At least 27 students, most younger than 13, and a teacher were killed when a school roof collapsed during classes in Peshawar on Thursday.
Authorities warned that the death toll could rise as more children were feared buried in the rubble.
The incident occurred at the privately run Al-Khair Education Center school, where rescuers pulled bloodied students from the debris.
District emergency officer Iftikhar Khan said at least 45 children had been taken out, adding that some more were reported trapped under the rubble.
Government official Bilal Faizi said rescue teams were working to extricate bodies and shift the injured to hospital.
Lady Reading Hospital spokesperson Mohammad Asim said 20 injured and most of the dead were brought to the hospital.
A rescue official said the ceiling came down on the students after the roof of a higher floor collapsed, crumpling two storeys.
Authorities said an investigation has been ordered to determine the cause of the collapse.
Peshawar police chief Mian Saeed said he feared the death toll could rise, as only 47 of the 110 students present in three classrooms had been rescued.
“It was a weak building structure. Its roof was overloaded with construction on a weak structure that caused the collapse,” he said.
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