With dusk setting in, traumatized and grief-stricken residents of Port-au-Prince prepared for a second night in the open after Tuesday's powerful quake, amid fears the death toll could reach 100,000.

Despite the launch of a massive aid operation, foreign rescue workers had yet to arrive, leaving the grim search for survivors to the battered and bruised Haitians already distraught at scenes of carnage and devastation.

Lacking heavy equipment, residents of the poorest nation in the Americas frantically dug with their bare hands in a race against time to reach the victims in the city which bore the worst of the 7.0 quake.

Drivers helped ferry the dead and the wounded, everyone pitching in to help the neighbors in the bleakest hours of the Caribbean nation.

The downtown area was "mostly destroyed," said AFP correspondent Clarens Renois, adding a tour of the area had left him "completely overwhelmed and shocked, my legs knocked out from under me, my heart ripped to shreds."

Hospitals, many of them either collapsed or damaged, were struggling to cope with a flow of wounded as basic services such as power and water as well as medical supplies dwindled.

Many bodies were just left crumpled in the ruins, as the morgues began to overflow. And there were fears that amid the sticky tropical climate disease could soon break out if corpses are left to fester.

"We need help. The hospital is full, we are lacking in everything," said one woman on a radio station, highlighting that the wounded were left lying next to the dead.

President Rene Preval said: "All the morgues are full, the hospitals are overflowing, there is not enough medicines."

Medical staff admitted they were completely overwhelmed. "Everywhere we go, there's a massive demand from people to help them with trapped family members or people suffering from major injuries," the Toronto-based spokesman for Medicines Sans Frontiers Paul McPhun said.

"Teams are basically managing what comes to them. They are already getting overwhelmed," he said, adding: "All of our health structures are either condemned or collapsed, so we can't use them."

Hours after the quake wrecked even the capital's most sturdy buildings, the dust and debris-covered city was hit by dozens more powerful aftershocks.

Two million people live in the densely populated capital of the impoverished Caribbean nation, many of them crammed into flimsy shantytowns thrown up around the coastal town and perched on its hillsides.

Prime Minister Jean-Max Bellerive, who toured the slum areas on Tuesday and again Wednesday, told the US television channel CNN that the final death toll could be "well over 100,000."

"I hope that is not true, because I hope the people had the time to get out. Because we have so much people on the streets right now, we don't know exactly where they were living."

The normally gleaming-white presidential palace on the central Champs de Mars square was in ruins, its central cupola now a collapsed symbol of a nation upended. And the UN mission's headquarters had collapsed.

Dozens of gravely injured Haitians were seeking refuge and medical attention in neighboring Dominican Republic, a AFP journalist at the scene said.

Buses from Port-au-Prince arrived at the General Meleciano Hospital, carrying injured children, women, men and the elderly, many with fractured skulls and broken limbs.

A Twitter message said to be from US musician Richard Morse based in Haiti reported there was little help available in the Carrefour Feuilles area on the edge of downtown Port-au-Prince.

"No police presence..there is no UN presence in the Carrefour Feuilles area..people are trying to take care of themselves," he wrote on the microblogging Internet social networking.

"People are buried in the St Gerard School by St Gerard Church..we heard voices in the rubble. I saw bodies..no official vehicles in area."

Haitian-born music star Wyclef Jean led an army of celebrities in an urgent appeal for aid, as the State Department and Red Cross appealed for donations to funds which can be made by texting from mobile phones.

Jean said on his website and on Twitter that millions in Port-au-Prince were in peril. "The over two million people in Port-au-Prince tonight face catastrophe alone. We must act now," he said.

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