There are fears of a “secondary disaster” in Turkey and Syria as hundreds of thousands of homeless earthquake victims are forced to live without shelter, water, fuel and electricity.

The death toll jumped again to 20,000 — surpassing the Fukushima earthquake, tsunami and nuclear disaster in Japan in 2011.

The World Health Organisation warned that survivors could lose their lives as they faced the bitter cold without basic necessities — triggering a “secondary disaster”.

Cold, hunger and despair are gripping hundreds of thousands of people in the middle of winter.

Many have camped out in makeshift shelters in supermarket car parks, mosques, roadsides or amid the ruins, often desperate for food, water and heat.

Syrians warm up by a fire at a makeshift shelter for homeless survivors. Photo: Getty

At a service station near the Turkish town of Kemalpasa, people picked through cardboard boxes of donated clothes.

In the port city of Iskenderun, Reuters journalists saw people huddled round campfires on roadsides and in wrecked garages and warehouses.

Authorities say 6500 buildings in Turkey collapsed and countless more were damaged.

In Turkey’s Maras, people camped inside a bank, taping a sheet in the window for privacy.

Others had set up on the grass median of a main road, heating instant soup on fires and wrapping themselves in blankets.

A homeless child on the roadside in Turkey. Photo: Getty

In the devastated Syrian town of Jandaris, Ibrahim Khalil Menkaween walked in the rubble-strewn streets clutching a white body bag.

He said he had lost seven members of his family including his wife and two of his brothers.

“I’m holding this bag for when they bring out my brother, and my brother’s young son, and both of their wives, so we can pack them in bags,” he said.

“The situation is very bad. And there is no aid.”

First help arrives

Turkish President Tayyip Erdogan said operations were now working normally and promised no one would be left homeless.

The first UN trucks carrying aid arrived in Syria — the first international help to have arrived there — and there was a promise of more coming.

Rescuers were still finding some people alive. But many Turks have complained of a lack of equipment, expertise and support to rescue those trapped — sometimes even as they could hear cries for help.

Syria’s ambassador to the UN admitted the government had a “lack of capabilities and lack of equipment,” blaming more than a decade of civil war in his country and Western sanctions.

Turkish authorities released video of rescued survivors, including a young girl in pyjamas, and an older man covered in dust, an unlit cigarette between his fingers as he was pulled from the debris.

Turkish officials say some 13.5 million people were affected in an area spanning roughly 450 kilometres from Adana in the west to Diyarbakir in the east. In Syria, people were killed as far south as Hama, 250 kilometres from the epicentre.