It was powerful enough to be felt in Bologna to the north and Naples to the south, both more than 220 km (135 miles) from the epicenter.
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Italy’s health minister told the BBC that many quake victims were children.
The 6.2-magnitude quake hit at 03:36 (02:36 BST), 100km (65 miles) north-east of Rome in mountainous central Italy.
Many who made it out safely are staying in tents set up around the devastated towns that are housing at least 1,200, although the mood continues to be tense as many are left penniless.
Amatrice is one of the worst affected areas, along with the towns of Arquata, Accumoli and Pescara del Tronto.
Firefighters’ spokesman Luca Cari said one body had been pulled out of the hotel rubble just before dawn after five were extracted earlier but searches continued there and elsewhere.
Fire service spokesman Luca Cari said one body had been pulled out of the hotel rubble just before dawn but the search was continuing there and elsewhere, even as 460 aftershocks rattled the area after the magnitude 6 quake struck at 3.36am on Wednesday.
The civil protection agency said that of the 5,400 people working under its command in the devastating zone, including police, soldiers and firemen, more than half were volunteers.
In one of the most remarkable stories of courage an eight-year-old girl sacrificed her own life by throwing herself on top of her younger sister as the rubble from the devastating natural disaster encased them, according to a Daily Mail report. A family of four, including two boys aged 8 months and 9 years, were buried when a church bell tower toppled into their house in nearby Accumoli. The British news site said all rescue efforts did not turn out as well as Giorgia’s.
Three Britons are reportedly among those killed in the Italy natural disaster.
Mr Renzi admitted that Italy has a hard task ahead to secure buildings – and its vast collection of historical heritage – against quake damage, but said that modern technology could play a role.
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Since it’s located atop two fault lines, Italy is accustomed to massive earthquakes and has invested in quakeproof infrastructure to compensate.
