PORT-AU-PRINCE, Haiti — As darkness fell on Haiti's capital Wednesday night, crowds gathered in the streets to spend the evening in the relative safety of the outdoors.
Their lives turned upside down by Tuesday's devastating magnitude 7 earthquake, many survivors broke out into communal song, seeking to soothe themselves and remain calm in a city with no power, little water, a limited number of inhabitable buildings and scores of bodies strewn along the roadways.
But then, about 6:30 p.m., the songs turned to screams, as a strong aftershock hit. Moments later, the crowds in the street grew larger, as many of those who had remained inside ran from their shaky shelters, away from the walls and ceilings that had caused such destruction a day earlier.
Officials feared the death toll could reach into the tens of thousands. Leading Sen. Youri Latortue told the Associated Press that 500,000 could be dead, but conceded that nobody really knows.
Speaking from the streets of the capital city, home to 2 million people, Haiti's President René Préval called the scene "unimaginable" and said he had no idea where he would sleep.
"It's incredible," Préval told CNN. "A lot of houses destroyed, hospitals, schools, personal homes. A lot of people in the street dead. . . . I'm still looking to understand the magnitude of the event and how to manage."
Asked what he now considered the biggest risk to his country, Préval said: "that the buildings will continue to collapse . . . and for an epidemic.''
Schools, hospitals and a prison were damaged. Sixteen United Nations peacekeepers were killed and 100 to 150 U.N. workers were missing, including the chief of its mission, Hédi Annabi. The city's archbishop, Monsignor Joseph Serge Miot, 63, was killed when his office and the main cathedral fell.
Power and phone service were out. Flights were severely limited at Port-au-Prince's main airport, telecommunications were barely functioning, operations at the port were shut down and most of the medical facilities had been severely damaged, if not leveled.
The first cargo planes with food, water, medical supplies, shelter and sniffer dogs headed to the Western Hemisphere's poorest nation.
At a triage center improvised in a hotel parking lot, people with cuts, broken bones and crushed ribs moaned under tent-like covers fashioned from bloody sheets.
"I can't take it any more. My back hurts too much," said Alex Georgés, 28, who was still waiting for treatment a day after the school he was in collapsed and killed 11 classmates. A body lay a few feet away.
"This is much worse than a hurricane," said doctors' assistant Jimitré Coquillon. "There's no water. There's nothing. Thirsty people are going to die."
Across Port-au-Prince, the damage seemed nearly random.
Some hillsides of homes look as if they simply crumbled into the dirt. Other buildings, such as the cheerful-looking Rose Restaurant, appear untouched.
But along the city's roadsides, the true cost of Tuesday's earthquake was readily visible: the bodies of victims neatly lined up, some covered in white sheets and some not.
The corpses included that of a girl, perhaps a teenager, in pink shorts and a man covered in a sheet, save for his horribly swollen feet poking out from beneath.
On Martin Luther King Avenue, just past a sign that said, "Welcome to Port-au-Prince," the slender legs of three young children poked out from under their sheets. Three adults were next to them.
Outside the St. Esprit Hospital, Jeudy Francia, a woman in her 20s, shrieked, "Please save my baby!" Her child, a girl about 4 years old, writhed in pain in the hospital's chaotic courtyard, near where a handful of corpses lay under white blankets. "There is no one, nothing, no medicines, no explanations for why my daughter is going to die."
There was virtually no sign of outside assistance other than a few U.N. vehicles passing by — and there was no police presence, no water being handed out, no encampments except those set up by people apparently left homeless by the quake or those too afraid to go back into their ramshackle homes in case of aftershocks.
Tent and tarp cities had quickly sprung up wherever there was shade or open space, including on the sprawling grounds outside the prime minister's office. Virtually no shops were open, leaving residents in the street with no apparent means of feeding themselves or finding water.
Looting began almost as quickly as the quake struck at 4:53 p.m. and people were seen carrying food from collapsed buildings. The U.N.'s 9,000-member peacekeeping force sent patrols across the capital's streets while securing the airport, port and main buildings — but also struggled to rescue colleagues from their collapsed headquarters.
People streamed into the Haitian countryside, where wooden and cinderblock shacks showed little sign of damage. Many balanced suitcases and other belongings on their heads.
President Barack Obama promised an all-out rescue and humanitarian effort and American officials said they were responding with ships, helicopters, transport planes and a 2,000-member Marine unit, as well as civilian emergency teams from across the United States.
"We have to be there for them in their hour of need," Obama said.
Partners in Health, the medical organization for the poor co-founded by former Brooksville resident Dr. Paul Farmer, set up an emergency clinic to treat victims.
Farmer was in Miami recovering from recent knee surgery when the earthquake hit, said Tricia Bechtelheimer, a friend of Farmer's from Brooksville.
Farmer, who in August was appointed as deputy to former President Bill Clinton, the U.N. special envoy to Haiti, planned to fly to New York on Wednesday and then travel with Clinton to Haiti.
The organization's network of hospitals in the central plateau of Haiti, northeast of Port-au-Prince, escaped serious damage, according to an e-mail sent by Partners in Health executive director Ophelia Dahl.
But Dahl also wrote that phone service had been knocked out by the quake and that the organization had not been able to contact all of its doctors and facilities. And she relayed an urgent plea for supplies for its emergency clinic from Louise Ivers, clinical director in Haiti.
"Port-au-Prince is devastated, lot of deaths. SOS. SOS.,'' Ivers wrote. "Temporary field hospital … needs supplies, pain meds, bandages. Please help us."
Information from the Los Angeles Times, New York Times and Associated Press was used in this report, which also includes a contribution from Times staff writer Dan DeWitt.