Iran's western Kermanshah province bore the brunt of the temblor Sunday night, with authorities saying the quake killed 348 people in the country and injured 6,603. Kermanshah is a rural, mountainous region where residents rely mainly on farming.
In Iraq, the earthquake killed at least seven people and injured 535, all in the country's northern Kurdish region, according to Iraq's Interior Ministry.
The quake was centered 31 kilometers outside the eastern Iraqi city of Halabja, according to the most recent measurements from the U.S. Geological Survey. It struck at 9:48 p.m. Iran time, just as people began retiring for the night.
Iranian social media and news agencies showed images and videos of people fleeing their homes. More than 100 aftershocks followed.
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The quake's worst damage appeared to be in the town of Sarpol-e-Zahab in Kermanshah province, which sits in the Zagros Mountains that divide Iran and Iraq.
Kokab Fard, a 49-year-old housewife in Sarpol-e-Zahab, said she fled empty-handed when her apartment complex collapsed. "Immediately after I managed to get out, the building collapsed," Fard said. "I have no access to my belongings."
Sarpol-e-Zahab residents said the power and water were out and telephone and cellphone lines were spotty.
Iran's Supreme Leader Ayatollah Ali Khamenei offered his condolences on Monday morning and urged rescuers and government agencies to do all they could to help those affected, state media reported. President Hassan Rouhani is scheduled to tour earthquake-damaged areas Tuesday.
The semi-official ILNA news agency said at least 14 provinces in Iran had been affected by the earthquake. Behnam Saeedi, a spokesman for the country's crisis management headquarters, told state TV that casualty figures stood at 348 killed and 6,603 injured.
The quake could be felt across Iraq, shaking buildings and homes from Irbil to Baghdad, where people fled into the streets of the capital.
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