A monstrous tornado at least a half-mile (800 meters) wide roared through the Oklahoma City suburbs Monday, flattening entire neighborhoods and destroying an elementary school with a direct blow as children and teachers huddled against winds up to 200 mph (320 kph). At least 51 people were killed, including at least 20 children, and officials said the death toll was expected to rise. The ferocious storm - less than 1 percent of all tornadoes reach such wind speed - ripped through the suburb of Moore in a Midwest region of the U.S. known as Tornado Alley. The storm laid waste to scores of buildings in Moore, a community of 41,000 people about 10 miles (16 kilometers) south of Oklahoma City. Block after block lay in ruins. Homes were crushed into piles of broken wood. Cars and trucks were left crumpled on the roadside. Rescuers launched a desperate rescue effort at the elementary school, pulling children from heaps of debris and carrying them to a triage center. The National Weather Service estimated that the tornado reached up to a half-mile wide and was an EF-4 on the enhanced five-point Fujita scale, the second most powerful type of twister. More than 120 people were being treated at hospitals, including about 50 children. And search-and-rescue efforts were to continue throughout the night. Amy Elliott, spokeswoman for the Oklahoma Medical Examiner's Office, told The Associated Press early Tuesday that officials could see as many as 40 more fatalities from the tornado in addition to the 51 already confirmed dead. She said at least 20 children were among the confirmed dead.