Updated 21.30

A massive tornado that tore a six-mile path across south-western Missouri killed at least 116 people as it smashed the city of Joplin, ripping into a hospital, crushing cars and leaving behind only splintered tree trunks where entire neighbourhoods once stood.

City Manager Mark Rohr announced the new death toll at a news conference this afternoon. He said seven people had been rescued, and Missouri Governor Jay Nixon said he was “optimistic that there are still lives out there to be saved.”

Search and rescue efforts continued throughout the city of 50,000 about 160 miles south of Kansas City. Much of its south side has been leveled, with churches, schools, businesses and homes reduced to ruins by winds of up to 198 mph.

Jasper County Emergency Management Director Keith Stammer has estimated about 2,000 buildings were damaged. Joplin Fire Chief Mitch Randles estimated the damage covered a quarter or more of the city of about 50,000 people some 160 miles south of Kansas City. He said his home was among those destroyed.

An unknown number of people were injured, and officials said patients were sent to any nearby hospitals that could take them.

Police officers staffed virtually every major intersection today as ambulances screamed through the streets. Rescuers involved in a door-to-door searches moved gingerly around downed power lines and jagged debris, while survivors picked through the rubble of their homes, salvaging clothes, furniture, family photos and financial records, the air pungent with the smell of gas and smoking embers.

Some neighborhoods were completely flattened and the leaves stripped from trees, giving the landscape an apocalyptic aura. In others where structures still stood, families found their belongings jumbled as if someone had picked up their homes and shaken them.

An untold number of homes were destroyed and reduced to ruin.

AP posted this raw video of the damage taken from a helicopter flying over Joplin:

Details about fatalities and injuries were difficult to obtain even for emergency management officials, because the tornado knocked out power, landline phones and some cellphone towers, said Greg Hickman, assistant emergency management director in Newton County.

The storm that hit Joplin spread debris about 60 miles away, with medical records, X-rays, insulation and other items falling to the ground in Greene County, said Larry Woods, assistant director of the Springfield-Greene County Office of Emergency Management.

Governor Jay Nixon declared a state of emergency, and President Barack Obama said the Federal Emergency Management Agency was working with state and local agencies.

Obama issued a statement sending condolences to families of those who died in storms in Joplin and across the Midwest.

- AP