Authorities in Colombia continue to struggle to meet the needs of the tens of thousands estimated to have been injured, displaced, or otherwise affected by the devastating 7.4-magnitude earthquake this week, telling local media on Thursday that hospitals near the epicenter are totally overwhelmed and city streets are in a state of “total chaos.”

Complicating matters, reports from Colombia detail ongoing aftershocks that interrupt search and rescue operations and threaten to send buildings that remain precariously standing crumbling down, trapping even more people. Many residents in the western Colombian department, or state, of Chocó where the earthquake hit are wandering the streets aimlessly with nowhere to stay. In the neighboring city of Pereira, a local report detailed the smell of natural gas everywhere, suggesting the constant threat of explosions.

As of Thursday, Colombian authorities have confirmed 265 deaths as a result of the earthquake, about 3,494 people injured, and 496 people missing, likely trapped under building rubble. As is typical in earthquakes, emergency officials expect these tolls to rise as access to remote affected areas expand and missing people are found. While the death toll remains in the hundreds, Colombian authorities estimate that as many as 43,000 people in Chocó alone have been displaced by the earthquake, in many cases losing their homes and most possessions.

According to the Colombian newspaper El Tiempo, the governor of Chocó, Nubia Córdoba, assesses that about 93 percent of the buildings in the city suffered “grave damage” in the earthquake.

“Some residents were left with nothing as their houses were totally destroyed and under a great cloud of smoke because of the ruins,” John Jairo Gutiérrez, the mayor of Chocó’s El Litoral del San Juan, told El Tiempo. “The tragedy reached various parts of the country and, in Chocó, the panorama is completely devastating… these are humble people. Don’t leave us alone.”

The state is largely isolated due to significant damage on the roads and at the El Caraño airport, complicating relief efforts and the arrival of emergency personnel from elsewhere in the country. Newly minted Colombian President Abelardo de la Espriella is expected in the capital of Chocó, Quibdó, on Thursday afternoon, to assess the true scale of the damage.

The bishop of Quibdó, Wiston Mosquera, told El Tiempo that the hospitals in the area are completely overwhelmed, matching estimates from the newspaper that they were at about 300 percent capacity as a result of earthquake injuries.

“I know they need more hands, especially medical personnel to help over there. The hospital has no space,” he explained. “It was a place that was already precarious in its care and infrastructure, but was also affected by the earthquake… Because of that, they have had to transfer many patients to hospitals of high complexity in Medellín. Some people who came injured have even died after arriving in the hospital.”

Bishop Mosquera described food as a top priority, as an untold large number of people were living on the street and had no access to food or kitchens.

In Pereira, Risaralda — which was also devastated by the earthquake — residents have organized a community kitchen to cook whatever food they can get their hands on and feed the neediest.

“They bring us food, the most that they can, and then we prepare the food and give it to people who need it,” organizer Pilar Quiñones told Colombia’s Caracol News. Even those whose home did not crumble to the ground, Caracol explained, do not have access to cooking areas because of potentially broken gas pipes.

Describing the situation in Pereira, the magazine Semana shared a state of round-the-clock chaos with many people sleeping outside to avoid being crushed by half-crumbled buildings.

“In many of the crumbled buildings, where people are trying to remove debris, it smells of gas,” the magazine observed. The streets are filled, it continued, with both “delinquents,” many from other parts of the country, looking to loot, and “vigilantes” hired by local business owners to protect what remains of their property.

The work to clear buildings on the verge of collapsing is advancing slowly, reports explain, in part because of aftershocks. Most recently, Chocó experienced a 4.2-magnitude earthquake on Thursday morning, rocking cities as far as Cali.

Emergency responders consider the first 72 hours, which have now elapsed, as critical for saving lives. Various dramatic rescues have taken place, including on Wednesday in Pereira where rescuers saved a woman trapped under a building for 36 hours.

Local media have highlighted rescue dogs, who use their superior senses of smell to identify living victims or find bodies, as critical to the rescues. Largo, 32, is reportedly hospitalized and in a state of severe injury. Her father, Julio César Largo, who refused to leave the rubble of the building where she was found, told media that she suffered severe dehydration that triggered cardiac arrest and her recovery is not guaranteed.

“The doctor did not give me hope, he said a miracle has to happen,” he added.