In an effort to find more survivors among the rubble after a 7.8 magnitude earthquake that killed more than 4,000 people and overturned thousands of structures across a vast territory, rescuers in Turkey and war-torn Syria searched through the icy night into Tuesday.

Authorities anticipated that as rescuers searched through the tangles of metal and concrete scattered across the region plagued by Syria’s 12-year civil war and refugee crisis, the death toll from Monday’s early-morning earthquake and its aftershocks would continue to rise.

As first responders struggled in the rain and snow, survivors shouted out for assistance from among the mounds of rubble. The area was shaken by more earthquakes, including one that was almost as strong as the first one.

As anxious relatives awaited word of loved ones, workers gently removed concrete slabs and reached for bodies.

“My grandson is one and a half. They were on the 12th floor,” Imran Bahur sobbed Monday in front of her demolished apartment complex in the Turkish city of Adana.

In Turkey and Syria, tens of thousands of people who were made homeless had to spend the night outside in the cold.

People sought sanctuary in malls, stadiums, mosques, and community centers in the Turkish city of Gaziantep, the province capital located about 33 kilometers (20 miles) from the epicenter.

Recep Tayyip Erdogan, the president of Turkey, proclaimed seven days of national mourning.

President of the United States Joe Biden contacted Erdogan to offer his condolences and support to the NATO ally. The White House announced that it would send search and rescue personnel to assist Turkey.

Residents of Damascus and Beirut rushed into the streets in response to the earthquake, which was felt as far away as Cairo and was centered in the province of Kahramanmaras in southeast Turkey.

It added to the region’s already extreme hardship over the previous ten years.

On the Syrian side, the region is split between territory under government control and the final opposition-held outpost, which is encircled by government forces with Russian support.

Millions of civil war refugees currently reside in Turkey.