A powerful earthquake that rocked central Italy on Wednesday left 38 people dead and the total is likely to rise, the country's civil protection unit said in the first official death toll.
"There are still so many people under masonry, so many missing," said Immacolata Postiglione, the head of the unit's emergency department.
Strong earthquake struck central Italy early on Wednesday, collapsing homes on top of residents as they slept leaving at least 37 people dead and dozens more injured or unaccounted for, according to a report in AFP.
Deaths were reported in the villages of Amatrice, Accumoli and Arquata del Tronto as residents and emergency services battled frantically to rescue people trapped beneath the ruins after the quake hit as people slept.
Pope Francis has skipped his catechism lesson during his Wednesday general audience and instead led pilgrims in praying the rosary for the victims of Italy's earthquake.
Holding a rosary in his right hand, Francis told the crowd that he was stunned by the devastation of the magnitude 6 temblor that struck central Italy early Wednesday. He said he wanted to express his pain and solidarity with the victims.
The crowd in St. Peter's Square recited the prayer along with him.
The magnitude 6 quake struck at 3.36 am (0136 GMT) and a 5.4-magnitude aftershock followed an hour later. The tremors were felt across a broad swath of central Italy, including Rome where residents of the capital felt a long swaying followed by aftershocks.
The hardest-hit towns were Amatrice and Accumoli near Rieti, some 80 kilometers (50 miles) northeast of Rome, which were partially demolished. The center of Amatrice was devastated, with entire palazzos razed to the ground. Rocks and metal tumbled onto the streets and dazed residents huddled in piazzas as aftershocks continued into the early morning hours.
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The Italian Geological service put the magnitude at 6.0. The U.S. Geological Survey reported the magnitude at 6.2 with the epicenter at Norcia, about 170 kilometers (105 miles) northeast of Rome, and with a relatively shallow depth of 10 kilometers (6 miles).
The mayor of the quake-hit town of Accumoli, Stefano Petrucci, said at least six people had died there, including a family of four, and two others. "There are deaths," he told state-run RaiNews24. "
In Amatrice, the ANSA news agency reported two bodies had been pulled from one building. The Rev. Fabio Gammarota told ANSA another three were killed in a separate collapse.
Amatrice Mayor Pirozzi told state-run RAI radio and Sky TG24 that residents were buried under collapsed buildings, that the lights had gone out and that heavy equipment was needed to clear streets clogged with debris. The town isn't here anymore," Amatrice mayor Sergio Pirozzi said.
Prime Minister Matteo Renzi cancelled a planned trip to France for a meeting with European Socialist leaders and other engagements to oversee the response to the disaster. The office of Premier Matteo Renzi tweeted that heavy equipment was on its way.
Rescue operations underway
As daylight dawned, residents, civil protection workers and even priests began digging out with shovels, bulldozers and their bare hands, trying to reach survivors.
Italy's forestry police say they have extracted dozens of people alive from hard-hit Pescara del Tronto in Italy's Le Marche region, but rescue crews still haven't reached the nearby hamlet of Peracchia di Acqua Santa Terme. The main road into and out of the town was covered in debris, making rescue difficult; residents were digging their neighbors out by hand. Photos taken from the air by regional firefighters showed much of the tiny town essentially flattened
The forestry police joined Italian carabinieri, firefighters, civil protection crews, Red Cross workers, army and Alpine troops in the rescue effort in towns hit by the magnitude 6 quake in central Italy. Pescara del Tronto was one of the hardest-hit towns, along with Accumoli and Amatrice.
Gastronomic beauty spot
A resident of Amatrice village told Rai television that she had been woken by the shaking in time to witness the wall of her bedroom cracking open. She was able to escape into the street with her children.
The village was packed with visitors at the peak of the summer season when the quake struck, destroying the picturesque hilltop village's main street.
The mayor said difficult access to the village had prevented emergency services getting through.
"There is a landslide on one road, a bridge is about to collapse on the other one," he said. "We can hear voices under the rubble."
Amatrice is famous in Italy as a beauty spot and is a popular holiday destination for Romans seeking cool mountain air at the height of the summer.
USGS's PAGER system, which predicts the impact of earthquakes, issued a red alert -- suggesting significant casualties and damage based on previous quake data.
In 2009, a 6.3-magnitude earthquake struck close to the university city of Aquila in the Abruzzo region and left more than 300 people dead.
That disaster led to lengthy recriminations over lax building controls and the failure of authorities to warn residents that a quake could be imminent.
Italy is often shaken by earthquakes, usually centred on the mountainous spine of the boot-shaped country but this is the worst tragedy since 2009.
In 2009, a 6.3-magnitude earthquake struck in the same region and killed more than 300 people. The earlier earthquake struck L'Aquila in central Italy, about 90 kilometers (55 miles) south of the latest quake.
A 1997 quake killed a dozen people in the area and severely damaged one of the jewels of Umbria, the Basilica of St. Francis in Assisi, filled with Giotto frescoes. The Franciscan friars who are the custodians of the basilica reported no immediate damage from Wednesday's temblor.
With inputs from AP and AFP