Rescuers raced to pull survivors from earthquake rubble as the death toll surpassed 9,000 in southern Turkey and war-ravaged northern Syria on Wednesday.

Officials and medics said 8,574 people have died in Turkey and 2,662 in Syria, bringing the total to 11,236. But that could still increase dramatically if the worst fears of experts are realised.

The hope of rescuing more people from under the rubble is now fading, as time passes since Monday’s pre-dawn magnitude 7.8 earthquake, the largest in Turkey since 1939, when about 33,000 people died in the eastern Erzincan province.

Since then, the region has been hit by more than 100 aftershocks, including a second 7.6-magnitude tremor.

Tragic scenes of a newborn plucked alive from the rubble and a broken father clutching his dead daughter’s hand have laid bare the human cost of the natural disaster.

Nearly two days after an apartment building collapsed in Kahramanmaras, a Turkish city not far from the epicentre, rescuers pulled a three-year-old boy from beneath the rubble.

The boy’s father, Ertugrul Kisi, who himself had been rescued earlier, sobbed as his son was pulled free and loaded into an ambulance.

A few hours later, rescuers pulled a 10-year-old girl 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 loaded into an ambulance.

In the northwestern Syrian town of Jindires, residents found a crying newborn still connected by the umbilical cord to her deceased mother. The baby reportedly was the only member of her family to survive.

At least 1,280 people have died in the opposition-held northwest, with more than 2,300 injured, according to the volunteer first responders known as the White Helmets. The Syrian government has reported an additional 1,250 deaths.

The rescue team, also known as the Syria Civil Defence, said on Twitter that the number of casualties was expected to “rise significantly due to the presence of hundreds of families under the rubble, more than 50 hours after the earthquake”.

Time running out

The World Health Organization chief Tedros Adhanom Ghebreyesus has warned that time is running out for the thousands injured and those still feared trapped.

Search teams from more than 20 countries joined more than 24,000 Turkish emergency personnel and aid pledges poured in.

But among those whose relatives were still under the rubble, help has been too slow to arrive.

“I can’t get my brother back from the ruins. I can’t get my nephew back. Look around here. There is no state official here, for God’s sake,” Ali Sagiroglu, a resident of Kahramanmaras, told AFP.

Al Jazeera’s Stefanie Dekker was in Gaziantep and she gave a chilling account as rescue workers raced against time to find survivors.

“Unfortunately, where we are here, and also at another location that we just returned from, it is a recovery operation, it is no longer a rescue operation,” Dekker said.

“Around 80 people, bodies at this stage as rescue workers are saying, are believed to be under the rubble of this apartment. They are no longer hearing voices,” she said.

“We just came back from another location where we saw a body being pulled from the rubble. It was a father. His daughter was there, she was sobbing – all the family members were there.

Absolutely heartbreaking to see,” Dekker added.

Turkish President Recep Tayyip Erdogan said 13 million of the country’s 85 million people were affected and declared a state of emergency in 10 provinces.

Erdogan visited Kahramanmaras on Wednesday, and announced plans to help the survivors of the earthquake.

“We will not allow citizens to go homeless,” Erdogan said, adding that victims would be able to stay in hotels. “The state housing authority will do what is necessary.”

In Syria, where a conflict that began in 2011 continues, despair was growing among those still waiting for help.

Aid efforts have been hampered by the continuing war and the isolation of the opposition-held region along the border, which is surrounded by Russia-backed government forces.

Damage to roads and other infrastructure in southern Turkey has prevented aid from reaching northern Syria through the only crossing, known as Bab al-Hawa.

Syria itself is under Western sanctions linked to the war. The government of Bashar al-Assad and its allies in Russia have seized the moment to renew their push for aid to the north to be routed through Damascus.

Countries opposed to al-Assad do not trust the Syrian authorities to effectively deliver aid to opposition areas and worry it would be diverted to benefit people and institutions linked to the government.

At a press conference on Tuesday in Damascus, Syrian Arab Red Crescent head Khaled Hboubati said his group is “ready to deliver relief aid to all regions of Syria, including areas not under government control”.

He called for the European Union to lift its sanctions on Syria in light of the emergency.

Stuck in the cold

Even for survivors, the future seems bleak. Many have taken refuge from relentless aftershocks, cold rain and snow in mosques, schools and even bus shelters, burning debris to stay alive.

In Gaziantep, where the violent aftershocks rumble on, shops are closed, there is no heat because gas lines have been cut to avoid explosions and finding petrol is tough.

Only bakeries remain open, drawing long queues.

Some of the worst damage in Gaziantep’s eponymous province took place in the most remote districts, where hundreds of buildings have collapsed.

With the airport and many roads outside the city blocked, attempts to flee the city have been frustrated.

Many survivors, who rushed outside without even having time to put on shoes when the earthquake struck, feel abandoned as they also battle cold weather.