A powerful earthquake shook central Italy in the early hours of yesterday, leaving at least 120 people dead and a trail of destruction across several mountain villages packed with holidaymakers.
With 368 people injured, some critically, and an unknown number trapped under rubble, the death toll from the pre-dawn quake was expected to rise, Prime Minister Matteo Renzi told reporters after visiting the badly-hit village of Amatrice.
"This is not a final toll," he warned as hundreds of emergency services staff and volunteers prepared to work through the night in the hope of plucking more survivors from the ruins. Renzi, who gave the latest toll figure after visiting the area, called for national unity.
Hundreds of people were to spend a chilly night in hastily-assembled tents with the risk of aftershocks making it too risky for them to return home.
Scores of buildings were reduced to dusty piles of masonry in communities close to the epicentre of the quake, which had a magnitude of between 6.0 and 6.2.
It was relatively shallow at 4 km below the earth's surface. Italy's earthquake institute INGV reported 150 aftershocks in the 12 hours following the initial quake, the strongest measuring 5.5.
It hit a remote area straddling Umbria, Marche and Lazio at a time of year when second-home owners and other visitors swell the numbers staying there. Many of the victims were from Rome.
All three regions are dotted with centuries-old buildings susceptible to earthquakes. And most of the deaths occurred in and around the villages of Amatrice, Accumoli and Arquata del Tronto.
"I was blown away by what I saw. We haven't stopped digging all day," said Marcello di Marco, 34, a farmer who travelled from the town of Narni some 100 km away to help with emergency services' rescue efforts in the hamlet of Pescara del Tronto.
In the nearby village of Accumoli, a family of four, including two boys aged 8 months and 9 years, were buried when their house imploded.
As rescue workers carried away the body of the infant, carefully covered by a small blanket, the children's grandmother blamed God: "He took them all at once," she wailed.
The army was mobilised to help with special heavy equipment and the Treasury released 235 million euros ($265 million) of emergency funds. At the Vatican, Pope Francis dispatched part of the Holy See's tiny firefighting force to help in the rescue.
Rescue workers used helicopters to pluck survivors to safety in more isolated villages cut off by landslides and rubble.
Aerial photographs showed whole areas of Amatrice, last year voted one of Italy's most beautiful historic towns, flattened by the quake.
"It's all young people here, it's holiday season, the town festival was to have been held the day after tomorrow so lots of people came for that," said Amatrice resident Giancarlo, sitting in the road wearing just his underwear.
"It's terrible, I'm 65 years old and I have never experienced anything like this, small tremors, yes, but nothing this big. This is a catastrophe," he said.
Scores of people are believed unaccounted for, with the presence of the holidaymakers making it difficult to tally.
Patients at the badly damaged hospital in Amatrice were moved into the streets and a field hospital was set up.
"Three quarters of the town is not there anymore," Amatrice mayor Sergio Pirozzi told state broadcaster RAI. "The aim now is to save as many lives as possible. There are voices under the rubble, we have to save the people there."
Accumoli's mayor, Stefano Petrucci, said some 2,500 people were left homeless in the local community of 17 hamlets.
Residents responding to wails muffled by tonnes of bricks and mortar sifted through with their bare hands before emergency services arrived with earth-moving equipment and sniffer dogs. Wide cracks had appeared like open wounds on the buildings that were still standing.
The US Geological Survey said the quake struck near the Umbrian city of Norcia. INGV registered it at 6.0.
David Rothery, Professor of Planetary Geosciences at Britain's Open University, said the shallow depth of the quake had made it more destructive.
Residents of Rome were woken by the tremors, which rattled furniture, swayed lights and set off car alarms in most of central Italy.
"It was so strong. It seemed the bed was walking across the room by itself with us on it," Lina Mercantini of Ceselli, Umbria, about 75 km away from the hardest hit area, told Reuters.