GENERAL SANTOS (Philippines) — Doctors treated patients in tents set up under a scorching Philippine sun today — including helping a young mother give birth — as the death toll from a major earthquake that collapsed buildings topped 40.

Thousands remained displaced and more than 450 injured following the magnitude-7.8 quake that struck off the southern island of Mindanao yesterday, according to national and local disaster agencies, with four people now believed missing.

In hardest-hit Sarangani province, some areas remain accessible only by helicopter while fears of aftershocks were slowing rescue efforts, local officials told reporters at a briefing today.

“There are still aftershocks, so the rescuers are very cautious in their approach. That’s a challenge,” said regional civil defence chief Rodrigo Sosmena

A series of powerful aftershocks rocked the area from about two hours after the first quake, while hundreds of tiny tremors followed.

Infrastructure damage, meanwhile, means some communities will be cut off for at least a week because of the damage to roads and the collapse of a bridge.

At a hospital just outside General Santos, the region’s largest city, AFP reporters heard cries of “push” then an infant’s cries as a mother gave birth outdoors behind a makeshift screen.

In Glan municipality, where at least 13 people were buried in their homes by a landslide, staff at another hospital told AFP more than 60 patients were on beds outside the facility due to fears for the building’s structural integrity.

“The hospital sustained a lot of damage,” she said. “The municipal engineer decided we could not use the building.”

As of this afternoon, the death toll from provincial sources contacted by AFP stood at 41.