The death toll in Turkey and Syria has reached 360 people after a powerful 7.8 magnitude earthquake toppled buildings and triggered a frantic search for survivors in the rubble in cities and towns across the region.
On both sides of the border, residents jolted out of sleep by the pre-dawn quake rushed outside on a cold, rainy and snowy winter night, as buildings were flattened and strong aftershocks continued.
Rescue workers and residents frantically searched for survivors under the rubble of their homes in multiple cities, working through tangles of metal and chunks of concrete.
Many of them live in decrepit conditions with little health care, with Russian-backed Syrian forces surrounding the area and sometimes carrying out air strikes. Rescue workers said hospitals in the area were packed.
“We fear that the deaths are in the hundreds,” Muheeb Qaddour, a doctor, said by phone from the town of Atmeh, referring to the entire rebel-held area.
The quake, felt as far away as Cairo, was centred about 90 kilometres (60 miles) from the Syrian border, just north of the city of Gaziantep, a major Turkish provincial capital of more than two million people.
The region has been shaped by more than a decade of war in Syria. Millions of Syrian refugees live in Turkey. The swathe of Syria affected by the quake is divided between government-held and opposition-held areas.
Turkish President Recep Tayyip Erdogan said on Twitter that “search and rescue teams were immediately dispatched” to the areas hit by the quake.
“We hope that we will get through this disaster together as soon as possible and with the least damage,” he wrote.
Turkey’s Disaster and Emergency Management agency said at least 76 people had been killed in seven Turkish provinces. The agency said 440 people were injured. The death toll in government-held areas of Syria climbed to 111 with at least 516 injured, according to Syrian state media. Earlier, 47 people were reported killed in rebel-held areas.
In Turkey, people trying to leave the quake-stricken regions caused traffic jams, hampering efforts of emergency teams trying to reach the affected areas.
Authorities urged residents not to take to the roads. Mosques around the region were being opened up as a shelter for people unable to return to damaged homes amid temperatures that hovered around freezing.
In Diyarbakir, rescue teams called for silence as they tried to listen for survivors under the wreckage of an 11-storey building.
A grey-haired woman wailed before being escorted away by a man, while a rescue worker wearing a white helmet tried to calm a crying girl, who was also being cuddled by two friends.
In north-west Syria, the opposition’s Syrian Civil Defence described the situation in the rebel-held region as “disastrous” adding that entire buildings have collapsed and people are trapped under the rubble.
The civil defence urged people to evacuate buildings to gather in open areas. Emergency rooms were full of injured, said Amjad Rass, president of the Syrian American Medical Society.
The US Geological Survey said the quake was centred 18 kilometres (11 miles) deep.
In Damascus, buildings shook and many people went down to the streets in fear.
The quake jolted residents in Lebanon from beds, shaking buildings for about 40 seconds. Many residents of Beirut left their homes and took to the streets or drove in their cars away from buildings.
The earthquake came as the Middle East is experiencing a snowstorm that is expected to continue until Thursday.
Turkey sits on top of major fault lines and is frequently shaken by earthquakes.
Some 18,000 were killed in powerful earthquakes that hit northwest Turkey in 1999.