Doctors in the Philippines are treating patients in makeshift tents under harsh sunlight after a powerful earthquake struck the southern region of Mindanao, killing at least 41 people and leaving thousands displaced.

In several affected areas, including near General Santos City, medical staff were forced to move patients outdoors, with even critical procedures such as childbirth taking place in temporary open-air setups. At one hospital, a young mother delivered a baby behind a makeshift screen as staff continued emergency care outside damaged facilities.

The magnitude-7.8 earthquake struck off the coast of Mindanao on Monday, triggering tsunami warnings across parts of the region before the alerts were later lifted. Disaster agencies reported more than 450 people injured, while only four individuals are currently listed as missing.

In the hardest-hit Sarangani province, rescue operations have been slowed due to aftershocks and difficult access, with some areas reachable only by helicopter. Officials warned that continuing seismic activity is making search efforts more dangerous and complex.

“There are still aftershocks, so rescuers are very cautious in their approach,” said regional civil defence chief Rodrigo Sosmena, noting that conditions remain highly unstable.

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Infrastructure damage has further complicated relief operations, with several communities expected to remain cut off for at least a week due to destroyed roads and a collapsed bridge. In Glan municipality, where at least 13 people were buried in landslides, more than 60 patients were treated outside a hospital after authorities declared the building unsafe.

Rescue teams in General Santos resumed operations at a collapsed grocery store, where two employees remain trapped. Search dogs and handlers are combing through debris of broken concrete and twisted metal, though officials say the operation has shifted closer to recovery mode.

At a nearby coastal area, the Philippine Coast Guard is searching for two missing swimmers after strong quake-triggered waves hit the shoreline. Meanwhile, tsunami warnings issued by several countries, including Indonesia and Japan, were later withdrawn after wave activity remained minimal.

Videos verified by international agencies showed widespread destruction, including the collapse of commercial buildings, a fast-food outlet in General Santos, and structural failures in schools during the violent shaking.

The Philippines has experienced similar seismic activity in recent months, including powerful earthquakes in eastern Mindanao in October that killed at least eight people, underscoring the region’s vulnerability to major tectonic events.