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Amatrice, Italy • Rescue crews using bulldozers and their bare hands raced to dig out survivors from a strong earthquake that reduced three central Italian towns to rubble Wednesday. The death toll stood at 247, but the number of dead and missing was uncertain given the thousands of vacationers in the area for summer's final days.

Residents, who wakened before dawn by the temblor, emerged from their crumbled homes to find what they described as apocalyptic scenes "like Dante's Inferno," with entire blocks of buildings turned into piles of sand and rock, thick dust choking the air amid a putrid smell of gas.

"The town isn't here anymore," said Sergio Pirozzi, the mayor of the hardest-hit town, Amatrice.

The magnitude-6.2 quake struck at 3:36 a.m. and was felt across a broad swath of central Italy, including Rome, where residents woke to a long swaying followed by aftershocks. The temblor shook the Lazio region and Umbria and Le Marche on the Adriatic coast, a highly seismic area that has witnessed major quakes in the past.

Dozens of people were pulled out alive by rescue teams and volunteers.

"She's alive!" two women cheered as they ran up the street in Pescara del Tronto, one of the three hardest hit hamlets, after a 10-year-old girl was pulled from the rubble 17 hours after the quake struck. And there were wails when bodies emerged.

"Unfortunately, 90 percent we pull out are dead, but some make it, that's why we are here," said Christian Bianchetti, a volunteer from Rieti who was working in devastated Amatrice where floodlights were set up so the rescue could continue through the night.

Premier Matteo Renzi visited the quake zone Wednesday, greeted rescue teams and survivors, and pledged that "No family, no city, no hamlet will be left behind." Italy's civil protection agency reported the death toll had risen to 247 by late Wednesday and at least 368 others were injured.

Worst affected were the tiny towns of Amatrice and Accumoli near Rieti, 60 miles northeast of Rome, and Pescara del Tronto, about 15 miles farther east. The civil protection agency set up tent cities around each hamlet to accommodate the thousands of homeless.

The quake zone is a popular spot for Romans with second homes, and the population swells in August when most Italians take their summer holiday before school resumes.

The medieval center of Amatrice was devastated, with the hardest-hit half of the city cut off by rescue crews digging by hand to get to trapped residents.

The birthplace of the famed spaghetti all'amatriciana bacon and tomato sauce, the city was full for this weekend's planned festival honoring its native dish. About 70 guests filled its top Hotel Roma, famed for its amatriciana, where five bodies were pulled from the rubble before the operation was suspended when conditions became too dangerous late Wednesday. Among those killed was an 11-year-old boy who had initially shown signs of life. The fate of the dozens of other guests wasn't immediately known.

Amatrice is made up of 69 hamlets that teams from around Italy were working to reach with sniffer dogs, earth movers and other heavy equipment. In the city center, rocks and metal tumbled onto the streets and dazed residents huddled in piazzas as more than 200 aftershocks jolted the region throughout the day, some as strong as magnitude 5.1.

"The whole ceiling fell but did not hit me," marveled resident Maria Gianni. "I just managed to put a pillow on my head and I wasn't hit, luckily, just slightly injured my leg."

Another woman, sitting in front of her destroyed home with a blanket over her shoulders, said she didn't know what had become of her loved ones.

"It was one of the most beautiful towns of Italy and now there's nothing left," she said, too distraught to give her name. "I don't know what we'll do."

As the August sun turned into a nighttime chill, residents, civil protection workers and even priests dug with shovels, bulldozers and their bare hands to reach survivors. A steady column of dump trucks brought tons of twisted metal, rock and cement down the hill and onto the highway toward Rome, along with a handful of ambulances bringing the injured to Rome hospitals.

"We need chain saws, shears to cut iron bars and jacks to remove beams. Everything, we need everything," civil protection worker Andrea Gentili told The Associated Press.