The death toll officially climbed above 5,300 Thursday in the aftermath of the earthquake and tsunami that struck Japan almost a week ago — though the toll is still expected to top 10,000. As officials struggle to cool reactors at a crippled nuclear plant and keep the crisis from escalating further, hundreds of thousands of survivors are struggling with a lack of water, shelter and other necessities.

Concerns about radiation levels also led the U.S. government to authorize the first evacuations for Americans out of Japan and warn U.S. citizens to defer all nonessential travel to any part of the country.

President Obama placed a telephone call to Prime Minister Naoto Kan on Wednesday to discuss Japan’s efforts to recover from last week’s devastating earthquake and tsunami, and the nuclear crisis at the Fukushima Dai-chi plant. Obama promised Kan that the U.S. would offer constant support for its close friend and ally, and “expressed his extraordinary admiration for the character and resolve of the Japanese people,” the White House said.

But a hastily organized teleconference late Wednesday with officials from the State and Energy Departments underscored the administration’s concerns. The travel warning extends to U.S. citizens already in the country and urges them to consider leaving. The authorized departure offers voluntary evacuation to family members and dependents of U.S. personnel in Tokyo, Yokohama and Nagoya and affects some 600 people.

Senior State Department official Patrick Kennedy said chartered planes will be brought in to help private American citizens wishing to leave. People face less risk in southern Japan, but changing weather and wind conditions could raise radiation levels elsewhere in the coming days, he said.

Pentagon spokesman Col. Dave Lapan said it will coordinate departures for eligible Defense Department dependents.

The decision to begin evacuations mirrors moves by countries such as Australia and Germany, who also advised their citizens to consider leaving Tokyo and other earthquake-affected areas. Tokyo, which is about 170 miles from the stricken nuclear complex, has reported slightly elevated radiation levels, though Japanese officials have said the increase was too small to threaten the 39 million people in and around the capital.

Anxious to safeguard the U.S. relationship with its closest Asian ally, Obama told Kan Wednesday evening about the steps the U.S. was taking, shortly before the State Department announced the first evacuations.

But the alliance looked likely to be strained, with the U.S. taking more dramatic safety precautions than Japan and issuing dire warnings that contradicted Japan’s more upbeat assessments.

Earlier Wednesday, the Obama administration urged the evacuation of Americans from a 50-mile radius of the stricken nuclear plant, raising questions about U.S. confidence in Tokyo’s risk assessments. Japan’s government was urging people within 20 miles to stay indoors if they could not evacuate.

Relief Efforts Continue

The thousands of residents evacuated from the exclusion zone surrounding the plant are among those getting help from the Japanese Red Cross, says International Red Cross Federation spokesman Paul Conneally.

The organization dispatched 115 national disaster response teams and nearly 1,000 medical staff to the massive international humanitarian mission already under way.

A blanket of snow in parts of the devastated northeast added to the misery for millions of people facing a sixth night with little food, water or heat. Police said more than 452,000 people were staying in temporary shelters.

Both victims and aid workers have appealed for more help.

“There is enough food, but no fuel or gasoline,” said Yuko Niuma, 46, as she stood looking out over Ofunato harbor, where trawlers were flipped on their sides.

Along the tsunami-savaged coast, people must stand in line for food, gasoline and kerosene to heat their homes. In the town of Kesennuma, they lined up to get into a supermarket after a delivery of key supplies, such as instant rice packets and diapers.

Each person was only allowed to buy 10 items, NHK television reported.

‘We’re Being Severely Tested’

With diapers hard to find in many areas, an NHK program broadcast a how-to session on fashioning a diaper from a plastic shopping bag and a towel.

Yasuji Chiba of Kesennuma’s emergency management center is trying to account for each of the city’s roughly 70,000 inhabitants.

“I don’t know how many people were killed or injured — 343 people are still missing,” Chiba said. Among the missing are three members of his own family.

Store owner Mikako Fujita has survived four tsunamis in Kesennuma, but none as destructive as the latest one, spawned by magnitude 9.0 earthquake off the east coast of Japan. Last Friday, she watched from her rooftop as a 30-foot-high wall of water surged toward her.

“This time the speed was so different. It was much faster. It came with a mighty whoosh!” she said.

Kesennuma business owner Katsuhida Honda was among the residents poring over lists and bulletin boards at city hall recently, searching for the names of survivors and victims.

“I’m looking for someone I know,” Honda said. “This person is not on any list yet. Many of the victims who are found can’t even be identified, so I’m worried.”

Recalling the sirens wailing just minutes before the tsunami hit, he had no words to express his grief over the loss of friends and neighbors.

“This time we’re being severely tested. If we can just get through it,” he said, wiping away his tears with a tissue. “We’ve got to show our Japanese spirit.”

Doualy Xaykaothao in Koriyama City, Lisa Schlein in Geneva and NPR’s John Ydstie in Tokyo and Anthony Kuhn in Kesennuma contributed to this report, which contains material from The Associated Press. Copyright 2011 National Public Radio. To see more, visit http://www.npr.org/.