The earthquake that ripped through this once-picturesque town Saturday did more than topple houses and send hillsides tumbling onto the streets. It also destroyed the main government hospital, so the injured were taken to a soccer stadium instead.

On Monday afternoon, many of them were still there.

"Please help me," said Mansour Mir, 48, a government auditor whose wife, Naveed, writhed in agony and called on Allah as she lay on a cot with her broken leg wrapped in dirty gauze. "She didn't cry for the last three days, but now she is not able to control the pain," he said.

A handful of army doctors were on the scene, and every now and then a helicopter would land, blowing down tents and kicking up a storm of debris before clattering off with a load of 15 or so victims. But that left Mir's wife and several hundred others still waiting their turn for evacuation at the stadium, where bloodstained bandages littered the ground and a shrouded corpse lay on a salvaged bed frame.

The scene at the improvised trauma center embodied the frantic and under-equipped rescue effort unfolding here in the capital of Pakistani-controlled Kashmir. Muzaffarabad is apparently the most grievously affected town of any in the earthquake zone, in both human and material terms.

Local officials estimated that the earthquake killed at least 10,000 people in Muzaffarabad, out of a total estimated death toll of more than 20,000, mostly in Pakistani-controlled Kashmir. The 7.6-magnitude temblor appears to have destroyed or damaged most buildings in the relatively prosperous community of about 125,000, knocking down schools and minarets, leaving cars crushed like soda cans and turning the main shopping bazaar into a maze of rubble and spilled goods.

Government institutions were paralyzed, and there were reports of looting by survivors desperate for food and water. The elected official in charge of the region was reported to be living in a tent outside his damaged official residence.

Muzaffarabad was largely cut off from the outside world until Monday morning, when relief workers finally reopened the main access road, which had been blocked by landslides. By afternoon, relief efforts were just getting underway.

Although there were plenty of soldiers in evidence, many appeared to have little to do but direct traffic. International aid agencies had only just begun arriving.

In the absence of significant outside help and heavy equipment, townspeople and soldiers picked at the ruins with shovels. The stench of decomposing bodies filled the air. Four men walked down a street carrying a child's body on a bed frame. There was no power or running water.

Many residents camped outside their homes, either because the buildings were uninhabitable or because they feared that the ground was not yet stable. Several landslides around the town on Monday afternoon sent up plumes of dust visible for miles.

"It is a whole generation that has been lost in the worst-affected areas," Maj. Gen. Shaukat Sultan, the chief military spokesman, told Agence France-Presse. "Rescuers are pulling out dead children in Muzaffarabad, but there is no one to claim the bodies, which shows their parents are dead."

The Bush administration pledged up to $50 million in relief and dispatched eight helicopters from Afghanistan to help in the rescue effort.

Secretary of State Condoleezza Rice said Monday she was considering going to Pakistan to review the earthquake damage and pledge U.S. support during her trip through Central Asia and Afghanistan this week.

"I have considered and am still considering it. We are going to reach out to Pakistan officials," she told reporters traveling on her plane. "I want to be clear to the Pakistani people that the United States stands with them."

In Islamabad, U.S. Ambassador Ryan C. Crocker said the scope of the disaster was "utterly overwhelming," according to the Associated Press. "We have underway the beginning of a very major relief effort."

U.N. officials estimated that 2.5 million people were left homeless and warned that some could be vulnerable to disease and exposure in the mountainous Kashmir region, parts of which will soon be buried in snow.

Although most of the casualties were in Pakistan, there were reports that as many as 2,000 people could have died in Indian-held Kashmir. The disputed Himalayan region has been provisionally divided between the two countries for more than half a century.

Sikander Hayat Khan, the highest elected official in Pakistani-controlled Kashmir, told the Reuters news agency from his tent that the earthquake had "totally paralyzed" Kashmir. "For the first two days, we have been either digging ground to recover bodies or digging to bury them," he said. "Kashmir has turned into a graveyard."

Situated in a valley at the confluence of two rivers, Muzaffarabad is wealthy by Pakistani standards, thanks largely to remittances from Kashmiris living abroad. But the town is barely recognizable now.

Some government institutions have collapsed, literally. One was the 400-bed Combined Military Hospital. "It is not functional at all," Col. Iqbal Hanif, the hospital director, said from his temporary quarters on the manicured lawn outside the destroyed complex.

Hanif said about 100 hospital patients had been killed in the quake along with 20 staff members. Soldiers continued to dig through the hospital rubble Monday, but with little sense of urgency, since all those remaining in the wreckage were presumed to have died.

The injured were taken to the soccer field at Muzaffarabad University, which was also largely destroyed. Army medical personnel could do little for the injured other than dispense painkillers and tetanus shots, and relatives were growing frantic.

"We have been trying since yesterday to arrange a vehicle, but there is none available," said Gul Iftar, 35, whose 18-year-old daughter, Farah, lay nearby on a cot with shoulder, leg and back injuries caused by a collapsing roof. "There are too many patients. Diesel is not available."

Between daybreak and 4 p.m., six helicopters landed on the field, carrying away about 70 injured, according to military personnel. An army captain, who declined to give his name, said there were not enough helicopters because there were "casualties in the forward areas, and they have gone there also."

Among the few international aid workers in town Monday were teams of rescue specialists from Britain and Turkey. The British team, using sniffer dogs and chain saws, was reported to have pulled a 20-year-old tailor alive from one wrecked building. But hopes of finding more survivors beneath the rubble were fading fast.

Across the street from the wrecked hospital, a Turkish rescue worker in an orange jumpsuit urged his German shepherd into the ruined interior of a small apartment building. Finding nothing, the dog emerged a moment later, and the team moved on to another building.

Among those watching the team was Sakhi Mohammed, 45, a father of five who lost his home and pashmina-wool business. His sister was still trapped in the ruins of her home, and Mohammed said she was probably dead.

He also said he had not seen his wife since Saturday morning, when she left for her job teaching school in a village.

"The entire village has disappeared," he said. "Whom should I contact?"

Staff writer Robin Wright, traveling with Rice, contributed to this report.

Fearing aftershocks from Saturday's earthquake, staff at Ayub Hospital in Abbottabad, Pakistan, set up a makeshift facility in the building's front yard. A woman is treated at Ayub Hospital in Abbottabad, Pakistan, where many of the survivors of the earthquake have been taken. Staff members treated injured people in a makeshift facility outside and also moved patients there after officials warned that the ground was unstable.A father desperately seeks help for his seriously injured son from among the very few doctors and nurses still working at Ayub Hospital, near the worst-hit area of the earthquake zone.A woman waits for treatment at the hospital. Help has been slow reaching the devastated area.