As search and rescue efforts continue, hospitals in the capital continue to function but are stretched to the limit. Powerful aftershocks continue to be felt, so further damage is a risk, increasing the climate of fear amongst the local population.

“I was in my fifth floor apartment and the shaking was extremely violent. We could see dust rising from the hills around the city and luckily we were able to evacuate," said a British Red Cross staff member working closely with Nepal Red Cross Society colleagues in Kathmandu.

The epicenter was 80km for Kathmandu in Lamjung, Gorkha district. Most casualties reported so far were in the Kathmandu valley where buildings have collapsed in densely populated areas, including historic buildings such as the Darahara Tower.

“We are extremely concerned about the fate of communities in towns and villages in rural areas closer to the epicenter,” said Jagan Chapagain, the IFRC’s Director for Asia Pacific. “Access roads have been damaged or blocked by landslides and communications lines are down, preventing us from reaching local Red Cross branches to get accurate information. We anticipate that there will be considerable destruction and loss of life.”

The Nepal Red Cross Society has extensive experience in responding to natural disasters and plays a lead role in the government’s contingency plans. Emergency responders from the Red Cross trained in first aid and search and rescue have been mobilised to affected areas. The organization's blood bank in Kathmandu is also providing blood supplies to the main medical facilities in the capital.

The IFRC is mobilising resources from its hubs in New Delhi, Kuala Lumpur and Bangkok and is releasing funds from its Disaster Response Emergency Fund to support the initial emergency response. International assistance is currently hindered by the closure of the Kathmandu airport.

Nepal’s National Society for Earthquake Technology had previously estimated that a large-scale earthquake in mid-Nepal could displace over 1.8 million people, kill over 100,000 and injure a further 300,000.

“We do not yet know the scope of damage, but no doubt this is the most deadly and devastating earthquake since the 1934 tremor which devastated Nepal and Bihar,” said Chapagain. “People will need considerable support including food, water, medical care and emergency shelter.”

The tremor was felt nationwide and as far as Pakistan, Tibet and Bangladesh. It is not clear how it has affected neighbouring Sikkim, Bihar and West Bengal.