Rights activists in China have called for a thorough probe into the deaths of two children in a stampede that also left more than 20 others injured.
The accidental crush happened at around 8.30 a.m. local time on Wednesday at the No. 3 Experimental Primary School in Henan's Puyang county.
"As of noon on Thursday, 22 students were injured," state news agency Xinhua reported in an update on Thursday.
The Puyang county government sent out a tweet on its official social media accounts confirming that two children had died and that a probe into the cause of the accident is under way.
Rights activist Wu Lijuan said many such incidents occur in China, and are usually the result of serious gaps in health and safety practices.
"The main responsibility here lies with the school, which had a duty of care towards the students, as it happened in school hours," Wu said. "They are responsible for the safety of each and every child."
"This incident should force them to take a long hard look at themselves, and to deal with it in good faith, then they should pursue whoever is responsible," Wu said. "This should be a lesson."
A local resident, who gave only a surname Poon, said reports of the tragedy surfaced on social media, sparking panic in the local community.
"I called my friend whose daughter goes to that school, and she said lots of people got hurt, more than 20 kids," Poon told RFA.
She said that reports on social media said a wall had collapsed in the toilets, sparking the stampede. RFA was unable to confirm these reports independently.
"More than 20 of the kids were taken to hospital, anyway," Pan said.
"Some went to Renqi Hospital, some to the municipal People's Hospital, and some to the county and the No. 2 county hospital for urgent treatment," Pan said.
Panic on the stairs
The accident happened during monthly examinations in the school, and around 1,700 students were in the building, media reports indicated.
"Pressed for time, many of the students rushed the toilets located on the first and second floors of the three-storey building," the Hong Kong Economic Journal reported, citing local officials.
"A stampede erupted when the students fought their way down a narrow staircase," the paper said, adding that many of those involved had no idea of what was happening to them.
Teachers and staff later arrived and helped take the injured students to ambulances, which took them to three local hospitals, it said.
It said the reports that a toilet wall had collapsed were denied by the school management.
Puyang county education officials had just last week ordered full safety and security checks on all schools in its jurisdiction.
Deputy school principal Liu Wenhua, who was caught up in the stampede, described trying to save a child from being caught in the deadly crush.
"Some students were coming down the stairs from the second floor after the toilet break was over, and they were squashed together on the fourth step," she told state broadcaster CCTV. "I saw that someone had fallen over, so I managed to step up onto the fourth step and grab the child [who had fallen]."
"After I did that, the kids who were coming down behind the fallen child were being shoved forwards, pushing me and the child I was carrying head down right over," she said. "The kids were still pouring down from above towards me, and I had no way to save the child."
Liu said she was effectively buried briefly under several children, and couldn't even call out. After the crush eased, she was able to wriggle out, she said.
Repeated calls to the No. 3 Experimental Primary School rang unanswered during office hours on Wednesday.
Calls to the Puyang county government main switchboard and the county education bureau also rang unanswered during office hours.
An appalling record
Henan rights activist Guo Chunping said China has an appalling construction safety record.
"The problem with the construction industry in China is that a lot of the money for projects, even in the education sector, gets siphoned off into various pockets after it is invested," Guo said.
"Local officials always expect to get something out of it for themselves, so when the project comes to be built, it has to be done at a pretty low cost, which means that they skimp on the right materials," he said.
"It's not out of the question that this is the case here."
In January 2015, 36 people died and dozens were injured in a New Year's crush and trampling incident as crowds gathered on the city's iconic waterfront to ring in the new year.
Investigators blamed the tragedy on the failure of local officials and a police chief to properly assess the risks ahead of the event and to communicate clearly with the public during it.
The deaths and injuries were also clustered around a stairway, the study found.
Reported by Ding Wenqi for RFA's Mandarin Service, and by Goh Fung for the Cantonese Service. Translated and edited by Luisetta Mudie.