At least 45 people were killed and more than 200 others were injured as heavy rains and strong winds tore through northwestern Pakistan on Sunday evening, hospital and rescue officials said.
Peshawar, the capital of northwestern Khyber Pakhtunkhwa province, was hit after a "mini-cyclone" tore roofs of buildings and brought down trees and power poles.
Army teams were on their way to the area of Peshawar city to help with the rescue, a military spokesman said.
A state of emergency was declared in Peshawar's hospitals and additional paramedics were called in to deal with the growing number of injured people.
According to Mushtaq Shah, director general of the Meteorological Office in Peshawar, winds reached up to 75 mph and was very unusual.
"Its speed in the open was more than 120 kph (75 mph) and that's what caused destruction on such a large scale. It's a completely new phenomenon in this region."
The wind, accompanied by heavy rain and hail disrupted power supplies, telecommunication services and damaged infrastructure and crops, said officials.
A number of city roads and streets were inundated in ankle-to-knee deep water as gusty winds knocked down scores of billboards and snapped electric wires. Ambulances and rescue vehicles struggled to enter some areas.
Heavy weather also forced the Pakistani military to cancel two flights to Nepal taking supplies to survivors of Saturday's earthquake. They were rescheduled to Tuesday.
Pakistan’s meteorological department is forecasting more widespread rain in the next 24 hours.
Peshawar and its adjoining districts have a long history of rain disasters, many of them caused by poor infrastructure and lack of basic safety measures.