Two days after the powerful earthquake struck Nepal, no one yet knows the scale of the devastation.

The epicentre was in the western hills, which is a relatively remote and neglected region. Other rural districts have also been severely affected. Information trickling in suggests that the eastern district of Sindhupalchowk has been badly hit.

The earthquake and subsequent powerful aftershocks affected a wide area. The few indications that are available suggest that villages near the epicentre were flattened. Yet almost no information is coming out of these areas, nor is relief yet reaching there. Provincial towns across the country are also reported to have suffered severe damage. So far though - inevitably - attention been has focused on Kathmandu.

The Nepalese capital is a conurbation of around 2.5 million people, which has long been known to be frighteningly vulnerable to a catastrophic earthquake. Saturday's 7.8 magnitude shock has wrought great suffering and destruction here too. Many hundreds have been killed in the city and thousands more have been injured. Kathmandu's hospitals are struggling to cope with an influx of patients suffering spinal injuries, broken bones and head wounds. Medical students have been drafted to help.

Still trapped

What caused the Nepal earthquake?

On Saturday at the Teaching Hospital in the north of the city, there was no electricity for lighting in the crowded orthopaedic centre. More bandaged patients, some on intravenous drips, were lying on trolleys or on the ground outside the building.

With rescue efforts continuing on Sunday, patients were still being brought to Kathmandu's new Trauma Centre from nearby areas. People may still be trapped in buildings in some places around the capital.

The effort is hampered by damage to roads, for instance on the road which links Kathmandu to Bhaktapur, a populous town 15km away. Yet what one sees as one walks, or drives, around the city is that the vast majority of buildings have survived seemingly unscathed.

Contrary to expectations, the modern concrete houses of which Kathmandu is principally composed, did not for the most part collapse. Whether bridges or power lines, there is relatively little visible damage to the infrastructure. In many neighbourhoods, the destruction is local and specific: a house here, a house there.

Often it seems to be the older, traditional brick and timber structures that could not withstand the tremors. For this reason, some of the worst affected areas in the Kathmandu Valley appear to include more traditional settlements such as Bhaktapur, and the villages which lie around the southern part of the ring road.

At Harisiddhi, a village of traditional buildings on the southeastern edge of the capital, there was widespread destruction and loss of life. Residents there are furious to have received "nothing" yet from the government by way of food, shelter or water. They were responding on Sunday by blocking the road, refusing to let government vehicles pass.

Monuments destroyed

Meanwhile, in the city centres, it is mainly historic monuments that have been destroyed. (There will be plenty of time to reconstruct those, as they have been after previous earthquakes, when the immediate emergency has passed.)

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Rather than a city which has been "flattened" (it has not been), most of Kathmandu appears to be a city in which the systems have failed. There is little sign of the authorities.

Where the security forces are visible they often seem to have little to do. And if they are working at all, water, electricity and fuel supplies, sanitation and telephone services, are under great strain and seem to be deteriorating. For many families, food is already growing scarce.

There have been many powerful aftershocks and there is widespread fear - partly due to widespread but baseless rumours that another huge quake is imminent. It is repeatedly claimed that there will be an X magnitude shock at such and such a time, and although earthquakes cannot be predicted many people believe it. Thousands of people are sleeping outdoors in makeshift shelters or without any shelter at all. There are no sanitation facilities.

If the authorities are doing anything to address the needs of the city's people, then those efforts are not widely visible, and few people know what's going on. There seems to be a grave danger that the situation in the Kathmandu Valley will deteriorate. So far people have been stoic and resourceful. There is a danger that if basic support remains unavailable that public anger may rise.

Relief

Getting relief to Kathmandu, to other towns, and especially to rural areas, will be extremely difficult due to the remoteness of these areas and damage to fragile mountain roads.

There is an urgent need for helicopters and relief supplies in the worst affected districts. And in the city, there is an urgent need for leadership and planning to restore supply chains, provide drinking water, food and sanitation.

This disaster was long anticipated. The initial impact of the earthquake - in Kathmandu at least, and terrible though it was - was not as bad as widely anticipated by planners. And there has been much planning and preparation, involving the government, humanitarian agencies and the international community.

It is now the third day since the disaster. Many relief supplies were already in place in anticipation. Despite the turmoil at the airport, more aid is arriving. The difficulties are great. The coming hours and days are the critical time to put all this expertise, resources and experience into action. Because it is in the aftermath of such a disaster that the worst crisis can arise.

Thomas Bell has reported on Nepal for over a decade. His new book of history and reportage is 'Kathmandu'.

The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera's editorial policy.

Source: Al Jazeera