The death toll from a devastating earthquake in central Italy rose to at least 247 people early on Thursday after rescue teams worked through the night to try to find survivors under the rubble of flattened towns.
The 6.2 magnitude quake struck a cluster of mountain communities 140 km (85 miles) east of Rome early on Wednesday as people slept, destroying hundreds of homes.
The provisional death toll has jumped to 247, from the 159 listed on Wednesday night, the Civil Protection department said. Officials said they expected the figure to rise further as the search operation continued. Trucks full of rubble left the area every few minutes, including one in which a dusty doll could be seen lying on top of tonnes of debris.
Hundreds of aftershocks have shaken the area since the earthquake. On Thursday, the sun rose on frightened people who had slept in cars or tents, the earth continuing to tremble under their feet. Two aftershocks registered 5.1 and 5.4 just before dawn.
"I haven't slept much because I was really afraid," said 70-year-old Arturo Onesi from the town of Arquata del Tronto, who spent the night in a tent camp for survivors and rescue workers.
The earthquake was powerful enough to be felt in Bologna to the north and Naples to the south, both more than 220 km (135 miles) from the epicentre.
The populations of the four worst-hit towns - Amatrice, Pescara del Tronto, Arquata del Tronto and Accumoli - increase by up to tenfold in the summer, and many of those killed or missing were visitors. Aerial video taken by drones showed swathes of Amatrice, last year voted one of Italy's most beautiful historic towns, completely flattened.
A hotel that collapsed in Amatrice, the Hotel Roma, probably had about 70 guests and only seven bodies have been recovered so far. The owner of the hotel said as many as 30 guests may have been able to escape before the building came down.
Girl found alive
About 270 people injured in Wednesday's quake were hospitalised, the Civil Protection department said, adding that about 5,000 people, including police, firefighters, army troops and volunteers, were involved in post-quake operations.
Rescuers working with emergency lighting in the darkness saved a 10-year-old girl, pulling her alive from the rubble where she had lain for some 17 hours in Pescara del Tronto.
Many other children were not so lucky. A family of four, including two boys aged 8 months and 9 years, were buried when a church bell tower toppled into their house in nearby Accumoli.
Prime Minister Matteo Renzi's cabinet was meeting on Thursday to decide emergency measures to help the affected communities.
"Today is a day for tears, tomorrow we can talk of reconstruction," he told reporters late on Wednesday.
The death toll appeared likely to surpass that from the last major earthquake to strike Italy, which killed more than 300 people in the central city of L'Aquila in 2009.
While hopes of finding more people alive diminished by the hour, firefighters' spokesman Luca Cari recalled that survivors were found in L'Aquila up to 72 hours after that quake.
Most of the damage was in the Lazio and Marche regions, with Lazio bearing the brunt of the damage and the biggest toll. Neighbouring Umbria was also affected. All three regions are dotted with centuries-old buildings susceptible to earthquakes.
Italy's earthquake institute, INGV, said the epicentre was near Accumoli and Amatrice, which lie between the larger towns of Ascoli Piceno to the northeast and Rieti to the southwest.
The quake was relatively shallow at 4 km (2.5 miles) below the earth's surface.
Italy sits on two fault lines, making it one of the most seismically active countries in Europe.
The country's most deadly earthquakes since the start of the 20th century came in 1908, when an earthquake followed by a tsunami killed an estimated 80,000 people in the southern regions of Reggio Calabria and Sicily.