Rescue crews dug through piles of splintered houses and crushed cars in a search for victims of a half-mile-wide tornado that killed at least 116 people as it blasted a Missouri town off the map and tore through its hospital.
It was the deadliest single twister in the US in nearly 60 years and the second major tornado disaster in less than a month.
Authorities fear the toll could rise as the full scope of the destruction in Joplin emerges: house after house reduced to slabs, cars crushed like cans, and shaken residents roaming streets in search of missing family members.
The danger was by no means over with fires from gas leaks burning across town, and more violent weather loomed, including the threat of hail, high winds and even more tornadoes.
At daybreak, the city’s south side emerged from darkness as a barren, smoky wasteland.
“I’ve never seen such devastation – just block upon block upon block of homes just completely gone,” said former state legislator Gary Burton who was helping at a volunteer centre at Missouri Southern State University.
Unlike the multiple storms that killed more than 300 people last month across the South, Joplin was smashed by just one exceptionally powerful tornado.
Not since a June 1953 tornado in Flint, Michigan, had a single twister been so deadly. That storm also killed 116, according to the National Weather Service.
Authorities were prepared to find more bodies in the rubble throughout the gritty, working-class town of 50,000 people about 160 miles south of Kansas City.
Missouri governor Jay Nixon said he did not want to guess how high the death toll would eventually climb, but he said: “Clearly, it’s on its way up.”
Seventeen people were pulled alive from the rubble. An unknown number of people were hurt.
Some of the most startling damage was at St John’s Regional Medical Centre, where staff had only moments to bustle their patients into the hallway. Six people died there, five of them patients, plus one visitor.
The storm blew out hundreds of windows and caused damage so extensive that doctors had to abandon the hospital soon after the twister passed.
A crumpled helicopter lay on its side in the car park near a single twisted mass of metal that used to be cars.
Dr Jim Riscoe said some members of his emergency room staff turned up after the tornado with injuries of their own, but worked through the night anyway.
“I spent most of my life at that hospital,” Dr Riscoe said at a triage centre at Joplin’s Memorial Hall entertainment venue. “It’s awful. I had two pregnant nurses who dove under gurneys ... It’s a testimony to the human spirit.”
While many residents had up to 17 minutes of warning, rain and hail may have drowned out the sirens.
Larry Bruffy said he heard the first warning but looked out from his garage and saw nothing. “Five minutes later, the second warning went off,” he said. “By the time we tried to get under the house, it already went over us.”
As rescuers toiled in the debris, a strong thunderstorm lashed the crippled city. Rescue crews had to move gingerly around downed power lines and jagged chunks of debris as they hunted for victims and hoped for survivors. Fires, gas fumes and unstable buildings posed constant threats.
National Weather Service director Jack Hayes said the storm was given a preliminary label as an EF4 – the second-highest rating assigned to twisters based on the damage they cause.
He said the storm had winds of 190 to 198mph. At times, it was three-quarters of a mile wide.
Once the centre of a thriving mining industry, Joplin flourished though the Second World War because of its rich lead and zinc mines. It also gained fame as a stop along Route 66, the famous highway stretching from Chicago to Santa Monica, California, before freeways diminished the city’s importance.
The community, named for the founder of the area’s first Methodist congregation, is now a transportation crossroads and manufacturing hub and also the home town of poet Langston Hughes and Gunsmoke actor Dennis Weaver.
Last month, a ferocious pack of twisters roared across six Southern states, killing more than 300 people, more than two-thirds of them in Alabama.
As in the Midwest, the Southerners also had warning – as much as 24 minutes. But those storms were too wide and too powerful to escape. They obliterated entire towns from Tuscaloosa, Alabama, to Bristol, Virginia, in what the weather service said was the nation’s deadliest tornado outbreak since April 1974.
Forecasters said severe weather would probably persist all week. Arkansas, Kansas, Missouri and Oklahoma could see tornadoes through today, and the bad weather could reach the East Coast by Friday.
The twister that hit Joplin was one of more than 50 reported across seven Midwest states over the weekend. One person was killed in Minneapolis and another in Kansas, but Missouri took the hardest hits.
Kerry Sachetta, principal of a flattened Joplin High School, could barely recognise his own building.
“You see pictures of World War II, the devastation and all that with the bombing,” he said. “That’s really what it looked like.”