At least 38 people have died, several hundred others are injured and thousands are in need of temporary housing after an earthquake rocked central Italy.
Rescue crews raced to dig survivors out of the rubble, but the toll is likely to rise as crews reach homes in more remote hamlets.
Sergio Pirozzi, the mayor of Amatrice, said: "The town isn't here any more."
The magnitude 6.0 quake struck at 3.36am local time and was felt across a broad swath of central Italy, including Rome. The tremor shook the Lazio, Umbria and Le Marche regions.
Confermati crolli importanti ad Amatrice, Accumoli, Arquata del Tronto. Forte replica con epicentro a Norcia M =5.3 pic.twitter.com/jjmeDckjx3
-- Cons. Naz. Geologi (@cngeologi) August 24, 2016
The hardest-hit towns were Amatrice, Accumoli, and Pescara del Tronto, which are all between 80 and 100 miles north-east of Rome. The centre of Amatrice was devastated, with entire buildings razed and the air thick with dust and smelling strongly of gas.
-- Daniela Beatrici (@DanielaBeatrici) August 24, 2016
Rocks and metal tumbled on to the streets and dazed residents huddled in piazzas as 39 aftershocks, some as strong as magnitude 5.1, jolted the region into the early morning hours.
As daylight dawned, residents, civil protection workers and priests began digging with shovels, bulldozers and their bare hands in an effort to reach survivors.
Prime Minister Matteo Renzi's office tweeted that heavy equipment was arriving, and he promised: "No family, no city, no hamlet will be left behind."
Il Dip. Protezione Civile è in contatto con tutti i territori colpiti, come ad Amatrice, dove sono in arrivo i mezzi speciali #terremoto
-- Palazzo_Chigi (@Palazzo_Chigi) August 24, 2016
Fabrizio Curcio, head of Italy's civil protection service, said: "Quakes with this magnitude at this depth in our territory, in general, create building collapses, which can result in deaths."
He added the region currently contains more residents than at other times of the year as it is popular with tourists escaping the heat of Rome, and a single building collapse could raise the death toll significantly.
The devastation harked back to the 2009 quake that killed more than 300 people in and around L'Aquila, which is about 55 miles south of the latest quake. The town sent emergency teams on Wednesday to help with the latest rescue.
Pope Francis skipped his traditional catechism for his Wednesday general audience and instead invited pilgrims in St Peter's Square to recite the rosary with him.