Aid groups received the first word from remote mountain villages – reports that suggested many communities perched on mountainsides were devastated or struggling to cope.
Landslides hindered rescue teams that tried to use mountain trails to reach those in need, said Prakash Subedi, chief district official in the Gorkha region, where the quake was centred.
"Villages like this are routinely affected by landslides, and it's not uncommon for entire villages of 200, 300, up to 1,000 people to be completely buried by rock falls," said Matt Darvas, a member of the aid group World Vision. "It will likely be helicopter access only."
Saturday's magnitude 7.8 earthquake spread horror from Kathmandu to small villages and to the slopes of Mount Everest, triggering an avalanche that buried part of the base camp packed with foreign climbers preparing to make their summit attempts. At least 18 people died there and 61 were injured.
Deputy inspector general of police Komal Singh Bam said the death toll had risen to 3,218. So far 18 people have also been confirmed dead in an avalanche that swept through the Mount Everest base camp in the wake of the earthquake. Another 61 people were killed in neighbouring India. China reported that 20 people had died in Tibet.
Kathmandu district chief administrator Ek Narayan Aryal said tents and water were being handed out at 10 locations in Kathmandu, but aftershocks were leaving everyone jittery.
"There have been nearly 100 earthquakes and aftershocks, which is making rescue work difficult. Even the rescuers are scared and running because of them," he said.
Tens of thousands spent the night sleeping in parks or on a golf course. Others camped in open squares lined by cracked buildings and piles of rubble.
"We don't feel safe at all. There have been so many aftershocks. It doesn't stop," said Rajendra Dhungana, 34, who spent the day with his niece's family for her cremation at the Pashuputi Nath Temple in Katmandu. "I've watched hundreds of bodies burn."
The capital city is largely a collection of small, poorly constructed brick apartment buildings. But outside of the oldest neighbourhoods, many in Kathmandu were surprised by how few modern structures collapsed in the quake.
Aid workers also warned that the situation could be far worse near the epicentre. The US Geological Survey said the quake was centred near Lamjung, about 50 miles north west of Kathmandu.
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