At least 89 people have been killed by a massive tornado that brought devastation to a city in the US state of Missouri.
Joplin city manager Mark Rohr announced the death toll at a news conference outside the wreckage of a hospital that took a direct hit from Sunday’s storm.
Mr Rohr said the twister cut a path nearly six miles long and more than a half-mile wide through the centre of the city which is close to the borders with Oklahoma and Kansas.
Much of the south side was levelled, with businesses, homes and restaurants reduced to ruins.
Many more were injured in the storm and were scattered to any nearby hospitals that could take them.
A door-to-door search of the damaged area was underway, but rescuers have to move carefully around downed power lines, jagged debris and a series of gas leaks that caused fires around the city overnight.
“We will recover and come back stronger than we are today,” Mr Rohr said.
Fire chief Mitch Randles estimated that up to 30% of the city of 50,000 people was damaged, and said his own home was among the buildings destroyed.
“It cut the city in half,” Mr Randles said.
St. John’s Regional Medical Centre appeared to suffer a direct hit. Staff had just a few moments’ notice to hustle patients into hallways before the storm struck the multi-storey building, blowing out hundreds of windows and leaving the facility useless.
In the car park a helicopter lay crushed on its side, its rotors torn apart and windows smashed. Nearby, a pile of cars lay crumpled into a single mass of twisted metal.
Triage centres and shelters were set up around the city.
Emergency management officials rushed heavy equipment to Joplin to help lift debris and clear the way for search and recovery operations.
Missouri Governor Jay Nixon declared a state of emergency, and President Barack Obama sent condolences to families of those who died in storms in Joplin and across the Midwest.
Jeff Lehr, a reporter for the Joplin Globe, said he was upstairs in his home when the storm hit but was able to make his way to a basement.
“There was a loud huffing noise, my windows started popping. I had to get downstairs, glass was flying. I opened a closet and pulled myself into it,” he said.
“Then you could hear everything go. It tore the roof off my house, everybody’s house. I came outside and there was nothing left.”
In Minneapolis, Minnesota, at least one person was killed and 30 others hurt. At least 100 homes were damaged.