Rescuers raced against time on Tuesday to find survivors from a powerful earthquake that killed at least 179 people in cental Italy as left tens of thousand homeless.
Rescue workers in the the historic town L'Aquila said that more that 24 hours after the quake struck in the early hours of Monday morning that 34 people were still reported missing.
Some 1,500 were injured quake which measured magnitude 6.2 and damaged an estimated 10,000 buildings, many beyond repair, leaving up to 70,000 people homeless, according to a government estimate.
More than 100 people have been pulled alive from the rubble of Renaissance and Baroque buildings around L'Aquila. The epicentre was under L'Aquila and massive destruction was reported for 30 kilometers (20 miles) in all directions from the town.
The nearby villages of Villa Sant'Angelo and Borgo di Castelnuovo were practically wiped out. Many residents fled L'Aquila, some even on foot. Others were lucky enough to find shelter in army barracks, stadiums and sports centres as overnight temperatures dipped.
Rescue workers said 139 of the dead had already been identified, the Italian news agency ANSA reported. Prime Minister Silvio Berlusconi declared a state of emergency in the Abruzzo region and cancelled a trip to Russia in order to visit L'Aquila, about 100 kilometres (60 miles) northeast of Rome.
He said an initial 30 million euros (40 million dollars) had been earmarked to help the region. "No one will be abandoned to his fate," he vowed, adding that a tent village was being set up that could accommodate between 16,000 and 20,000 people.
Interior Minister Roberto Maroni pledged 1,700 additional rescuers, including 1,500 firefighters. He said rescue efforts would continue working "day and night", and television footage showed rescue workers in L'Aquila toiling overnight under huge lights. But much of the town was quiet in the evening as most residents had left.
"Some of the inhabitants have left of their own will, while others have been escorted by the authorities," a public safety official said.
"You can say that most of the old city has been emptied of its residents," adding that it was mostly elderly people who decided to stay. The quake struck just after 3:30 am (0130 GMT) and lasted about 30 seconds, bringing down many historic buildings, including the dome on the 16th century San Bernardino church.
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.
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, 20 minutes of hell, our house collapsed. It's destroyed, and there's nothing left to recover." "It's a scandal what's happened," she said.
"For the past three months there have been regular tremors, and they've been getting stronger and stronger!" L'Aquila suffered the biggest toll while police reported deaths in the towns and villages of Castelnuovo, Poggio Picenze, Torminparte, Fossa, Totani and Villa Sant'Angelo, ANSA reported.
Offers of help poured in from around the world. "We want to send our condolences to the families there," US President Barack Obama said during an official visit in Turkey.
State Department spokesman Robert Wood said the US embassy in Rome would provide 50,000 dollars in emergency relief funding, while US House Speaker Nancy Pelosi telephoned Berlusconi to offer condolences.
Italian authorities told countries offering assistance they did not need rescue teams. UN chief Ban Ki-moon was "saddened by the loss of life and destruction of property in central Italy," his spokeswoman said.
Russian President Dmitri Medvedev said his country was shocked by the tragedy, adding: "We sympathise with those who have suffered and share their sorrow." Pope Benedict XVI sent his prayers, the Vatican said.
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.