their homes have found shelter in tents, stadiums and other temporary accommodation, others have spent the nights outdoors.
"Especially in this cold, it is not possible to live here," he said. "If people haven’t died from being stuck under the rubble, they’ll die from the cold."
Winter weather and damage to roads and airports have hampered the response in both Turkey and Syria, where a civil war that displaced millions has further complicated efforts. Some in Turkey have complained the response was too slow — a perception that could hurt President Recep Tayyip Erdogan at a time when he faces a tough battle for reelection in May.
In the Turkish town of Elbistan, rescuers stood atop a high stack of rubble from a collapsed home and fished out an elderly woman who had been submerged.
Teams urged quiet in the hopes of hearing stifled pleas for help, and the Syrian paramedic group in the rebel-held northwest known as White Helmets noted that "every second could mean saving a life."
But more and more often, the teams pulled out dead bodies from under the rubble. In Turkey's Antakya, over 100 bodies, covered by blankets and awaiting identification, lay in a makeshift morgue outside a hospital and in refrigerated trucks.
With the chances of finding people alive in the rubble dwindling, teams in some places began demolishing buildings. In others, they simply had to move on.
In Adiyaman, Associated Press journalists saw a local resident plead with rescuers to come and sift through the rubble of a building where relatives were trapped. The crew refused, saying there was no one alive there, and they had to prioritize areas where there may be survivors.
A man, who gave only his name as Ahmet out of fear of government retribution, later asked the AP: "How can I go home and sleep? My brother is there. He may still be alive."
In Nurdagi, throngs of onlookers — mostly family members of people trapped inside — watched as heavy machines ripped at one building that had collapsed, its six floors pancaked together.
Mehmet Yilmaz watched from a distance, estimating that around 80 people were still beneath the rubble — but that it was unlikely any would be recovered alive.
"There’s no hope," said Yilmaz, 67, who had six relatives, including a 3-month-old baby, trapped inside. "We can’t give up our hope in God, but they entered the building with listening devices and dogs and there was nothing."
Authorities called off search-and-rescue operations on Thursday in the cities of Kilis and Sanliurfa, where destruction was not as severe as in other impacted regions.
Across the border in war-riven Syria, assistance trickled in. Smaller aid organizations have sent in shipments to Syria's rebel-held northwest, but the first U.N. trucks arrived Thursday. The U.N. is only authorized to deliver aid through one border crossing and road damage has prevented that thus far.
U.N. officials said more was needed, and they pleaded for humanitarian concerns to take precedence over politics.
The scale of loss and suffering to tend to remained massive. Turkish authorities said Thursday that the death toll had risen to more than 16,100 in the country, with more than 64,000 injured.
On the Syrian side, which includes in government-held and rebel-held areas, of the border, more than 3,100 have been reported dead and more than 5,000 injured.
It was not clear how many people were still unaccounted for in both countries.
Among the missing were members of a high-school volleyball team from northern Cyprus, as well as teachers and parents who had been staying in a hotel that collapsed, said Nazim Cavusoglu, the education minister in the breakaway Turkish Cypriot north, on Turkey’s NTV television.
Turkey’s disaster management agency said more than 110,000 rescue personnel were now taking part in the effort and more than 5,500 vehicles, including tractors, cranes, bulldozers and excavators had been shipped. Teams from places as diverse as Poland, Switzerland, Israel and the West Bank were contributing to the deployment to Turkey.
But international aid for Syria was far more sparse, where efforts have been hampered by the ongoing war and the isolation of the rebel-held region along the border that is surrounded by Russia-backed government forces. Syria itself is an international pariah under Western sanctions linked to the war.
The U.N. shipment was scheduled before the earthquake happened but was delayed by road damage. U.N. officials said more trucks were set to follow.
Erdogan, who continued touring devastated areas Thursday, has sought to deflect criticism of the response — and vowed it was improving. He renewed a promise to quake survivors that destroyed homes would be rebuilt within a year. He has said the government will distribute 10,000 Turkish lira ($532) to affected families.
Alsayed reported from Bab al-Hawa, Syria, and Bilginsoy from Istanbul. Associated Press journalists Suzan Fraser in Ankara, Turkey, Emrah Gurel and Yakup Paksoy in Adiyaman, Turkey, Robert Badendieck in Istanbul and David Rising in Bangkok contributed.