Hardly a building was left standing in Joplin, 240km south of Kansas City after the tornado, reported to be 1.5km wide, hit late in the afternoon.
"I would say 75 per cent of the town is virtually gone," Kathy Dennis of the American Red Cross told CNN.
By nightfall local time, the death toll had risen to 24 and was expected to climb further.
The worst-hit building was the multi-storey St John's Hospital, where TV images showed nearly every window to be blown out. There were reports that debris from the building had been found 75km away, and local television reported fires throughout the building amid fears that broken gas lines in the hospital could cause an explosion.
The tornado was part of a series of severe weather patterns that hit the midwest, including in Minneapolis where a twister was blamed for the death of a 59-year-old man. A number of others were injured after tornadoes hit parts of Minnesota.
But Joplin and its population of 174,000 took a "direct hit" according to National Weather Service meteorologist Mike Griffin. "It went right through the centre of town," he told the Springfield News-Leader.
A man living almost 75km away from the hospital said that debris from the building, including medical supplies and X-rays, was found in his yard.
Jeff Lehr, a reporter for the Joplin Globe, was upstairs in his home when the storm hit but was able to make his way to a basement closet. "There was a loud huffing noise, my windows started popping. I had to get downstairs, glass was flying. I opened a closet and pulled myself into it," he said.
"Then you could hear everything go. It tore the roof off my house, everybody's house. I came outside and there was nothing left. There were people wandering the streets, all mud-covered.
"I'm talking to them, asking if they knew where their family is. Some of them didn't know, and weren't sure where they were."
The tornado struck less than a month after another tornado outbreak left 354 dead across seven US states.
[The Australian, Tornado 1.5km wide kills 24 in US midwest, 24 May 2011]
Images found at National Geographic and The Australian
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