Hundreds, if not thousands of people are still missing after Category 5 Hurricane Dorian blasted its way across the Bahamas and the US east coast last weekend.

In strongest storm on record to hit the Bahamas, global aid agencies are on their way to the worst-hit areas on Great Abaco Island in the northern Bahamas as relief workers begin the gruelling task of sifting through the debris of shattered homes and buildings.

The death toll currently stands at 43, but that figure is expected to rise dramatically as family and friends took to social media, posting photographs of loved ones who have still not made contact.

Urgent messages such as this one became a familiar pattern:

“Please if anybody has seen or knows that Shawn Nadia and Carter Neely are ok, get in touch. Friends & family haven’t heard from them since Sunday!!,” wrote one concerned family member.

It comes as Hurricane Dorian made landfall on the Outer Banks of North Carolina, USA, hitting the beach resort area with powerful winds and battering waves.

The Miami-based National Hurricane Centre reported Dorian, packing 150km/h winds, made landfall at Cape Hatteras about 9am local time on Friday.

It lashed the Outer Banks with hurricane-force winds as far as 72km from the centre of the hurricane and sent tropical storm winds more than 320km from its centre.

It has already dumped up to 25cm of rain along the coast between Charleston, South Carolina, to Wilmington, North Carolina, about 275 km away, forecasters said.

“The rain is moving up north,” National Weather Service forecaster Alex Lamers said early on Friday.

“Even the Raleigh-Durham area inland will get 3 inches (7.6cm) today.”

Dorian is expected to push out to sea later on Friday local time and bring tropical storm winds to Nantucket Island and Martha’s Vineyard, Massachusetts.

But it will likely spare much of the rest of the East Coast the worst of its rain and wind, before making landfall in Canada’s Nova Scotia on Saturday night local time.

“It’s in the process of moving out, going north,” Mr Lamers said.

Officials say the death toll in the Bahamas, which stands at 30, is likely to shoot up in the country of about 400,000 people as more bodies are discovered in the ruins and floodwaters left behind by the storm.

“You smell the decomposing bodies as you walk through Marsh Harbour,” said 37-year-old Sandra Sweeting amid the wreckage on Great Abaco.

“It’s everywhere. There are a lot of people who aren’t going to make it off this island.”

These satellite images show the scale of the destruction from Hurricane Dorian in the Bahamas. Here's how one town is coping. https://t.co/1iremNsqUB pic.twitter.com/8q0Qx9QK1D

— The New York Times (@nytimes) September 6, 2019

Some locals called the government’s initial official death toll a tragic underestimate.

“I work part-time in a funeral home. I know what death smells like,” 27-year-old Anthony Thompson said.

“There must be hundreds. Hundreds.”

Chaotic conditions around the islands were interfering with flights and boats, hampering relief efforts.

The medical chief of staff of the Bahamas’ only functioning public hospital said the death toll would be “staggering”.

Two refrigerated, 12-metre trucks would be needed to hold the bodies that were expected to be found, Dr Caroline Burnett-Garraway said in an interview at Princess Margaret Hospital in Nassau, the country’s capital.

“We’ve ordered lots of body bags,” she said, adding that processing all the dead will take weeks.

The US Coast Guard, working with NEMA, has rescued 295 people since Dorian began, the US embassy in Nassau tweeted.

Relief groups are focusing on getting doctors, nurses and medical supplies into the hardest-hit areas and helping survivors get food and safe drinking water.

The relief effort faces formidable logistical challenges because of the widespread destruction caused by Dorian, which hovered over the Bahamas for nearly two days with torrential rains and fierce winds that whipped up 3.7- to 5.5-metre storm surges.

The risk of outbreaks of diarrhoea and waterborne diseases is high because drinking water may be contaminated with sewage, according to the Pan American Health Organisation, which described the situation for some people on Abaco as “desperate.”

The United Nations estimated 70,000 people were in “immediate need of life-saving assistance” such as food, water and shelter. The UN World Food Program is airlifting storage units, generators, prefab offices, and satellite equipment as well as 8 metric tonnes of ready-to-eat meals.

Those injured by the storm, which was a Category 5 hurricane on the five-step Saffir-Simpson scale of intensity, were being treated for fractures, head injuries, deep lacerations, skin rashes and dehydration.

Here's a thread on a few of the more harrowing stories @Reuters reporters heard from #Dorian survivors awaiting relief flights in Abaco, #Bahamas, Thursday into Friday: pic.twitter.com/BVMWlkRW90

— Nick Brown (@NickPBrown) September 6, 2019

Survivors are also dealing with the emotional trauma triggered by the horrors of the preceding days.

Near an area called The Mudd at Marsh Harbour, the commercial hub of Great Abaco, a Reuters photographer described a devastating scene, with most houses levelled, a man lying dead near a main street and dead dogs in water.

Some residents were leaving the area with meagre possessions, while others were determined to remain.

Had chance to helicopter back to Great Abaco & took it. Wanted to cover what happened in The Mudd. This poor, low-lying part of Marsh Harbour was devastated by mammoth storm surge, with many deaths. It's important the world sees what happened—the scale of this cataclysm. #DORIAN pic.twitter.com/oxakWWyUA1

— Josh Morgerman (@iCyclone) September 5, 2019

Aubynette Rolle of the Bahamas Public Hospitals Authority said medical facilities in Grand Bahama, the Abacos and Nassau were “coping, so far” with the injured.

Rolle said urgent care was being provided on the hurricane-hit islands while makeshift clinics were dealing with non-urgent casualties.

A triage system has been set up at a Nassau airport to direct more critical patients to Princess Margaret Hospital.

Shelter material for hundreds of people as well as hygiene kits including basic items like soap were unloaded from the British ship RFA Mounts Bay and distributed in Marsh Harbour, the United Kingdom’s Department for International Development said on Friday.

British forces are also distributing water from supplies aboard the ship, which has a system to turn sea water into drinking water.

-with AAP