The Albanian Defence Ministry says the official death toll from an earthquake that has hit the country stands at 28, while 45 people have been rescued.

There is no estimate on how many people are missing.

Some 650 people have been treated for injuries, mostly minor, according to Albania's health ministry.

Emergency crews on Wednesday used drones, dogs and heavy machinery to search for survivors through the wreckage after Albania's worst earthquake in decades.

The 6.4 magnitude quake, centred 30 km (19 miles) west of Tirana, was felt across the Balkans and in the southern Italian region of Puglia, across the Adriatic Sea from Albania.

In Durres, Albania's second largest city, on the Adriatic Sea, residents slept in tents and cars and at a soccer stadium as powerful aftershocks from the earthquake continued. Others spent the night on open ground, huddling around fires to stay warm.

Children sleep in a soccer field at a makeshift camp , following a deadly earthquake in Durres, Albania, on Tuesday, Nov. 26, 2019

People stand outside their tents at a makeshift camp after an earthquake in Thumane, western Albania, Wednesday, Nov. 27, 2019 AP

In the nearby town of Thumane, Kristina Margjini also spent the night outdoors.

"The quake left us without shelter. Everything we have is destroyed: The apartment, windows, everything, and we cannot live there anymore," she said to AP.

A woman carries belongings on her shoulder following Tuesday's powerful earthquake in Thumane, Albania, November 27, 2019. REUTERS

The government proclaimed Wednesday a day of mourning and Prime Minister Edi Rama said "the priority is to save people's lives."

He added that the authorities would re-house people who had lost their homes in hotels during the winter.

"I believe we shall put them in new houses in 2020, in better housing that they had," Rama said in a televised comment.

Flags are flying at half-staff on public buildings around the country as Albania observes a national day of mourning.

Festivities planned for Albania's Independence Day celebrations on November 28 and 29 have been cancelled.

Schools would remain closed until Monday, as Thursday and Friday were national holidays.

The country's soccer federation announced that all matches would be cancelled for the rest of the week.

International solidarity

Italy, France, Romania, Turkey, Greece, Croatia, Montenegro, Kosovo and Serbia have sent 200 specialised troops, tools and teams of tracker dogs to help the relief effort.

Neighbouring Kosovo, whose population is mostly ethnic Albanian, also declared Wednesday a day of mourning.

Prime Minister Edi Rama thanked neighbour Greece and other countries for offering support.

"We feel good to not be alone and I'm very grateful to all our friends,'' Rama said late on Tuesday, visiting Durres with Greek Foreign Minister Nikos Dendias.

Pope Francis says he is praying for the victims, the wounded and their families in Albania following Tuesday's earthquake.

Francis said that Albania was the first country in Europe that he wanted to visit as pontiff, and he feels very close to the Albanian people.

The Pope made his comments to thousands of people gathered in St. Peter's Square for his weekly audience.

Turkey's president has called for a donors' conference of Muslim countries to help Albania surmount the destruction caused by the deadly earthquake.

President Recep Tayyip Erdogan made the call on Wednesday during an opening address at an annual meeting of the Organisation of the Islamic Cooperation to discuss economic issues.

Erdogan said: "I call on the entire Islamic world to support Albania."

"We must all stand together with Albania concerning the treatment of the injured or sheltering those whose homes collapsed or were damaged," he added.

The Turkish leader also declared that Turkey has dispatched military cargo planes, emergency assistance teams and aid convoys to Albania.

Relatives speak

In the town of Thumane, close to the centre of the quake, a woman stood in front of a collapsed building calling out for rescuers to find her niece.

"Hope is the last thing that dies," Asije, 40, a close relative of the Lala family who had come to the port city from Albania's poor north in search of a better life, told AFP.

Another relative, Hasan Lala, was working with rescuers who used pickaxes, shovels and their hands to clear debris and move slabs on concrete. They continued through the night with headlamps and mobile phones.

"The rescue operation is very difficult because you can't use heavy machinery, you have to work with your hands," he said, as distraught neighbours watched from the house next door.

Early Wednesday in Thumane, tormented relatives wept as search teams retrieved the remains of a married couple, Pellumb and Celike Greku, from one of the buildings torn down by the force of the earthquake.

Their son Saimir was rescued alive from the rubble Tuesday night but later died in hospital, according to relatives and neighbours.

"Terrible, terrible," an elderly woman dressed in black shouted as the bodies were carried away, tearing at her hair.

A woman mourns after rescuers found the body of a relative after an earthquake in Thumane, western Albania, Wednesday, Nov. 27, 2019 AP

Another local, 60-year-old Valbona Cupi, said Saimir had been visiting his parents from abroad when the earthquake struck before dawn on Tuesday.

"They went to heaven together, they were very honest and poor people," she said in tears.

Adrian Muci said six of his relatives had died in two separate buildings, and his own house was on the point of collapse.

"I have other cousins and relatives but I don't know where they are and if they are dead or not," he told Reuters. "I will never be able to live in my house anymore."

Among those desperate for news was police officer Ajet Peci, who managed to emerge from the ruins of an apartment block that collapsed in the port city of Durres, killing his two adult daughters. His wife is still missing.

"How can I live?'' Peci said to AP reporter, sobbing as he was consoled by neighbours, a bandage under his right eye and on a finger of his left hand. "I don't know what I did to make it out. I wish I had stayed with them.''

Aftershocks

At least 250 aftershocks – two of them magnitude 5 – then shook the Balkan country, continuing into Wednesday.

A 5.3 magnitude quake struck just off Albania's coast on Wednesday afternoon 38 km (24 miles) from the capital Tirana, where some shaken by the tremor shut their shops.

The defence ministry also briefly suspended all rescue efforts following the sizeable aftershock.

Amid fears of more tremors in the region, media in some countries have carried emergency advice for citizens in case of an earthquake.

Albania is the poorest country in Europe, with per capita income a quarter of the European Union average, according to the International Monetary Fund.

If the death toll continues to rise, the earthquake could be more deadly than one in 1979 when 40 people were killed.

In neighbouring Greece, a strong 6.1-magnitude underwater earthquake shook the island of Crete on Wednesday morning.

Earthquakes are common in the Balkans due to the movements of two large tectonic plates – the African and Eurasian – and the smaller Adriatic micro-plate.