Twenty-seven pupils and a teacher were killed on Thursday after a roof collapsed at a school in the northwest Pakistani city of Peshawar, a hospital official said.
Asim Khan from Peshawar's Lady Reading Hospital confirmed the toll to AFP, adding that over 30 people were injured, with six believed to be in a critical condition.
A spokesman for the emergency rescue service in Khyber Pakhtunkhwa province said the schoolchildren were crushed and trapped after the roof gave way.
"When the Rescue 1122 emergency response teams arrived at the scene, they found that one roof had collapsed on to another, causing the classroom below to be crushed and trapping children inside," spokesman Bilal Ahmad Faizi said.
"There are concerns that more children may still be trapped beneath the rubble," he said, adding that 16 ambulances, two disaster response vehicles and more than 60 personnel were deployed to the site.
Images released by the emergency services showed rescue workers in high-vis vests scrambling to move debris, rubble and dirt.
AFP journalists saw dozens of people at the scene.
Resident Sher Ahmed said he blamed "substandard construction materials" for the tragedy, and called for a probe.
"With profound grief and sorrow, I urge the authorities to conduct a thorough investigation and take strict action against anyone found responsible so that such tragedies can be prevented in the future," he said.
- 'Deep sorrow' -
Pakistan's Prime Minister Shehbaz Sharif in a statement expressed "deep sorrow and grief over the loss of precious lives".
"The Prime Minister extends his condolences to the bereaved families and prays for them to have the strength and patience to bear this irreparable loss," the statement said.
President Asif Ali Zardari branded the roof collapse a "heartbreaking tragedy".
"In this hour of grief, the entire nation shares the sorrow of the affected families," he said in a statement.
Roof and building collapses are common across Pakistan, mainly because of poor safety standards and shoddy construction materials in the South Asian nation of more than 240 million people.
In June this year more than a dozen children were killed in a roof collapse at a tutoring centre in the eastern city of Lahore.
In 2025, 27 people were killed and 10 injured when a five-storey building collapsed in the impoverished area of Lyari in the southern city of Karachi.
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