In the nearby village of Accumoli, a family of four, including two boys aged 8 months and 9 years, were buried when their house 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 town isn’t here anymore,” said Sergio Pirozzi, the mayor of Amatrice. “I believe the toll will rise.”

Complicating matters was that the area is a popular vacation spot in summer, with populations swelling, making the number of people in the area at the time difficult to estimate.

The center of Amatrice was devastated, with entire blocks of buildings razed and the air thick with dust and smelling strongly of gas. Amatrice is made up of 69 hamlets that rescue teams were working to reach.

The Italian geological service put the magnitude at 6.0; the US Geological Survey reported 6.2 with the epicentre at Norcia, about 170 kilometers (105 miles) northeast of Rome, and with a relatively shallow depth of 10 kilometres (6 miles).

“No family or village or town will be left alone,” Prime Minister Matteo Renzi said in a national address. Saying Italy would vigorously accelerate the ongoing rescue effort, he added, “we will continue to find people alive.”

Pope Francis on Wednesday dispatched one-sixth of the Vatican’s tiny fire department to join rescue efforts following the earthquake.

Speaking in Vatican City’s St. Peter’s Square, Pope Francis said: “I cannot but express my great pain and say I am with the people in all the places stricken by this earthquake.”

The Vatican said six of its firefighters travelled to the town of Amatrice to help civil protection workers look for survivors still under the rubble and assist those already rescued.

The total force of the 108-acre city-state’s fire department numbers 37.

In the worst-hit towns including Amatrice – famed as the birthplace of the classic amatriciana pasta sauce – rescue workers and local residents desperately clawed through rubble to save buried victims amid a scene of widespread devastation. Several survivors, including a small girl, were plucked alive from heaps of debris. Hospitals in the impacted areas were fast filling up with injured people. Thousands of residents were left homeless.

On the dusty, rubble-strewn streets of Amatrice, three women walked restlessly, one of them in a panicked search for her fiancé. Ten rescue workers with a search dog pinpointed a possible person - or body - buried in the rubble. They laboured feverishly with pick axes and tools in the debris of a gutted building.

Nearby, a dazed Mariana Lleshi, a Catholic nun from Albania, walked toward the destroyed religious institute where she lived along with a group of other nuns and elderly women. Of the 20 women who lived there, she said, seven were still unaccounted for. Lleshi clutched her head, where a large bandage covered the wound she sustained as the ceiling collapsed in her bedroom.

“I remember hearing something, a loud noise, and then hiding under my bed,” she said. “I was screaming, and I got out and started running when the ceiling started coming down.”

She said a young Colombian man who was staying overnight at the institute found her in the chaos and guided her out to safety.

“All I could see was destruction around me,” she said. “I had lost all hope to get out of this alive, but God sent me his messenger.”

The damage from the powerful temblor was far flung, with devastation striking the narrow, cobblestone streets of historic towns scattered across a sprawling zone including the earthquake-prone provinces of Marche and Lazio, which sustained some of the heaviest casualties.

Images showed heavy rubble from fallen buildings piled high on the narrow streets of old Roman towns. The blocked roads, officials said, were hindering rescuers attempting to reach victims.

A string of aftershocks as strong as 5.5 magnitude continued to hit the affected zone, catching the country during the high August vacation period when large numbers of Italians leave cities and towns for annual holidays.

Luca Cari, spokesman for the Italian fire department, told Reuters that the worst-hit towns were Accumoli, Amatrice, Posta and Arquata del Tronto. Rescue workers took to the air in helicopters to assess the damage at dawn.

Pirozzi, the mayor of the devastated town of Amatrice in the province of Lazio, told RAI that residents were buried under the debris of collapsed buildings.

Amatrice is a town of 2,700 also known for its local sons who became the cooks of popes. Video and still images showed damaged archways, partially collapsed buildings and town squares in ruins.

Men could be seen cleaning away piles of rubble with their hands, buckets and excavators. Live on RAI, a young man, his hand moving, was rescued from the rubble and carried away by workers.

People draped in white blankets stood next to destroyed buildings. Aerial views of before and after showed the magnitude of the destruction in what used to be a picturesque town.

Pirozzi said debris was so bad that streets needed to be cleared to reach stranded residents.

“The streets are not passable, and there are people under the rubble,” he told RAI. “We are trying by all means to bring first aid, but we are working without light.”

Later, ANSA reported that at least five bodies were pulled from the rubble in Amatrice, with more expected.

The mayor of another hard-hit town, Accumoli, described extensive damage and casualties.

“Four people are under the rubble, but they are not showing any sign of life. Two parents and two children,” the mayor, Stefano Petrucci, told RAI.

Journalist Sabrina Fantauzzi was in Illica, a village 141 kms northeast of Rome, when the earthquake struck.

“When I woke up during the night from the shock, I saw a big crack in the wall, I made it just in time to take the kids, taking the stairs and leave,” she told ANSA. “The oldest houses, those of 1700, are damaged . . . but those made in the ‘70s are pulverised. The only buildings that held up were those built after the ‘80s, according to earthquake-resistant criteria.”

Authorities called on residents in Lazio and other affected provinces to avoid congesting roadways to help rescue workers. They also issued appeals for blood as hospitals dealt with a rush of earthquake injuries.

In Norcia, a number of homes had been reinforced to withstand earthquakes. That appeared to have limited the damage, although there were reports of injuries.

Aid stations were being set up to distribute warm drinks. “Now we are trying to set up camps,” city councillor Giuseppina Perla told RAI.

“This was very, very bad. I’ve never seen anything like it,” Sabrina Sbermola, a resident of the central Italian town of Arquata el Tronto, told the BBC.

The earthquake evoked memories of 2009, when a 6.3-magnitude earthquake struck farther south, killing more than 300 people. That quake was centred around L’Aquila, about 87 kms south of the latest quake.

Remy Bossu, head of the EMSC in France, said shallow earthquakes of this magnitude were not highly unusual in the zone hit on Wednesday. In addition to the 2009 L’Aquila earthquake, another hit in 1997 in Umbria and Marche that severely damaged the Basilica of St. Francis of Assisi.

He said the main problems in the area were widespread older buildings that cannot withstand earthquakes of this magnitude.

“The problem is that the [earthquake-proof] building code only applies to new buildings,” he said. “To retrofit an old building is a very complex and costly operation. So it’s only done for key buildings, such as hospitals.