Sick and wounded people lay on a dusty road outside Kathmandu Medical College while hospital workers carried more patients out of the building on stretchers and sacks.
Doctors set up an operating theater inside a tent and rushed in the most critical, following a particularly big tremor that sent people running terrified into the streets.
The aftershock, itself a strong 6.7 magnitude quake, triggered more avalanches in the Himalayas after Saturday’s 7.9 quake – which unleashed Everest’s worst disaster and was the strongest since 1934 when 8,500 people were killed.
Outside the National Trauma Centre in Kathmandu, patients in wheelchairs who had been under treatment before the earthquake hit joined hundreds of injured with fractured and bloody limbs, who lay inside tents made from hospital sheets.
“We only have one operation theater here. To be able to provide immediate treatment we require 15 theaters. I am just not able to cope,” said Dipendra Pandey, an orthopedic surgeon, adding he had done 36 critical operations since Saturday.
Relief agencies and officials said most hospitals were overflowing and short on medical supplies.
“Both private and government hospitals have run out of space and are treating patients outside, in the open,” said Nepal’s envoy to India, Deep Kumar Upadhyay.
Neighboring countries sent in military transport planes laden with medical supplies, food and water. But little sign of organized relief efforts was visible as aid agencies struggled to fly helicopters in cloudy weather, aftershocks forced the intermittent closure of Kathmandu airport and roads were blocked by landslides.
The extent of the damage around the epicenter, near Gorkha in the western highlands, had still not been fully assessed.
Patchy mobile telephone and email communication added to the slow progress of relief as Asia’s poorest country reeled from its worst earthquake in eight decades.
As rescuers dug with their hands through the rubble of brick buildings in crowded Kathmandu, thousands of survivors prepared to spend a second rainy night outside because they were afraid of going back to damaged homes.
Meanwhile a plane carrying the first 15 climbers injured on Everest arrived in Kathmandu around noon local time. One, Gelu Sherpa, said: “There is a lot of confusion on the mountain. The toll will rise.”
The bodies of 17 climbers were recovered from the mountain, where the big aftershock sent boulders and ice crashing around camps in the high mountains.
It hit as Indian climber Arjun Vajpai spoke to Reuters over the phone from Makalu base camp near Everest.
“Another one, we have an aftershock right now. Oh shit!” he shouted. “Avalanche!”
Screams and the roar of crashing snow could be heard over the line as he spoke.
OTHER COUNTRIES HELP
With Nepal’s government overwhelmed by the scale of the disaster, India flew in medical supplies and members of its National Disaster Response Force, while China sent in a 60-strong emergency team. Pakistan’s army said was sending four C-130 aircraft with a 30-bed hospital, search and rescue teams and relief supplies.
Nepali army officer Santosh Nepal and a group of rescuers worked all night to open a passage into a collapsed building in Kathmandu. They had to use pick axes because bulldozers could not get through the ancient city’s narrow streets.
“We believe there are still people trapped inside,” he told Reuters, pointing at concrete debris and twisted reinforcement rods where a three-storey residential building once stood.
Among the capital’s landmarks destroyed in the earthquake was the 60-metre (200-foot) Dharahara Tower, built in 1832 for the queen of Nepal.
A jagged stump was all that was left of the lighthouse-like structure. As bodies were pulled from the ruins on Saturday, a policeman said up to 200 people had been trapped inside.
At one hospital in Kathmandu, police officer Sudan Shreshtha said his team had brought 166 corpses overnight.
“I am tired and exhausted, but I have to work and have the strength,” Shreshtha told Reuters as an ambulance brought three more victims to the Tribhuvan University Teaching Hospital.
Bodies, including that of a boy aged about seven, were heaped in a dark room. The stench of death was overpowering.
Outside, a 30-year-old woman who had been widowed wailed: “Oh Lord, why did you take him alone? Take me along with him.”
Some buildings in Kathmandu toppled like houses of cards, others leaned at precarious angles, and partial collapses exposed living rooms and furniture in place and belongings stacked on shelves.
People wandered the streets clutching bed rolls and blankets, while others sat in the street cradling their children, surrounded by a few plastic bags of belongings.
Rescuers, some wearing face masks to keep out the dust, scrambled over mounds of splintered timber and broken bricks in the hope of finding survivors.
The quake struck at midday on Saturday at a busy time of year for the tourism-reliant country’s trekking and climbing season, with an estimated 300,000 foreign tourists in the country, home to many World Heritage sites.
There were nearly 1,000 climbers and sherpas on Everest when the first avalanche struck and claimed the highest toll of any disaster on the world’s highest mountain.
Tents at Everest base camp were flattened by rocks and snow, climber photographs on social media showed. Another 100 climbers higher up Everest at camps 1 and 2 were safe, but their way back down the mountain was blocked by damage to the treacherous Khumbu icefalls, scene of an avalanche that killed 16 climbers last year.
Helicopters were able to fly in on Sunday morning as clouds lifted, to evacuate the injured to a lower altitude, from where they were being flown to Kathmandu.
Authorities put the death toll in Nepal at 2,460, and police said 6,492 were hurt. At least 1,100 were killed in the capital, a city of about 1 million people where many homes are old, poorly built and packed close together.
Some 66 people were reported killed in neighboring India. The aftershock rocked buildings in the Indian capital New Delhi and halted the city metro.
In Tibet, the death toll climbed to 18, according to a tweet from China’s state news agency, Xinhua. Four people were killed in Bangladesh.