The man accused of shooting dead 11 people inside a Pittsburgh synagogue, an incident described by prosecutors as “a horrific act of violence”, has appeared in court in a wheelchair where 29 charges were read to him aloud.

Robert Bowers, 46, who is said to have written a number of racist and antisemitic social media posts before carrying out the rampage, was wheeled into the court in handcuffs and was asked if he understood the charges levelled against him.

CNN said that Mr Bowers, dressed in a blue shirt, briefly had the handcuffs removed so he could sign legal documents. The judge then read to him the 29 federal charges, which included 11 counts of using a firearm to commit murder. Mr Bowers also faces numerous state charges.

The brief hearing in a packed courtroom, came just two days after Mr Bowers allegedly entered the Tree of Life synagogue in the city’s Squirrel Tree neighbourhood, armed with three hand guns and a semi-automatic rifle.

He is accused of killing eight men and three women – aged 54 to 97 – and injuring six others, among them four police officers who shot and detained him. Prosecutors said they are treating the incident as a hate crime and have requested permission to seek the death penalty if Mr Bowers is convicted.

After the hearing, US Attorney Scott Brady told reporters the court had ordered the suspect to appear for a preliminary hearing on Thursday in relation to the “horrific act of violence”.

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He said at the next hearing prosecutors would start providing evidence to show the accused killed 11 people who were “exercising their religious beliefs”.

“Our investigation of these hate crimes continues,” Mr Brady said. “Our thoughts and prayers continue to be with the victim’s families and with the community. And rest assured, we have a team of prosecutors working hard to ensure that justice is done.”

The court appearance came as Pittsburgh and the nation are still reeling from what was the deadliest ever attack against the Jewish community in the US, which itself followed the revelation that pipe bombs had been mailed to more than a dozen high-profile Democrats and critics of the president.

At the same time, the nation is intensely debating whether the language and actions of President Donald Trump are helping create an environment in which such actions are more likely, something his critics say is the case. Amid opposition from some in Pittsburgh’s Jewish community, the president is due to visit the city on Tuesday.

“This president’s modus operandi is to divide us,” Democratic congressman Adam Schiff told CNN on Sunday. “It’s not enough that on the day of a tragedy he says the right words, if every other day of the year he’s saying things to bring us into conflict with one another.”

Sarah Sanders, the White House press secretary, rejected such accusations, on Monday.

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“The very first thing the president did was condemn attacks, both in Pittsburgh and the pipe bombs,” she said at a briefing. “The first thing the media did was blame the president.”

She said Mr Trump was no more responsible for the latest violence than Bernie Sanders was when one of his supporters shot and wounded congressman Steve Scalise and other Republicans in June 2017.

She added: “The president is not responsible for these acts.”

Elsewhere, as Pittsburgh prepared to hold the first of the funeral services for the shooting victims on Tuesday, a Jewish doctor who heads the hospital where the suspected shooter was treated and who is a member of the synagogue he allegedly attacked, said Mr Bowers “hears noise…telling him to rise up and do something”.

Jeff Cohen, a member of Tree of Life synagogue and president of Allegheny General Hospital, described how he heard the gunshots break out on Saturday morning. He also revealed he had spoken to the alleged gunman.

“I went to see the shooter and the cops that were guarding him. You look at him, I wanted to try and understand, why did he do this,” he told CNN.

“And I have no answers. I asked him, how are you feeling, and he was sort of groggy and said, I’m feeling okay. And I introduced myself as Dr Cohen, the president of Allegheny General. And I left. The FBI agent in charge looked at me and says, I don’t know how you did that because I’m not sure I could.”

He added: “The gentleman didn’t appear to be a member of the Mensa society. He listens to the noise, he hears the noise. The noise was telling him his people were being slaughtered. He thought it was time to rise up and do something. He’s completely confused, and the words mean things. The words are leading to people doing things like this.”

Jon Pushinksy, who a congregant at Dor Hadash, another Pittsburgh Jewish community that lost one of its members in Saturday’s attack, attended the court hearing and said he was surprised when he saw Mr Bowers.

“It was not the face of villainy that I thought we’d see,” Pushinksy told the Associated Press.

Federal prosecutors set in motion plans to seek the death penalty against Mr Bowers, a truck driver, who authorities say expressed hatred of Jews during the rampage and later told police: “I just want to kill Jews”, and: ”All these Jews need to die”.

Survivors, meanwhile, began offering harrowing accounts of the mass shooting.

Barry Werber, 76, said he found himself hiding in a dark storage closet as the gunman tore through the building.

“I don’t know why he thinks the Jews are responsible for all the ills in the world, but he’s not the first and he won’t be the last,” Mr Werber told the AP. “Unfortunately, that’s our burden to bear. It breaks my heart.”

The news agency said that just minutes before the synagogue attack, Mr Bowers apparently took to social media to rage against HIAS, a Jewish organisation that resettles refugees under contract with the US government.