At least 73 people are dead and hundreds more injured after an earthquake in central Italy reduced three towns to rubble.
The death toll is likely to rise as crews reach homes in more remote mountain hamlets where the scenes were apocalyptic "like Dante's Inferno", said one witness.
The area is a popular holiday spot, with populations swelling in summer.
"My town isn't here any more," said Sergio Pirozzi, the mayor of Amatrice. "I believe the toll will rise."
The magnitude 6 quake struck at 3.36am and was felt across a broad area of central Italy, including Rome, where residents woke to a long swaying followed by aftershocks. It shook the Lazio region, Umbria and Le Marche on the Adriatic coast.
Hardest-hit were the tiny towns of Amatrice and Accumoli near Rieti, 130km north-east of Rome, and Pescara del Tronto farther east.
A family of four, including two boys aged eight months and nine years, were buried when their house in Accumoli imploded.
As rescue workers carried away the body of the infant, covered by a small blanket, the children's grandmother blamed God and wailed: "He took them all at once."
Italy's civil protection agency, which was co-ordinating rescue operations, said the provisional toll was 73 dead, several hundred injured and thousands in need of temporary housing
The centre of Amatrice was devastated, with entire blocks of buildings razed and the air thick with dust and smelling strongly of gas.
Rocks and metal tumbled on to streets and dazed residents huddled in piazzas as more than 40 aftershocks jolted the region into the early morning hours.
A woman sitting in front of her destroyed home said she did not know what had become of her loved ones.
"It was one of the most beauti- ful towns of Italy and now there's nothing left," she said. "I don't know what we'll do."
Residents, civil protection workers and priests dug with shovels and their bare hands to reach survivors. Dozens were pulled out alive.
"We need chainsaws, shears to cut iron bars, and jacks to remove beams - everything, we need everything," said civil protection worker Andrea Gentili.
The national blood transfusion service appealed for donations to Rieti's hospital.
To the north, in Illica, the response was slower as residents anxiously waited for loved ones to be pulled from the rubble.
"We came out to the piazza, and it looked like Dante's Inferno", said Agostino Severo, a Rome resident visiting the area.
The devastation harked back to the 2009 quake that killed more than 300 people in and around L'Aquila, about 90km south of the latest quake.
The town, which still has not bounced back fully, sent emergency teams yesterday to help with the rescue.
"We are living this immense tragedy," said Fr Savino D'Amelio, a priest in Amatrice. "We are only hoping there will be the least number of victims possible and that we all have the courage to move on."
Another hard-hit town was Pescara del Tronto, in the Le Marche region.
Residents were digging their neighbours out by hand since emergency crews had not yet arrived in force.
Photos taken from the air by regional firefighters showed the town essentially flattened.
Italy requested EU satellite images of the whole area to better assess the scope of the damage.
The Italian geological service put the magnitude of the quake at 6.0. The US Geological Survey reported 6.2 with the epicentre at Norcia, 170km north-east of Rome, and with a relatively shallow depth of 9km.
"Quakes of this magnitude at this depth in general create building collapses, which can result in deaths," said the head of Italy's civil protection service, Fabrizio Curcio.
Central Myanmar was also shaken yesterday by a 6.8 magnitude quake that killed at least three people including two children and damaged some of the famous pagodas in the Southeast Asian nation's ancient capital of Bagan.