The blast ripped through a trolleybus in Volgograd this morning raising fears the country is vulnerable ahead of the Sochi Olympic Games.
Debris was strewn across the street and bodies left mangled in devastating scenes.
A witness said: “For the second day, we are dying – it's a nightmare.
“What are we supposed to do, just walk now?"
Regional Health Minister Veronika Skvortsova told Rossiya24 TV: “They (the victims) have burns, multiple traumas, blast-injuries. If needed, they will be airlifted to Moscow."
The National Anti-terrorist Committee believe the bomb may have been left on board during rush-hour rather than being brought on by a suicide bomber.
Eyewitness Alina Averyasova told RT.com: “I woke up because of an enormous blast I heard. I heard the glass shattering in the first two stories of the building.
“I looked out of the window, it was still dark, and I saw a bus that was ripped by a blast and people were running away from it screaming.”
The bus was near one of Vlgograd's, formally known as Stalingrad, markets.
This comes less than 24 hours after 17 people were brutally murdered in an attack on the city’s railway station.
A further 50 people were left injured, including a nine-year-old girl who is considered serious.
It is thought Islamic extremist Oksana Aslanova detonated her bomb before going through a train station metal detector.
The 26-year-old has been on Russia’s wanted list for 18 months.
Sources say Aslanova has twice married Muslim gang leaders from the Caucuses region.
The bomb was reportedly made from at least 10kg of TNT.
Metal detectors have been mandatory in railway stations and airports throughout Russia since a suicide bomber killed 37 people at Domodedovo airport in 2011.
Aslanova is believed to have been friends with Naida Asiyalova, 30, who was responsible for another terrorist attack on Volgograd in October.
The attacks add fuel to fears of a larger incident at the Sochi 2014 Winter Olympic Games, 620 miles from Volgograd.
A Daily Star Report.
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