America was put on alert for more violent storms on Tuesday, barely 36 hours after the deadliest tornado in modern history killed 116 and turned a small Missouri town into a disaster zone.
As day broke on Monday, Joplin awoke to unimaginable destruction: a vast expanse of splintered trees where entire neighbourhoods once stood, and cars were flung about like freeform metal sculptures.
The rescue effort once again pitched humans against the elements, as emergency crews equipped with axes and torches worked their way through rubble looking for survivors, lashed by strong winds and occasional hail. The authorities warned the death toll could rise.
And there was no immediate end in sight. A new tornado watch was issued on Monday night for the areas around Joplin, as well as Oklahoma and parts of Kansas and Texas.
Sunday night's tornado was the deadliest since 1953, and the second tornado disaster in the US in less than a month.
The twister cut a six-mile swath through the centre of the town, wrecking churches, schools, businesses and homes. The town's fire department estimated up to a third of buildings were damaged or destroyed.
The former mayor, Gary Shaw, described the scene in the town of 50,000 as a war zone. "The trees," he told National Public Radio, "they're like somebody's taken a knife and cut all the bark off of them. We've lost tonnes and tonnes of homes, and we have people out trying to uncover the dead right now."
Some of the worst destruction was at St John's Regional Medical Centre. The nine-storey building, the tallest in town, took a direct hit. At least five of the 116 dead were killed at the hospital.
About 180 patients were in the hospital when the warning sirens went off, witnesses said. They had about 20 minutes before the black funnel cloud descended, hovering over the hospital for about a minute.
Nurses told of desperate attempts to move patients away from windows and into enclosed hallways. Some patients were evacuated on pick-up trucks.
Within 90 minutes, the hospital was empty. But rescue workers told reporters that many of the patients had been cut by glass after the windows were blown out.
The ceiling of the emergency room caved in. Trolleys were tossed more than five city blocks away, and medical records and x-rays were scattered for 60 miles. Cars were flung out of the car park. A helicopter was hurled out of the landing pad and flipped on its side, its rotors a twisted wreck.
"Every window in that building is now broken," Melodee Colbert-Kean, a city council woman, told National Public Radio. "Cars are tumbled all over the parking lot."
Officials said the hospital was now unusable. The seriously ill were transported out of town to other hospitals. Those able to walk were taken to a makeshift ward at a community centre.
Across the southern end of town, an estimated 2,000 buildings were damaged, street signs and other landmarks vanished, rendering Joplin unrecognisable to residents who had spent their lives there.
"You see pictures of world war two, the devastation and all that with the bombing. That's really what it looked like," Kerry Sachetta, the principal of a flattened Joplin high school, told reporters. "I couldn't even make out the side of the building. It was total devastation in my view. I just couldn't believe what I saw."
Missouri's governor, Jay Nixon, said he feared the death toll would rise as rescue workers began searching the rubble for survivors and bodies. "I don't think we are done counting," he told reporters.
But he said he remained hopeful of finding survivors in the rubble. "I still believe that because of the size of the debris and the number of people involved that there are lives to be saved."
As rescue workers moved out to look for survivors in the rubble, fires from gas leaks burned across the city. Downed power lines blocked roads.
Nixon said he had reports of 15 missing elderly residents from a care home. The website of the local paper, the Joplin Globe, carried messages from people searching for loved ones.
And with phone services down, dazed survivors tried to make their way through streets blocked by debris to look for relatives. Outside the remains of a shopping mall, Justin Gibson pointed to a black pickup truck tossed into the ruins of a hardware store that he said had belonged to his room mate's brother.
"He was last seen here with his two little girls," Gibson told reporters. "We've been trying to get hold of him since the tornado happened."
But there were also triumphs. Search crews pulled people from the rubble of a local Walmart and a hardware chain.
Following Sunday's events, 2011 is in the running to be a record year for lethal storms. There have been 1,000 reported tornadoes this year.
About 350 people were killed last month after an estimated 200 tornadoes ripped across Alabama and five other southern states.
The storms set a record for the deadliest single tornado event, but even that has been eclipsed by the devastation in Joplin.
It was the town's misfortune to take a direct hit. "If the Joplin tornado had struck 10 miles north, we wouldn't be hearing about it, but it went right through the centre of town," said Robert Henson, a spokesman for the University Corporation of Atmospheric Research.
The tornadoes could have inflicted even greater casualties and damage, however, said Josh Wurman of the Centre for Severe Weather Research. "What if this had gone through St Louis or Oklahoma City or Chicago instead of Joplin," he said. "The potential consequences would have been much worse."
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