The tireless rescuers are continuously digging through the rubble as their hope ignited when a young girl was rescued 17 hours after being trapped. However, many were not so fortunate.
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In the first official death toll, Italy’s civil protection unit said there had been 38 deaths in and around the villages of Amatrice, Accumoli and Arquata del Tronto.
The most deadly temblor since the start of the 20th century came in 1908, when an quake followed by a tsunami killed an estimated 80,000 people in the southern regions of Reggio Calabria and Sicily.
Aftershocks continue to affect the region, hampering rescue and emergency operations.
Spain’s foreign minister said one Spanish national had been killed, with Spanish media saying it was a young woman who had lived in the village of Illica with her Italian husband, who survived.
The hardest-hit towns were Amatrice and Accumoli near Rieti, some 50 miles northeast of Rome.
Rescue efforts have continued all through the night, said Luigi D’Angelo, an official with Italy’s Civil Protection Department.
As many as 70 tourists were staying at the hotel when the quake struck.
Many other children were not so lucky.
A day after a shallow quake killed 250 people and leveled three small towns, a 4.3 magnitude aftershock sent up plumes of thick gray dust in the hard-hit town of Amatrice.
Rescue workers try to save the girl in Pescara del Tronto.
Italian newspaper La Repubblica said local prosecutors have opened an investigation to determine whether shoddy construction was the cause of some building collapses.
Italian Prime Minister Matteo Renzi is helping coordinate rescue efforts with authorities, the Italian Council of Ministers said in a statement.
“We are waiting for the military”, said resident Alessandra Cappellanti.
Rescue crews aided by sniffer dogs dug through crumbled homes Thursday looking for natural disaster survivors as Italy again anguished over how to secure its ancient towns and modern cities from the country’s highly seismic terrain.
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Pope Francis skipped his traditional catechism for his Wednesday general audience and instead invited the thousands of pilgrims in St. Peter’s Square to recite the rosary with him.
