A violent earthquake jolted central Italy on Monday killing at least 92 people and injuring 1,500 as buildings and homes in a walled medieval town were reduced to rubble.
More than 1,700 rescuers scrambled to find victims trapped under collapsed dwellings in L'Aquila, the quake's epicentre, and officials warned the toll would rise.
Prime Minister Silvio Berlusconi declared a state of emergency and cancelled a trip to Russia so he could go to the city, the capital of the Abruzzo region, about 100 kilometres (60 miles) northeast of Rome.
Shortly after emergency officials said the death toll had risen to 92, Berlusconi said at a news conference here that another 1,500 were injured.
"Among the victims, two are students, including one from the Czech Republic," Berlusconi said.
"I want to say something important, no one will be abandoned to his fate," he said, adding that a tent village was being set up that could accommodate between 16,000 and 20,000 people and would be ready by nightfall.
Some 50,000 people were made homeless, emergency services said.
The quake struck just after 3:30 am (0130 GMT) and lasted about 30 seconds, bringing down many Renaissance era and Baroque buildings, including the dome on one of L'Aquila's centuries-old churches. The city's cathedral was also damaged.
Roofs caved in on sleeping inhabitants and boulders fell off mountain slopes blocking many roads. At least five children were among the dead in L'Aquila, according to police quoted by ANSA news agency.
The quake measured magnitude 6.2, according to the Italian geophysical institute.
The epicentre was just five kilometers (three miles) directly below L'Aquila, which explained the heavy damage that was inflicted up to 30 kilometres away in all directions.
Sirens blared across the city as rescue workers with dogs raced to find survivors. Many of the 60,000 residents fled into the streets as more than a dozen aftershocks rattled the buildings.
Some even left L'Aquila by foot with belongings in suitcases picking through debris strewn through the streets.
Rescue workers pulled several people alive out of one four-storey building and said they could hear the cries of a woman still trapped. They planned to try to lift the roof with a giant crane.
Doctors treated people in the open air outside L'Aquila's main hospital as only one operating room was functioning.
L'Aquila resident Maria Francesco said: "It was the apocalypse, our house collapsed. It's destroyed, and there's nothing left to recover."
"It's a scandal what's happened," she told AFP. "For the past three months there have been regular tremors, and they've been getting stronger and stronger!"
Luigi D'Andrea, a student, was asleep when the quake struck. "Everything shook really hard and bricks started falling on me. Then it was an entire wall that collapsed in my bedroom, then a second."
He escaped through a neighbour's flat and returned to recover his computer. "I'm very lucky I wasn't hurt, but now I don't know what to do, whether I should leave here or not. I'll wait and see."
L'Aquila suffered the biggest toll. Other dead were reported in the surrounding towns and villages of Castelnuovo, Poggio Picenze, Tormintarte, Fossa, Totani and Villa Sant'Angelo, said police quoted by ANSA.
US President Barack Obama, in Turkey as part of a landmark European tour, expressed concern. "We want to send our condolences to the families there and hope that we are able to get rescue teams in," Obama told a press conference.
Pope Benedict XVI sent a cable of condolences to the L'Aquila archbishop saying he was praying for the victims, the Vatican said.
A powerful earthquake in the region claimed 13 lives in 1997 and damaged or destroyed priceless cultural heritage.
Italy is criss-crossed by two fault lines, making it one of Europe's most quake-vulnerable regions, with some 20 million people at risk.
An October 2002 quake killed 30 people including 27 pupils and their teacher who were crushed under their schoolhouse in the tiny medieval village of San Giuliano di Puglia.
On November 23, 1980, a violent quake struck the southern region of Irpiona near Naples, killing 2,570, injuring 8,850 and displacing 30,000.