Hopes of finding more survivors trapped in the rubble of thousands of buildings toppled by a huge earthquake are fading – as the death toll approached 12,000.

Stretched rescue teams have toiled through the night in Turkey and Syria, hunting for signs of life in the aftermath of the world’s deadliest quake in more than a decade.

Amid calls for the Turkish government to send more help to the disaster zone, President Recep Tayyip Erdogan visited the especially hard-hit Hatay province, where more than 3,300 people died and entire neighbourhoods were destroyed.

Residents in the area have criticised the government’s response, saying rescuers were slow to arrive.

Mr Erdogan, who faces a tough battle for re-election in May, acknowledged “shortcomings” in the response to the 7.8-magnitude quake on Monday but said the winter weather had been a factor.

The earthquake destroyed the runway in Hatay’s airport, further disrupting the response.

“It is not possible to be prepared for such a disaster,” Mr Erdogan said. “We will not leave any of our citizens uncared for.”

He vowed to have all debris removed and homes rebuilt within a year in the 10 provinces of his country most affected by the earthquake.

Recep Tayyip Erdogan visited a quake-hit area
Recep Tayyip Erdogan visited a quake-hit area (Turkish Presidency via AP)

Search teams from more than two dozen countries have joined tens of thousands of local emergency personnel and aid pledges have poured in from around the world.

But the scale of destruction from the quake and its powerful aftershocks was so immense — and spread so wide, including in areas isolated by Syria’s ongoing civil war — that many are still waiting for help.

In the Turkish city of Malatya, bodies were placed side by side on the ground, covered in blankets, while rescuers waited for funeral vehicles to pick them up, according to former journalist Ozel Pikal, who saw eight bodies pulled from the ruins of building.

Mr Pikal, who took part in the rescue efforts, said he believes at least some of the victims may have frozen to death as temperatures dipped to minus six degrees Celsius.

Locates earthquake in southern Turkey
(PA Graphics)

“Today isn’t a pleasant day because as of today there is no hope left in Malatya,” he said. “No one is coming out alive from the rubble.”

Mr Pikal said a hotel building collapsed in the city and more than a hundred people may be trapped.

There is a shortage of rescuers in the area he is in and the cold has hampered rescue efforts by volunteers and government teams, he said.

Road closures and damage in the region have also impeded mobility and access.

“Our hands cannot pick up anything because of the cold,” Mr Pikal said. “Work machines are needed.”

Relatives weep over the dead body of Goktug, a baby boy, in Elbistan, southern Turkey
Relatives weep over the dead body of Goktug, a baby boy, in Elbistan, southern Turkey (Ismail Coskun/IHA/AP)

The scale of suffering is staggering in a region already beset by more than a decade of civil war in Syria, which has displaced millions within the country and sent more to seek refuge in Turkey. With thousands of buildings toppled, it is not clear how many people may still be trapped underneath the rubble.

Turkey’s disaster management agency said the country’s death toll has passed 8,500. The Syrian Health Ministry said the death toll in government-held areas has climbed past 1,200, while at least 1,400 people have died in the rebel-held northwest, according to volunteer first aiders known as the White Helmets.

That brought the overall total to 11,000 since Monday’s earthquake and multiple strong aftershocks. Tens of thousands more are injured.

A 2011 earthquake near Japan which triggered a tsunami left nearly 20,000 people dead. Neither Turkey nor Syria provided figures for the number of people still missing as Pope Francis asked during his weekly general audience for prayers and demonstrations of solidarity following the “devastating” earthquake.

A van with coffins is parked next to a destroyed building in Gaziantep, south-east Turkey
A van with coffins is parked next to a destroyed building in Gaziantep, south-east Turkey (Kamran Jebreili/AP)

Syrian officials said the bodies of more than 100 Syrians who died during the earthquake in Turkey have been taken home for burial through the Bab al-Hawa border crossing. Mazen Alloush, an official on the Syrian side of the border, said 20 more bodies were on their way to the border, saying all of them were Syrian refugees who fled war in their country.

While concerns are rising for those still trapped, Polish rescuers working in Turkey said they have pulled nine people alive from the rubble so far, including parents with two children and a 13-year-old girl from the ruins in the city of Besni.

They said low temperatures are working against them, though two firefighters told Polish TVN24 the fact people were caught in bed under warm covers by the pre-dawn quake could help. The rescuers are currently trying to reach a woman who they know is in her bed.

Nearly two days after the quake, rescuers pulled a three-year-old boy, Arif Kaan, from under the rubble of a collapsed apartment building in Kahramanmaras, which is not far from the earthquake’s epicentre.

With the boy’s lower body trapped under slabs of concrete and twisted rebar, emergency crews lay a blanket over his torso to protect him from below-freezing temperatures as they carefully cut the debris away from him, mindful of the possibility of triggering another collapse.

A man prays on a collapsed building in Malatya, Turkey
A man prays on a collapsed building in Malatya, Turkey (Emrah Gurel/AP)

The boy’s father, Ertugrul Kisi, who was rescued earlier, sobbed as his son was pulled free and put in an ambulance.

“For now, the name of hope in Kahramanmaras is Arif Kaan,” a Turkish television reporter proclaimed as the dramatic rescue was broadcast to the country.

A few hours later, rescuers pulled 10-year-old Betul Edis from the rubble of her home in the city of Adiyaman. Amid applause from onlookers, her grandfather kissed her and spoke softly to her as she was put in an ambulance.

On Monday afternoon in a north-west Syrian town, residents found a crying newborn still connected by the umbilical cord to her dead mother. The baby was the only member of her family to survive a building collapse in the small town of Jinderis, relatives said.

But such stories are rare more than two days after Monday’s pre-dawn earthquake, which hit a huge area and brought down thousands of buildings, with frigid temperatures and ongoing aftershocks complicating rescue efforts.

Many survivors in Turkey have had to sleep in cars, outside or in government shelters.

“We don’t have a tent, we don’t have a heating stove, we don’t have anything. Our children are in bad shape. We are all getting wet under the rain and our kids are out in the cold,” Aysan Kurt, 27, said.

Rescuers search for people in a destroyed building in Adana, Turkey
Rescuers search for people in a destroyed building in Adana, Turkey (Francisco Seco/AP)

“We did not die from hunger or the earthquake but we will die freezing from the cold.”

In Syria, aid efforts have been hampered by the ongoing war and the isolation of the rebel-held region along the border, which is surrounded by Russia-backed government forces. Syria itself is an international pariah under western sanctions linked to the war.

The region sits on top of major fault lines and is frequently shaken by earthquakes. Some 18,000 were killed in similarly powerful earthquakes which hit north-west Turkey in 1999.