With hope fading to find survivors, stretched rescue teams toiled Wednesday in Turkey and Syria, searching for signs of life in the rubble of thousands of buildings toppled by a catastrophic earthquake. The death toll passed 11,000 in the deadliest quake worldwide in more than a decade.

Amid calls for the Turkish government to send more help to the disaster zone, President Recep Tayyip Erdogan toured a “tent city” in hard-hit Kahramanmaras where people forced from their homes are living. He conceded shortfalls early on in the response but vowed that no one would “be left in the streets.”

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 7.8 magnitude 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.

At times rescuers were using excavators, at others they picked gingerly through debris to find survivors or the dead. With thousands of buildings toppled, it was not clear how many people might still be trapped underneath the rubble.

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 a building.

Pikal, who took part in the rescue efforts, said he believed at least some of the victims froze to death as temperatures dipped to minus 6 degrees Celsius (21 Fahrenheit).

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

Road closures and damage in the region made it hard to access all the areas that need help, he said, and there was a shortage of rescuers where he was. Meanwhile, cold hampered the efforts of those who were there, including volunteers.

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

The region was already beset by more than a decade of civil war in Syria that has displaced millions in that country and left them reliant on humanitarian aid and sent millions more to seek refuge in Turkey.

Turkey’s president said the country’s death toll passed 8,500. The Syrian Health Ministry, meanwhile, 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 responders 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 that triggered a tsunami left nearly 20,000 people dead.

Syrian officials said the bodies of more than 100 Syrians who died during the earthquake in Turkey were brought back home for burial. Mazen Alloush, an official on the Syrian side of the border, said 20 more bodies were on their way, adding that all of them were Syrian refugees who fled civil war.

More than two days after the quake, concerns grew for those still trapped, though stories of rescues gave many hope. A crying newborn still connected by the umbilical cord to her deceased mother was rescued in Syria on Monday. In Turkey’s Kahramanmaras, rescuers pulled a 3-year-old boy, Arif Kaan, from the rubble.

“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.

Low Temperatures Impeding Rescues

Polish rescuers told TVN24 that low temperatures were working against them, though two firefighters said that the fact that people were caught in bed under warm covers by the pre-dawn quake could help.

The cold also made life miserable for those who lost their homes. 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. “We did not die from hunger or the earthquake, but we will die freezing from the cold.”

Erdogan, on this tour of quake-hit areas, acknowledged that there were problems early on in the response but said it had improved.

He said the government would distribute 10,000 Turkish lira ($532) to affected families.

The quake comes at a sensitive time for Erdogan, who faces presidential and parliamentary elections in May amid an economic downturn and high inflation. Perceptions that his government mismanaged the crisis could severely hurt his standings.

Kemal Kilicdaroglu, the leader of Turkey’s main opposition party, blamed the devastation on Erdogan’s two-decade rule, saying he had not prepared the country for a disaster and accusing him of misspending funds.

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 European Union said Wednesday that Syria had finally asked for humanitarian assistance to deal with the victims of the devastating earthquake and insisted the bloc’s sanctions against the government had no impact on its potential to help.

On Wednesday, Syria’s Prime Minister Hussein Arnous visited neighborhoods in the northern city of Aleppo that saw buildings collapse because of the earthquake.

“Our priority now is to rescue the people who are still under the rubble,” he said.

In rebel-held parts of northwest Syria, rescuers pulled a man, a woman and four children from the rubble in the towns of Salqeen, Harem and Jinderis, according to the White Helmets group.

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