The confirmed death in Turkey and northwest Syria from the region’s deadliest earthquake in 20 years stands at more than 24,000, five days after it hit, according to officials.

Casualties from the 7.8 magnitude earthquake, which struck in the early hours on Monday, as well as several powerful aftershocks, have surpassed the more than 17,000 killed in 1999 when a similarly powerful earthquake hit northwest Turkey.

Turkish President Recep Tayyip Erdogan acknowledged during a visit to Adiyaman province on Friday that the government’s response could have been better.

“Although we have the largest search and rescue team in the world right now, it is a reality that search efforts are not as fast as we wanted them to be,” he said.

Al Jazeera’s Resul Serdar said rescue teams had become “frantic” as hope for finding survivors dimmed with each passing hour.

Rescuers were “digging into the rubble and hoping to find some people dead or alive because now it has been more than 96 hours and the hopes here are fading”, he said, standing in front of a collapsed block of buildings in Kahramanmaras in southern Turkey, close to the epicentre of the first magnitude 7.8 earthquake.

“The families are here, waiting anxiously,” he added. “The scale of devastation is beyond imagination.”

Some time later, rescuers managed to dig out a man alive from under the rubble 110 hours since the earthquake struck, Serdar said.

Al Jazeera’s Stefanie Dekker, reporting from the Turkish city of Gaziantep, said entire families have been lost.

“We were talking to a woman here. She said ‘I have four of my brothers, my mother, my cousins and all of her nieces and nephews … all gone in an instant when the building just completely pancaked upon itself.”

Kemal Kilicdaroglu, the leader of Turkey’s main opposition party, criticised the government’s response.

“The earthquake was huge but what was much bigger than the earthquake was the lack of coordination, lack of planning and incompetence,” Kilicdaroglu said in a statement.

With anger simmering over delays in the delivery of aid and getting the rescue effort under way, the disaster is likely to play into Erdogan’s bid for reelection, with the vote scheduled for May 14. The election may now be postponed due to the disaster.

‘We cannot cope’

The number of deaths in Turkey rose to 20,665 on Friday, the country’s health minister said. In Syria, more than 3,500 have been killed. Many more people remain under rubble.

In Syria, the government on Friday approved humanitarian aid deliveries across the front lines of the country’s 12-year war, a move that could speed up the arrival of help for millions of desperate people.

The World Food Programme said earlier it was running out of stocks in rebel-held northwest Syria as the state of war complicated relief efforts.

Dr Mohamed Alabrash, a general surgeon at the Central Hospital of Idlib in northwestern Syria, issued an urgent appeal for assistance.

“We face a shortage of medication and instruments,” he told Al Jazeera. “The hospital is full of patients, and so is the intensive care unit.”

“We cannot cope with this huge number of patients. The patients’ injuries are very heavy, and we need more support.”

The doctor said medical workers at the facility were under extreme pressure, working around the clock.

“All medical staff are working for 24 hours and we’ve consumed all the materials that we have, from medication to ICU materials,” Alabrash said, adding that the hospital’s generators were almost out of fuel.

Hope amid the ruins

Rescuers, including teams from dozens of countries, toiled night and day in the ruins of thousands of wrecked buildings to find buried survivors. In freezing temperatures, they regularly called for silence as they listened for any sound of life from mangled concrete mounds.

In Turkey’s Samandag district, rescuers crouched under concrete slabs whispering “Inshallah” (God willing) and carefully reached into the rubble to pick out a 10-day-old baby.

His eyes wide open, baby Yagiz Ulas was wrapped in a thermal blanket and carried to a field hospital. Emergency workers also took away his mother, dazed and pale but conscious on a stretcher, video images showed.

Across the border in Syria, rescuers from the White Helmets group used their hands to dig through plaster and cement until they reached the bare foot of a young girl, still wearing pink pyjamas, grimy but alive.

But hopes were fading that many others would be found alive.

In the Syrian town of Jandaris, Naser al-Wakaa sobbed as he sat on the pile of rubble and twisted metal that had been his family’s home, burying his face in the baby clothes that had belonged to one of his children.

“Bilal, oh Bilal,” he wailed, shouting the name of one of his dead children.

The head of Turkey’s Humanitarian Relief Foundation, Bulent Yildirim, went to Syria to see the impact there. “It was as if a missile has been dropped on every single building,” he said.

Some 24.4 million people in Syria and Turkey have been affected, according to Turkish officials and the United Nations, in an area spanning roughly 450km (280 miles) from Adana in the west to Diyarbakir in the east.

In Syria, people were killed as far south as Hama, 250km (155 miles) from the epicentre.

Hundreds of thousands more people have been left homeless and short of food in bleak winter conditions and leaders in both countries have faced questions about their response.

Many people have set up shelters in supermarket car parks, mosques, roadsides or amid the ruins. Many survivors are desperate for food, water and heat.