A massive tornado that swept through the Missouri town of Joplin has killed at least 89 people, the city manager announced early on Monday.
"We have 89 confirmed dead due to this tornado," city manager Mark Rohr said in a statement.
The tornado struck the town of Joplin near the border with Oklahoma and Kansas on Sunday evening, less than a month after a horrific tornado outbreak left 354 dead across seven US states.
It was the deadliest of 46 tornadoes reported to the National Weather Service in seven states on Sunday.
"It's a war zone," Scott Meeker of the Joplin Globe newspaper told AFP.
"We've got hundreds of wounded being treated at Memorial Hall (Hospital), but they were quickly overwhelmed and ran out of supplies, so they've opened up a local school as a triage center," Meeker said.
People clawed through the rubble looking for friends, family and neighbours after the storm tore buildings apart and turned cars into crumpled heaps of metal.
Flames and thick black smoke poured out of the wreckage of shattered homes, and water gushed out of broken pipes as shocked survivors surveyed the damage, early photos showed.
A tangled medical helicopter lay in the rubble outside St. John Regional Medical centre, which took a direct hit.