A powerful earthquake that hit mountain towns in central Italy has killed at least 247 people, the country's civil protection agency says.
The earthquake struck on Wednesday at 3.36am local time (1.36pm NZT), when most residents were asleep, collapsing homes and buckling roads in the cluster of towns some 140km east of Rome.
Authorities say the search for bodies continued through the night.
A tally by local officials this afternoon showed that at least 190 people were killed in Rieti province, with at least 57 dead in the province of Ascoli Piceno, Reuters reported.
Aerial photographs showed whole areas of the historic town of Amatrice flattened by the 6.2 magnitude quake.
Residents in many towns have been told their homes are not safe, CNN reported, and it was estimated about 3000 people had been left homeless following the quake.
The earthquake was the latest in a series of severe earthquakes in the country, one of the most seismically active countries in Europe.
Many of the dead were in Amatrice, where the mayor said three quarters of the town was destroyed. Patients at the badly damaged hospital in the city were moved into the streets as a field hospital was set up.
"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."
Speaking to RNZ from the ancient hilltop village, BBC journalist Jenny Hill was outside a partially collapsed convent building where nuns and elderly people were believed to be sleeping when the quake struck.
"Those rescuers called for absolute silence here as they shouted into the rubble, having had a sniffer dog to indicate that there might be someone trapped under it.
"We just saw one of them raise his hand and yes, it sounded as though someone inside was making knocking noises, so they're now trying to go about the very, very delicate task of getting into a building which is in a state of near collapse."
She said aftershocks were continuing, the town has been evacuated, and tents were being put up in nearby areas to help those left homeless.
The death toll could also be expected to rise, she said, with mayor Sergio Pirozzi saying at least 75 people had died in Amatrice alone and at least 100 more were still missing.
Mr Pirozzi also said at least 1000 people from the town had been displaced, she said.
In the hard-hit town of Arquata del Tronto, food and shelter were being offered to survivors but many were reluctant to leave their homes.
"There are tent camps available for people to stay but most of the residents I've spoken to just didn't want to stay there," said CNN's Attika Schubert.
"They're trying to stay as close to their homes as possible, not only to find any news of relatives, any poss of survivors but also to save mementoes - you know, these are homes that have been handed down for generations families and so there are family heirlooms inside that mean a great deal."
In nearby Accumoli, a family of four, including two boys aged eight months and nine years, were buried when their house collapsed.
Accumoli mayor Stefano Petrucci said about 2500 people were left homeless in the local community made up of 17 hamlets.
The towns of Posta and Pescara del Tronto were also badly affected.
The earthquake was powerful enough to be felt in Bologna to the north and Naples to the south, each more than 220km from the epicentre.
Many people were still believed to be buried under the rubble, with hundreds hurt.
Prime Minister Matteo Renzi paid tribute to the volunteers and civil defence officials who had rushed to the scene in the middle of the night and used their bare hands to dig for survivors.
Many of those killed or missing were visitors. The quake hit during the summer when the populations of the towns and villages in the area, normally low during the rest of the year, swelled with holidaymakers.
The area is mountainous and access is difficult. Tent camps were being set up for those who needed shelter, while others would be accommodated in buildings such as gymnasiums.
Meanwhile, Italians living in New Zealand say they're shocked by news of the devastation.
Antonio Cacace, who runs Wellington restaurant La Bella Italia, said he used to take tour groups through some of the villages that were worst hit and the photos of the destruction were heartbreaking.
He said members of the Italian community had been sending messages to friends and relatives in Italy and, so far, all of them were safe.
Mr Cacace said they were thinking of all the people who had lost loved ones, homes and businesses in the quake.
"Big shock and sad to see what happened in these little villages in Italy and our prayers and our thoughts are constantly with them all the time now - and anything we can do to help them, we will."
The last major earthquake to hit the country struck the central city of L'Aquila in 2009, killing more than 300 people.
The most deadly earthquake 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.
Another earthquake struck Myanmar just hours later, killing at least three people.
- Reuters / BBC