The death toll from the earthquakes in Turkey and Syria has passed 5,000, rescuers said

More than 5,000 people have been confirmed dead after a powerful earthquake hit central Turkey and northwestern Syria, as weather hampered efforts to rescue survivors.

An unknown number of people are trapped under the rubble and the World Health Organization has warned that the death toll could exceed 20,000. Up to 23 million people may be affected, WHO said.

Turkish Vice President Fuat Oktay said on Tuesday that the death toll in Turkey had risen to 3,419, with 20,534 injured.

Thousands of buildings were flattened in cities spread over vast areas. Rescue teams continue to search under piles of cement and metal, but freezing temperatures are limiting their work time.

“It is now a race against time,” said WHO chief Tedros Adhanom Ghebreyesus, explaining that the UN health agency was urgently sending aid to the region.

The ongoing civil war in Syria is also complicating relief efforts. State news agency SANA said the death toll in Syrian government-held areas had risen to 812. Deaths were reported as far away as Hama, about 100 km from the epicenter. In rebel-held northwest Syria, the Syrian Civil Defense, known as the White Helmets, confirmed 790 dead.

According to the WHO, Syria will need the most urgent aid in the immediate and medium term.

US President Joe Biden called Turkish President Recep Tayyip Erdogan to express his condolences and offer support to the NATO ally. The White House said it was sending search and rescue teams to support Turkey’s efforts.

At the General Assembly session on Monday, UN Secretary-General Antonio Guterres called for international assistance, noting that people in the affected areas were “already in dire need of humanitarian assistance”.

Europe on Monday activated its civil protection system to deploy aid to victims. Some 19 European Union countries have sent coordinated search and rescue teams and medical aid. In total, 1,185 rescue and 79 search dogs have been offered by European countries, and the number is likely to increase. The EU has also activated the Copernicus satellite system to provide emergency mapping of affected areas.

“In Syria, the EU is liaising with its humanitarian partners on the ground and funding humanitarian agencies that are carrying out search and rescue operations, as well as providing water and sanitation assistance and distributing blankets and hygiene items to affected areas.” The European Commission has given this information in a statement.

Just three months before Turkey’s presidential and parliamentary elections, Erdogan faces a formidable restructuring challenge. Even before the earthquake, the country was facing an economic crisis with inflation running at 58 percent.

The collapsed buildings in many areas were built in the early 2010s and generally should have followed seismic codes after the 1999 earthquake.

Governments dealing with this humanitarian crisis can influence election results. The government’s response to the massive earthquake in northwestern Turkey in 1999 is widely seen as a decisive factor in the rise of Erdogan’s AKP party.