At least 38 people have been killed and 150 missing after a strong earthquake hit central Italy in the early hours of Wednesday morning with the Pope leading prayers for those affected.
Rescue crews raced to dig out survivors from the rubble in the two hardest hit towns of Amatrice and Accumoli near Rieti, some 80 miles north-east of Rome.
The epicentre was close to Accumoli with nearby Amatice reduced to rubble.
"The town isn't here anymore," Amatrice mayor Sergio Pirozzi said.
The magnitude 6 quake struck at 3.36am local time and was felt across a broad swathe of central Italy, including the capital, Rome, where residents felt a long swaying followed by aftershocks.
It was also felt beyond the Lazio region into Umbria and Le Marche on the Adriatic coast.
The Pope has offered his condolences to all those affected by the quake.
Pope Francis on Wednesday cancelled a speech he was to have given at his general audience and instead prayed with the crowd for victims and survivors of the quake.
"Hearing the mayor of Amatrice say that the town no longer exists and hearing that there are children among the victims, I am deeply saddened," he told tens of thousands of people who had gathered in St Peter's Square for his general audience.
The centre of Amatrice was devastated, with entire palazzos razed to the ground. Rocks and metal tumbled on to the streets and dazed residents huddled in piazzas as dozens of aftershocks continued into the early morning hours, some as strong as 5.1.
"The whole ceiling fell but did not hit me," said resident Maria Gianni. "I just managed to put a pillow on my head and I wasn't hit, luckily, just slightly injured my leg."
As daylight dawned, residents, civil protection workers and even priests began digging out with shovels, bulldozers and their bare hands, trying to reach survivors. There was a sigh of relief as a woman was pulled out alive from one building, followed by a dog.
"We need chainsaws, shears to cut iron bars, and jacks to remove beams: everything, we need everything," civil protection worker Andrea Gentili told the Associated Press.
The devastation harked back to the 2009 quake that killed more than 300 people in and around L'Aquila, which sent emergency teams to help with the rescue on Wednesday.
The Italian geological service put the magnitude at 6.0. The US Geological Survey put the magnitude at 6.2 with the epicentre at Norcia, about 105 miles (170km) north-east of Rome, and with a relatively shallow depth of six miles (10km).
"I don't know what to say. We are living this immense tragedy," said the Rev Savino D'Amelio, an Amatrice parish priest. "We are only hoping there will be the least number of victims possible and that we all have the courage to move on."
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 that 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 office of Premier Matteo Renzi tweeted that heavy equipment was on its way.
In 2009, a 6.3-magnitude earthquake struck in the same region and killed more than 300 people. The earlier earthquake struck in L'Aquila was about 55 miles (90km) 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 earthquake.
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