Albanian rescuers dug through rubble Tuesday as survivors trapped in toppled buildings cried out for help after the strongest earthquake in decades killed at least 18 people and left hundreds injured.
Tormented families looked on as soldiers, police and emergency workers sifted through debris of shredded apartment blocks in the towns near Albania's northwest Adriatic coast, close to the epicentre of the 6.4 magnitude earthquake.
Eighteen people were found dead by the late afternoon, mostly in the city of Durres, a coastal tourism destination, and the town of Thumane north of the capital Tirana, according to the defence ministry.
In neighbouring Kurbin a man in his fifties died after jumping from his building in panic. Another perished in a car accident after the earthquake tore open parts of the road, the ministry said.
Some 42 survivors were rescued alive.
In Thumane, relatives watching emergency workers comb over a collapsed five-storey building shouted the names of their loved ones still inside: "Mira!", "Ariela!", "Selvije!".
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A series of strong aftershocks also sent fresh bolts of panic through crowds huddled outside.
Dulejman Kolaveri, a man in his 50s in Thumane, told AFP he feared his 70-year-old mother and six-year-old niece were trapped inside the collapsed apartment, because they lived on the fifth floor.
"I don't know if they are dead or alive. I'm afraid of their fate... only God knows," he said with trembling hands.
There were also brief bursts of joy as the rescuers delicately extracted survivors.
One, a thin middle-aged man covered in a film of grey dust, was seen carried out of the rubble on a stretcher in Thumane.
In Durres, onlookers cheered "Bravo!" as a team rescued a young man from the wreckage of a toppled seaside hotel in a two-hour operation.
The health ministry said that more than 600 people received first aid for injuries.
Some 300 soldiers and 1,900 police were sent to Durres and Thumane to assist with the rescue efforts, according to authorities.
Teams from Italy, Greece and Romania were also deployed to help, the European Commission said in a Tweet.
Albania is known for its chaotic urban planning, particularly in popular tourist spots along the coast, where illegal construction is rife.
Tuesday's quake was the strongest to hit the Durres region since 1926, seismologist Rrapo Ormeni told local television.
Albanian Authorities described it as the strongest earthquake in the last 20-30 years.
It struck before dawn at 3:54 am local time (0254 GMT), with an epicentre 34 kilometres (about 20 miles) northwest of the capital Tirana, according to the European-Mediterranean Seismological Centre.
The quake was followed by several aftershocks, including one of 5.3 magnitude.
In Tirana, panicked residents ran out onto the streets and huddled together in the darkness when the quake hit.
The tremors were felt across the Balkans, from Sarajevo in Bosnia to the Serbian city of Novi Sad almost 700 kilometres away, according to reports in local media and on social networks.
The Balkans is an area prone to seismic activity and earthquakes are frequent.
The peninsula lies near the fault line of two large tectonic plates -- the African and Eurasian.
The movements of the small Adriatic micro-plate also produces earthquakes, according to Kresimir Kuk from the Croatian seismological institute.
The most devastating quake in recent times hit North Macedonia's capital Skopje in July 1963, killing around thousand people and destroying some 80 percent of the city.