ISLAMABAD, Pakistan (CNN) -- The death toll from the massive South Asia earthquake soared above 42,000 as the first trickle of humanitarian aid began to flow into the region, authorities said.

Islamic Relief spokesman Waseem Yaqhoob told CNN he thought the death toll would reach "80,000, maybe more."

"This could get very close to tsunami levels," he said. "It's horrific. It really is terrible."

Meanwhile, 120 metric tons of ready-to-eat food arrived Tuesday, enough to feed 240,000 people for five days, a World Food Programme spokesman told CNN.

Another 80 million metric tons of food aid is in the pipeline, Amjad Jamal said. (World boosts quake aid effort)

But he acknowledged the need was great and said appeals were being made to the international community for additional donations of food, supplies and money.

In parts of northern Pakistan, India and the disputed region of Kashmir, the scene is one of utter devastation: entire villages destroyed, millions left homeless and survivors using anything they can to wade through mountains of rubble searching for survivors, food and clean water.

Even with many far-flung areas still not reached, the death toll has hit 41,000 in Pakistan alone, with another 1,239 dead in India and one reported death in Afghanistan, officials have said.

In Pakistan, survivors are becoming more frustrated over the pace of relief efforts, with some resorting to looting.

As many as 5 million people have been left homeless, living in the open air and freezing temperatures since the quake.

Officials in both Pakistan and India have defended relief efforts, saying blocked roads and a lack of helicopters have prevented rescue teams from reaching areas in mountainous terrain.

A strong autumn cold front descended on central Asia Tuesday, spawning severe storms and hindering search teams as they continued their frantic efforts to find survivors.

Pakistani presidential spokesman Maj. Gen. Shaukat Sultan told CNN some areas had been "virtually impossible to reach" via land routes, but that rescue teams were on their way "to the most affected areas."

"Convoys are now moving during night as well as during the day to reach the area. The scale of the rescue is now going to be much more than what we could manage through the helicopters only," he said.

India's Home Secretary V.K. Duggal said Monday that relief has been sent to most areas, but some remote patches in Uri, Kupwara and Baramulla have not yet been covered.

"As road accessibility improves, we hope to reach these villages by (Tuesday)," Duggal told a news conference in New Delhi.

Reporting from the Pakistani capital of Islamabad, CNN's Andrew Stevens said there was a "lot of anger" over the relief efforts.

"There is a general feeling more needs to be done," Stevens said, adding the government says it cannot deal with the sheer scale of the disaster.

Miracle rescue
Rescuers, meanwhile, were still finding survivors in the wreckage of an apartment building in an upscale district of Islamabad late Monday. (See video on survivors pulled from rubble )

The capital, about 60 miles (96 kilometers) south-southwest of the earthquake's epicenter, was spared the worst of the damage.

Early Tuesday, search teams launched a frantic rescue effort after making contact with another person buried under the rubble of the apartment building.

Rescuers pulled a 2-year-old girl and her mother from the wreckage hours earlier.

Few details were immediately available about the latest rescue effort, but authorities said they had spoken with someone still buried beneath the rubble of the once 11-story building.

A total of 25 people have been rescued at the site, but search teams also have found 35 bodies in the rubble. (Signs of hope amid crisis)

The building was about 10 years old, and others in the upscale block survived the quake. Pakistani authorities have said they plan an extensive probe into the cause of the collapse.

Andrew MacLeod, a U.N. disaster relief official in northern Pakistan, said another 11 people were rescued from collapsed schools in the hard-hit region.

Looting, scuffling
The quake's epicenter was in Muzaffarabad, the capital of Pakistan-administered Kashmir, which sits in the Himalayan foothills. (Terrain major barrier to aid)

The Pakistani army hospital in Muzaffarabad was heavily damaged, and mass burials were held Monday.

Trucks of aid arrived in the ruined capital of Pakistan-administered Kashmir on Tuesday, and victims scuffled for badly needed food and blankets three days after the quake flattened whole communities.

"They've lost everything. They have no clothes, no food, nothing," resident Asim Butt told Reuters. "People have started looting things from shops."

Also badly hit was Pakistan's North-West Frontier province, where many villages were leveled and roads destroyed, making travel all but impossible.

CNN's Matthew Chance, reporting from the city of Balakot in the North-West Frontier province, described a "scene of utter devastation," saying nearly every building in the tourist town of 250,000 had been destroyed. (Survivors decribe shock)

Traveling in the Baramullah district of Indian-controlled Kashmir Tuesday, CNN's Ram Ramgopal said residents were in a "desperate situation."

In addition to the more than 1,200 deaths, police officials in the state capital Srinagar reported 7,082 injuries, with significant damage to 34,245 dwellings and another 9,836 destroyed.

"Obviously, people have lost everything," Ramgopal said. "These are people who have been cut off. They have very little means of their own right now and they are relying on states to provide that assistance."

'Assistance is flowing'
Late Sunday, the White House announced the United States would provide initial aid of up to $50 million for reconstruction and relief efforts in Pakistan, a key U.S. ally in the war on terrorism. (Full story)

Ryan Crocker, the U.S. ambassador to Pakistan, said Monday that "assistance is flowing in now."

"Our first flight came in (Sunday) night -- the military airlift with blankets, water, rations," he said. "There will be additional flights tonight and on through the week."

Crocker also said that eight military helicopters had been brought to Pakistan from U.S. operations in Afghanistan.

European Union Commissioner Louis Michel said he was sending $4.4 million in emergency relief aid to the region.

The United Nations has been coordinating relief efforts from the international airport in Islamabad, said Jan Egeland, U.N. undersecretary for humanitarian affairs.

Military tensions aside
But the need is staggering, Egeland said, with the number of homeless rivaling those left without shelter after last year's Indian Ocean tsunami.

"There will be need for hundreds of thousands of tents and emergency shelter for all the people who have lost everything," he said.

Political tensions between India and Pakistan over the Kashmir region appeared to take a back seat as Indian Prime Minister Manmohan Singh called Musharraf and offered help. (Full story)

The two nations have fought three wars -- two of them over Kashmir -- since independence from British rule in 1947.

"We have offered all possible assistance for rescue and relief measures," Indian Foreign Ministry spokesman Navtej Sarna told CNN from New Delhi.

Musharraf said he thanked the Indian leader for the offer. "Whatever we need, we will certainly ask," he said, though he noted that there is "a little bit of sensitivity there."

CNN's Andrew Stevens, Satinder Bindra, Matthew Chance, Ram Ramgopal, Syed Mohsin Naqvi and John Raedler and journalists Mukhtar Ahmed and Tom Coghlan contributed to this report.