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21 people have died after taking part in a race when "freezing rain and hail" struck.
The runners, who were taking part in an ultramarathon in China on Saturday, died after the extreme weather hit a bend during the trail.
The ultramarathon, taking place in China's northwestern Gansu province, began in a lush tourist site at a bend in the Yellow River.
The river is China's second-longest river in the country.
The route would take runners through deep canyons in a rugged landscape.
The race kicked off on Saturday morning with runners dressed in t-shirts and shorts under overcast skies, according to photographs posted on the social media account of the Yellow River Stone Forest scenic area in Jingtai, a county under the jurisdiction of Baiyin city.
One participant told local publication Red Star News: "At one point, I couldn't feel my fingers (because it was so cold). At the same time, my tongue felt frozen, too."
He said: "I retreated back to halfway down the mountain, and entered a wooden cabin at the direction of a rescuer.
"There were already about 10 more runners who came down earlier and we waited for rescue in the cabin for about an hour. Eventually, about 50 runners came and took shelter in the cabin."
Around noon on Saturday, a mountainous section of the race was hit by hail, freezing rain and gales, with temperatures falling sharply, officials from Baiyin told a news briefing on Sunday.
A total of 172 people took part in the race.
By Sunday, 151 participants had been confirmed safe, including the injured, the official Xinhua news agency reported.
Eight people were lightly injured as of 12am GMT on Sunday, the Baiyin officials said.
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A massive rescue effort has been initiated, with more than 1,200 rescuers dispatched.
Rescuers are being assisted by thermal-imaging drones, radar detectors, and demolition equipment, according to Xinhua.
Temperatures dropped again during the night due to the area's complex terrain and topography, making the search and rescue more difficult, Xinhua added.
The last missing runner was found dead at 9:30 a.m. on Sunday, state television reported.
A landslide following the severe weather also hampered the rescue work, said officials from Baiyin, about 1,000 km west of the Chinese capital Beijing.
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