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ADANA, Turkey (AP) — Rescuers in Turkey and war-ravaged Syria searched through the frigid night into Tuesday, hoping to pull more survivors from the rubble after a 7.8 magnitude earthquake killed more than 4,000 people and toppled thousands of buildings across a wide region.

Authorities feared the death toll from Monday’s pre-dawn earthquake and aftershocks would keep climbing as rescuers looked for survivors among tangles of metal and concrete spread across the region beset by Syria’s 12-year civil war and refugee crisis.

Survivors cried out for help from within mountains of debris as first responders contended with rain and snow. Seismic activity continued to rattle the region, including another jolt nearly as powerful as the initial quake. Workers carefully pulled away slabs of concrete and reached for bodies as desperate families waited for news of loved ones.

“My grandson is 1 1/2 years old. Please help them, please. … They were on the 12th floor,” Imran Bahur wept by her destroyed apartment building in the Turkish city of Adana on Monday.

Tens of thousands who were left homeless in Turkey and Syria faced a night in the cold. In the Turkish city of Gaziantep, a provincial capital about 33 kilometers (20 miles) from the epicenter, people took refuge in shopping malls, stadiums, mosques and community centers. Turkish President Recep Tayyip Erdogan declared seven days of national mourning.

U.S. President Joe Biden called Erdogan to express condolences and offer assistance to the NATO ally. The White House said it was sending search-and-rescue teams to support Turkey’s efforts.

The quake, which was centered in Turkey’s southeastern province of Kahramanmaras, sent residents of Damascus and Beirut rushing into the street and was felt as far away as Cairo.

It piled more misery on a region that has seen tremendous suffering over the past decade. On the Syrian side, the area is divided between government-controlled territory and the country’s last opposition-held enclave, which is surrounded by Russian-backed government forces. Turkey, meanwhile, is home to millions of refugees from the civil war.

In the rebel-held enclave, hundreds of families remained trapped in rubble, the opposition emergency organization known as the White Helmets said in a statement. The area is packed with some 4 million people displaced from other parts of the country by the war. Many live in buildings that are already wrecked from military bombardments.

Strained medical centers quickly filled with injured people, rescue workers said. Some facilities had to be emptied, including a maternity hospital, according to the SAMS medical organization.