At least 120 people including children have died after an earthquake hit central Italy in the early hours of this morning, Prime Minister Matteo Renzi announced.
Mr Renzi spoke in the provincial capital of Rieti after visiting rescue crews and survivors in the hard-hit town of Amatrice.
The magnitude 6 quake struck at 3.36am local time and was felt across a broad swath of central Italy, including Rome, where residents woke to a long swaying followed by aftershocks.
The centre of Amatrice was devastated, with entire blocks of buildings razed and the air thick with dust and smelling strongly of gas. Amatrice is made up of 69 hamlets that rescue teams were working to reach.
Rocks and metal tumbled onto the streets of the city centre and dazed residents huddled in piazzas as more than 40 aftershocks jolted the region into the early morning hours, some as strong as 5.1.
Resident Maria Gianni said: "The whole ceiling fell but did not hit me.
"I just managed to put a pillow on my head and I wasn't hit luckily, just slightly injured my leg."
Another woman, sitting in front of her destroyed home with a blanket over her shoulders, said she did not know what had become of her loved ones.
"It was one of the most beautiful towns of Italy and now there's nothing left," she said. "I don't know what we'll do."
Residents, civil protection workers and even priests dug with shovels, bulldozers and their bare hands to reach survivors. Dozens were pulled out alive.
To the north, in Illica, the response was slower as residents anxiously waited for loved ones to be extracted from the rubble.
"We came out to the piazza, and it looked like Dante's Inferno," said Agostino Severo, a Rome resident visiting Illica. "People crying for help, help. Rescue workers arrived after one hour ... one and a half hours."
The devastation harked back to the 2009 quake that killed more than 300 people in and around L'Aquila, about 55 miles south of the latest quake.
The town, which still has not bounced back fully, sent emergency teams on Wednesday to help with the rescue.
Additional reporting by AP
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