The earthquake struck near the central Italian town of Norcia in the province of Perugia at 3:36am local time (0136 UTC) on Wednesday.

The quake, which struck at a low depth of 10 kilometers (six miles), was reportedly felt as far away as Rome, some 160 kilometers (ninety nine miles) from the epicenter. Several aftershocks were also reported, forcing local residents to run out into the streets to avoid collapsing buildings.

According to the latest official death toll, released Wednesday afternoon, at least 120 people died in the quake and 150 are still missing. The worst affected towns were Accumoli, Amatrice, Posta, and Arquata del Tronto.

The United States Geological Survey's PAGER system issued an orange alert for shaking-related fatalities, suggesting significant casualties are likely.

It issued a red alert for economic damage, saying "extensive damage is probable and the disaster is likely widespread."

DW reporter Lewis Sanders, in Ascoli Piceno, about 60 kilometers from the epicenter, said he "woke up to the house shaking violently."

'More dreadful than we feared'

As morning broke, residents, civil workers, and priests began digging through the rubble with shovels and bulldozers in the hope of finding survivors.

Guido Castelli, the mayor of Ascoli Piceno, the seat of government for the province where Arquata del Tronto is located, told DW that the earthquake was "devastating."

"Some of the affected areas look like a war zone. It seems [like the destruction] in Aleppo," Castelli said.

The areas hit by the earthquake are sparsely populated except in July and August, when Italian migrants return to their hometown, especially from Rome, he added.

In nearby Amatrice, the hospital was evacuated and its 15 patients moved into the streets.

"Half the town is gone," said Amatrice mayor Sergio Pirozzi.

"There are people under the rubble ... There's been a landslide and a bridge might collapse," he said.

Speaking in Estonia, German Chancellor Angela Merkel said the country would offer any aid needed to Italy following Wednesday's tragedy.

In 2009, a 6.3 magnitude earthquake near L'Aquila in the Abruzzo region killed more than 300 people.

ksb, cw/mm/sms (AFP, Reuters)