Emergency workers were still hunting frantically for survivors last night in the medieval city of L'Aquila, near the epicentre of the quake, and in scores of surrounding villages across the mountainous Abruzzo region in the country's centre There were reports that one team had rescued at least 60 people from the rubble.
More than 1,500 people are thought to have been injured and up to 17,000 left homeless. Dozens of people are missing and officials said the death toll was likely to rise significantly.
But even as Prime Minister Silvio Berlusconi declared an emergency and promised a record number of rescue teams, a bitter row was raging over whether lives could have been saved by evacuating homes before the quake struck at 3.32am. The quake measured 5.8 on the Richter Scale, according to the Italian National Institute of Geophysics. The US Geological Survey measured it as 6.3.
A flurry of earth tremors struck the L'Aquila area in mid-January, prompting Giampaolo Giuliani, a researcher at the National Institute of Nuclear Physics, whose laboratories are deep beneath the Gran Sasso mountain on L'Aquila's skyline to sound the alarm.
In interviews before the earthquake struck he claimed that he had developed an early warning system based not on seismic waves but on radon which is only expelled from the earth under intense pressure.
After his warnings, vans with megaphones toured L'Aquila urging people to leave their homes. But the mayor, Massimo Cialente, allegedly served the seismologist with a warning of criminal charges for scare-mongering, even though the region had experienced nine tremors since the start of April.
"Now there are people who have to apologise to me and who will have what has happened on their conscience," Mr Giuliani told La Repubblica. The expert said he was helpless to act as it became clear to him on Sunday that a quake was imminent. "I didn't know who to turn to, I had been put under investigation for saying there was going to be an earthquake."
Mr Berlusconi, who cancelled a trip to Russia to fly to the disaster zone, appeared on the defensive when asked about official complacency.
Now was the time to concentrate on relief efforts he said, and "we can discuss afterwards about the predictability of earthquakes".
In the centre of L'Aquila piles of rubble, cement, furniture and roof tiles were strewn on the ground. Grey dust carpeted the streets and covered parked cars. The roof of the cupola on one of the churches on the Piazza Duomo was completely gone.
Local people told of the horror of finding their city falling away beneath them in the night. "I woke up hearing what sounded like a bomb," Angela Palumbo, 87, said. "We managed to escape with things falling all around us. Everything was shaking, furniture falling. I don't remember ever seeing anything like this in my life."
In L'Aquila alone, 30,000 buildings were thought to have been affected.
Outside one collapsed four-storey apartment building, dozens of rescue workers were digging both with heavy equipment and bare hands. Every now and then they ordered the machines to stop so they could hear human voices – they had heard a young woman named Francesca buried beneath urging them to "hurry up", they said.
Scenes of grief and despair played out across the city as dazed survivors, some still in their underwear, others wearing pyjamas and slippers, wept or sought out family members.
Parts of the main hospital had to be evacuated because of fears of collapse and injuries had to be treated in the open air. As the city trembled repeatedly with aftershocks, one woman, whose sister was still trapped inside the ruins of a building cried out: "Enough God! Enough! Enough of these earthquakes."
About 5km away, in Paganica, all 8,000 residents had been evacuated and the small 18th century Church of the Immaculate Conception had a gaping hole in the roof, another in the centre on the façade, and its bells askew.
In Bazzano, relief workers were distributing pizza, water and soft drinks to the hungry, dusty locals. Nicoletta Tarquini, 78, looked lost as she sat in her purple pyjamas, crying. She said she didn't know when she would have the courage to return home.
Last night, rain was complicating rescue efforts but one firefighter in L'Aquila, Antonio Giangiobbe, had a miracle to report. He had been working from 10.30am on a building: "We knew there was somebody alive in there, and after digging for eight hours we pulled her out. "A wardrobe had fallen on her, protecting her from the two floors of debris that fell on top. She was calm but said, 'Hurry up hurry up, because I can feel the pressure on my legs.' She had been protected by the wardrobe."
Seismic events: Italian earthquakes
8 September 1905 Some 5,000 people killed when a 7.9 magnitude earthquake tears through Calabria, obliterating 25 villages.
28 December 1908 More than 82,000 people killed in a 7.2 magnitude earthquake which reduces Messina, Sicily's second town, to rubble. A tidal wave follows, causing more devastation.
13 January 1915 An earthquake measuring 7.0 strikes Avezzano in central Italy and kills 32,600.
27 July 1930 A quake measuring 6.5 strikes the region of Irpinia in southern Italy, killing about 1,400 people.
6 May 1976 An earthquake measuring 6.5 rocks Friuli in Italy's northeastern corner, killing 976 people and leaving 70,000 others homeless.
23 November 1980 Some 2,735 people are killed and more than 7,500 injured in an earthquake measuring 6.5. The epicentre is at Eboli but damage is reported over a huge area towards Naples.
13 December 1990 Earthquake centred in the sea off Sicily kills 13 people and injures 200.
26 September 1997 Two earthquakes measuring 6.4 kill 11 people and cause serious damage to the Basilica of St Francis in Assisi, ruining priceless medieval frescoes. A further quake measuring 5.1 hits Umbria days later causing damage.
6 September 2002 An earthquake measuring 6.0 strikes Sicily. Two people died from heart attacks triggered by the quake which also damaged artistic treasures.
31 October 2002 An earthquake measuring 5.9 hits Campobasso, south-central Italy, killing 30 people, most of them children, in San Giuliano di Puglia.
11 April 2003 An earthquake measuring 4.6 rocks northern Italy, rattling buildings from Milan to Turin and prompting officials to evacuate some schools.
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