City Manager Mark Rohr said the deadly twister cut like a knife through the town of 50,000, leaving a six-mile-long and half-mile-wide swath of devastation in its wake.
"It cut the city in half," city Fire Chief Mark Randles said.
Rescuers continued to go door-to-door but were slowed by downed power lines, jagged debris and gas-fed fires that raged throughout the city.
"It's a very, very precarious situation," Missouri Gov. Jay Nixon told CNN. "It's going to be a stark view as people see dawn rise."
PHOTOS: DESTRUCTION ACROSS THE CITY
The devastating funnel cloud destroyed a hospital and leveled a school as well as heavily damaging scores of homes.
Debris from the hospital - including medical records and X-rays - was found up to 60 miles away.
In all, 2,000 buildings were damaged, officials said.
"You see pictures of World War II, the devastation and all that with the bombing. That's really what it looked like," said Joplin High School Principal Kerry Sachetta. "I just couldn't believe what I saw."
The storm system spawned twisters throughout the Midwest, touching down across a broad area stretching from Oklahoma to Wisconsin.
At least one person was killed in Minnesota, but the devastation was by far the heaviest in Missouri.
The killer storm comes just weeks after a similar series of deadly twisters killed more than 300 people across the south.
Experts with the Storm Prediction Center in Norman, Okla., said weather conditions on Monday could cause further strong storms.
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