Bodies of those killed in an earthquake are laid out in line as people try to identify them at a hospital in Kathmandu, Nepal, on Sunday.

Barely any sign of an organized relief effort was visible outside Nepal’s capital on Sunday, as aid agencies struggled to fly and truck relief supplies to a country stricken by its worst earthquake in eight decades.

In the lush Dhading farming district 80 km outside Katmandu, people camped in the open, the hospital was overflowing, the power was off and shops were closed. Rocks were strewn across the lightly traveled single road running west from the capital.

“Many people have lost their homes. Many people have died,” said English teacher Chandra Lama, whose home village lies two hours’ drive further west. The crops in his village ruined, Lama was hunting for rice and pulses to feed his family.

“We are waiting to see what the government will do.”

Indian military helicopters airlifted some injured to local hospitals but officials said their operations had been hampered by rain, cloud cover and repeated aftershocks. With thousands sleeping in the open with no power or water and downpours forecast, fears mounted of a humanitarian disaster.

Across the country, hundreds of villages have been left to fend for themselves.

“We are overwhelmed with rescue and assistance request from all across the country,” said Deepak Panda, a member of the country’s disaster management.

Charity CARE International said that the death toll could run into the thousands, with hundreds of thousands homeless. “Almost everyone has slept outside and they are creating temporary shelters with what they have,” said CARE’s emergency response coordinator in Katmandu, Santosh Sharma. CARE said shelter and washing facilities were a priority, as well as food. “There is no electricity, and soon there will be a scarcity of water.”

Aid agencies held a first meeting with the Nepalese government on Sunday to coordinate the relief effort. But the majority of rescue workers face a grueling journey by land from Nepal’s state capital Katmandu along rough, badly damaged roads, more often frequented by groups of adventurous tourists heading for Himalayan trekking trails.

British charity Save the Children said hospitals in the Katmandu Valley were overcrowded, running out of room to store dead bodies and short on emergency supplies.

“Thousands of people have to stay outside of their homes, which have been damaged or destroyed by the earthquake. Shelter assistance is urgently needed,” said Save the Children’s Peter Olyle, who is based in Katmandu.

Charity Medecins sans Frontieres was struggling to get relief supplies including thousands of blankets and shelter in from India’s northern state of Bihar — also hit by Saturday’s quake — because landslides had made roads difficult to navigate.

Strong aftershocks further hampered aid and caused panic after the Saturday’s midday quake, which measured 7.9 on the Richter scale and flattened buildings, opened cracks in roads and knocked out phone networks.

At the Dhading district hospital, patients were crammed in three to a bed and some being treated in the open. Officials reported 24 dead in the nearby village of Kumpur.

Three people lay on stretchers in a hospital corridor waiting for treatment. Bins were filled with used bandages and medical equipment as the hospital ran short of supplies, while volunteers had to help overstretched medical staff.

“No, I didn’t sleep last night,” said Rashila Amatya, medical superintendent at the hospital. New patients were being brought in from outlying areas on Sunday. “For this new batch of patients there will probably not be enough medicine to last for today.”

Basudev Ghimire, head of the local rescue unit, said that more than 130 people had been killed in the district but the number injured ran into the thousands. The Indian military, he said, had brought more than 100 people by helicopter to the district hospital or to Katmandu. But they had brought no supplies; only evacuated people.

Meanwhile, locals prepared for another cold night outside. Officials on motorcycles rode through the town, telling residents through loudhailers that it was not safe to go indoors because of the risk of aftershocks. People were building tents with bamboo and sheets, with at least 1,000 ready to spend the night in several makeshift camps.

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