A tornado has killed at least 116 people when it tore through the United States city of Joplin, in Missouri.
The twister hit the city of 50,000 on Sunday evening, ripping the roof off a hospital and destroying thousands of homes and businesses.
US weather officials it was the deadliest single tornado in the country since 1953.
Emergency officials said on Monday that 116 people were killed and about 400 were injured. According to local officials many had massive internal injuries.
Emergency crews searched through the night and through Monday's driving rain and thunderstorm for anyone left alive.
Storm survivors told harrowing stories of riding out the winds of more than 200km/h in walk-in coolers in restaurants and convenience stores, hiding in bathtubs and closets, and of running for their lives as the tornado bore down.
More severe storms have been predicted for the region, in a year that has brought tornadoes of record intensity across several states. There are warnings that more tornadoes could appear in Missouri, Arkansas, Kansas and Oklahoma in coming days.
Further complicating the rescue effort, power lines were downed, broken gas lines ignited fires, and cellphone communications were spotty due to 17 toppled phone towers.
Missouri Governor Jay Nixon said the search was continuing for people believed alive under the rubble. Some 2000 homes and many other businesses, schools and other buildings were destroyed.
The city's residents were given about 20 minutes' notice when 25 warning sirens sounded throughout the city, but the governor said many people likely were unable to get to shelter in time.
Mr Nixon declared a state of emergency and called out the Missouri National Guard to help.
Tornados killed more than 300 people and caused more than $US2 billion in damage across southern states in April.
