The death toll from a massive earthquake that struck Japan on New Year's Day has climbed to 64 as authorities rush to bring aid to survivors facing freezing temperatures and forecast heavy rain.
The quake, with a preliminary magnitude of 7.6, struck the Noto peninsula on Monday afternoon, levelling houses and cutting off remote areas from much-needed aid.
Heavy rains were forecast in the quake-hit areas on Wednesday raising fears of landslides, authorities said, which could further hinder efforts to free many more trapped under rubble.
Severed roads, damaged infrastructure, and the remote location of the hardest-hit areas have complicated rescue efforts, and the full extent of damage and casualties remains unclear, two days after the quake.
Authorities confirmed 64 deaths so far, making the earthquake the deadliest in Japan since at least 2016.
More than 33,000 people have evacuated their homes and some areas have no access to water or electricity, according to Ishikawa prefecture.
The mayors of the hardest-hit cities demanded the government clear roads and deliver aid swiftly at a regional emergency disaster meeting held on Wednesday morning.
"Even those who narrowly escaped death can't survive without food and water," said Masuhiro Izumiya, the mayor of Suzu, a town of about 13,000 near the quake's epicentre.
"We haven't received a single loaf of bread," he added.
Shigeru Sakaguchi, the mayor of hard-hit Wajima city, said he was grateful for the government's efforts but had received only 2000 meals for some 10,000 evacuees so far.
"Some people are very cold because there are areas that have no access to electricity and therefore heating," he said.
Many roads were severed and several areas outside of the city centre could only be reached by helicopter, he added.
Japanese Prime Minister Fumio Kishida emphasised the urgency of the situation at a news conference on Wednesday.
"It's been over 40 hours since the initial quake. This is a battle against time, and I believe now is a crucial moment in that battle," he said.
The government opened a sea route to deliver aid and some larger trucks are now able to reach some of the hardest-hit areas, Kishida said.
Mitsuru Kida, 74, a survivor of the earthquake who lives in hard-hit Wajima city, feared a return to life as usual would be time-consuming process.
"The road conditions are terrible. This is the first time the roads have been damaged this badly," he said at a community building which had been turned into a makeshift evacuation centre.
"I have an impression that most people have yet to regain energy to stand up again at the moment."
Smaller quakes continue to hit the peninsula.
Firefighters searching for survivors in the rubble of a partially collapsed building were seen rushing out to safety as an earthquake warning alarm sounded before noon on Wednesday, according to footage broadcast by public broadcaster NHK.
