Two thousand bodies were washed up on the shores of north-east Japan yesterday.
The horrifying tide of death in Miyagi province raised fears that the official expected toll of 10,000 could be a huge underestimate.
Bodies wrapped in blue tarpaulins were laid on military stretchers and lined up for collection.
Men, women and children were picked from the rubble by rescue workers, their task made that much harder by the constant aftershocks threatening more death and destruction.
Miyagis police chief, Naoto Takeuchi, warned: I think the number of deaths here will undoubtedly be in the tens of thousands.
Senen General Hospital in Takajo town, near Miyagi prefectures capital of Sendai, had about 200 patients when the earthquake hit, tossing its medical equipment around and collapsing part of the ceiling in one wing.
All of its food and medicine was stored on the first floor. Everything was ruined or lost in the following minutes when Takajo was flooded by the tsunami.
Were only administering the bare necessities, said administrator Ryoichi Hashiguchi.
Nurses have been cutting open soiled intravenous packs and scrubbing down muddy packs of pills with alcohol to cleanse them.
Mr Hashiguchi said he had warned city officials that the conditions of many patients is worsening, adding: I dont think this is going to be resolved any time soon.
The pulverised coast has been hit by hundreds of aftershocks since Friday, the latest a 6.2 magnitude quake which was followed by a fresh tsunami scare yesterday.
As sirens wailed, soldiers abandoned their search operations and told people on the devastated shoreline to run to higher ground. The warning turned out to be a false alarm.
Its a scene from hell, absolutely nightmarish, said Patrick Fuller, of the International Red Cross Federation.
The situation here is just beyond belief. Almost everything has been flattened.
Japan Red Cross president Tadateru Konoe added: After my long career in the Red Cross where I have seen many disasters and catastrophes, this is the worst I have ever seen.
The Japanese government and aid agencies are struggling to ferry food, water and medicines to survivors after panic-buying stripped shelves bare in the few shops left standing.
Crematoriums were overflowing with the dead and rescue workers ran out of body bags as the nation faced the reality of its mounting crisis.
Officials have been overwhelmed by the scale of the crisis, with millions of people facing a fourth night without electricity, water, food or heat in near-freezing temperatures.
Officials estimate that 430,000 people are living in emergency shelters or with relatives.
The government has sent 120,000 blankets, 120,000 bottles of water and 29,000 gallons of petrol plus food to the affected areas.
The stock market plunged over the likelihood of huge losses by Japanese industries including big names such as Toyota and Honda following the 9.0 magnitude quake on Friday.
Almost 2million households are without power in the freezing north and about 1.4million have no running water while drivers are waiting in queues for five hours for rationed petrol.
Hajime Sato, a government official in Iwate prefecture, said authorities were receiving just 10 per cent of the food and other supplies they need. Body bags and coffins were running so short that the government might turn to foreign undertakers for help.