At least 120 people have been killed in a powerful earthquake that devastated a cluster of mountain communities in central Italy on Wednesday.
Many more victims are feared trapped under the rubble.
Hundreds of people are injured and thousands are homeless.
The new death toll of 120 was confirmed by Prime Minister Matteo Renzi who came to the central, mountainous region to thank emergency workers for their efforts.
Voted last year one of Italy’s most beautiful historic towns, Amatrice was flattened by the 6.2 magnitude quake.
Aerial photographs showed whole areas of the town in ruins. Many of those killed or missing were visitors.
“It’s all young people here, it’s holiday season, the town festival was to have been held the day after tomorrow so lots of people came for that,” said Amatrice resident Giancarlo, sitting in the road wearing just his underwear.
“It’s terrible, I’m 65-years-old and I have never experienced anything like this, small tremors, yes, but nothing this big. This is a catastrophe,” he said.
Patients at the badly damaged hospital in Amatrice were moved into the streets.
“Three quarters of the town is not there anymore,” Amatrice mayor Sergio Pirozzi told state broadcaster RAI.
“The aim now is to save as many lives as possible. There are voices under the rubble, we have to save the people there.”
A massive search operation is underway with volunteers, civil protection teams and the army mobilised. Earth-moving equipment and sniffer dogs have been brought in.
Rescue workers used helicopters to pluck trapped survivors to safety in the more isolated villages, which had been cut off by landslides and rubble.
EU partners France and Germany say they are ready to help. Pope Francis has sent firefighters from the Vatican’s tiny fire department to join rescue efforts.
Stefano Petrucci, mayor of nearby Accumoli, said some 2,500 people were left homeless in the local community, made up of 17 hamlets.
A family of four, including two boys aged 8 months and 9 years, were buried when their house in Accumoli imploded.
As rescue workers carried away the body of the infant, carefully covered by a small blanket, the children’s grandmother blamed God: “He took them all at once,” she wailed.
The quake struck at 03.36 on Wednesday morning when people were sleeping.
Victims include children and holidaymakers.
The region, some 140 km east of Rome, is a popular tourist spot at this time of year.
The earthquake was powerful enough to be felt in Bologna to the north and Naples to the south, each more than 220 km from the epicentre.
Italy sits on two fault lines, making it one of the most seismically active countries in Europe.
The last major quake to hit the country struck the central city of L’Aquila in 2009, killing more than 300 people.
The national Civil Protection Department said some survivors would be put up elsewhere in central Italy, while others would be housed in tents that were being dispatched to the area.
Speaking earlier in the day in a brief televised address, Renzi said:
“No one will be left alone, no family, no community, no neighbourhood. We must get down to work .. to restore hope to this area which has been so badly hit.”
The US Geological Survey said Wednesday’s quake struck near the Umbrian city of Norcia.
Some 150 aftershocks were reported in the 12 hours following the initial quake, the strongest measuring 5.5.