An increasingly forlorn search for victims of the earthquake that brought carnage to central Italy entered a third day on Friday as the confirmed death toll climbed to 267.
Releasing the new count, Immacolata Postiglione, head of the Civil Protection agency's emergency unit, indicated there had been no survivors found overnight in any of the remote mountain villages devastated by Wednesday's powerful pre-dawn quake.
At least 367 people have been hospitalised with injuries but no one has been pulled alive from the piles of collapsed masonry since Wednesday evening.
As hundreds of people woke from a second night sleeping in cars or hastily erected tented villages, the area was rocked by a 4.8 magnitude aftershock just after 6:00 a.m. local time, underlining the perilous nature of a rescue effort involving more than 4,000 emergency service staff and volunteers.
More than 900 aftershocks have rattled the region since Wednesday's 6.0-6.2 magnitude first one triggered the collapse of hundreds of ill-prepared old buildings across dozens of tiny communities playing host to far more people than usual because of the summer holidays.
Many of the survivors camping out in the tents were carrying plastic bags containing the handful of possessions — clothes, ID documents, phones and wallets — they had been able to grab before fleeing their homes in terror.
Over a dinner provided by an emergency cell of an Italian chefs' organisation on Wednesday evening, one survivor told how close she had come to being trapped in a house in the tiny hamlet of Illica.
"I managed to get out alive because I found a hole in the wall and managed to make it bigger and I made it out onto a roof and walked across until I got to a terrace and managed to get down from there," said Elisa.
"We shared clothes, there were people going around with one slipper on, those who were basically naked until 11:00 am.
"When dawn came it was devastating because then we really understood what the damage was, and that there were people who couldn't be found, who were missing, who were dead."
Italian Prime Minister Matteo Renzi has declared a state of emergency for the regions affected by Wednesday's quake, which occurred in an area that straddles Umbria, Lazio and Marche.
Renzi also released an initial tranche of 50 million euros ($56 million) in emergency aid. Quake experts have estimated the cost of the short-term rescue effort and mid to longer-term reconstruction could exceed a billion euros.
There are also fears of a negative impact of an already stagnating Italian economy.
Past experience indicates that quakes always have a negative impact on tourism for the whole country in which they occur. Tourism is particularly important to Italy, contributing around four per cent of its GDP.
At least eight foreigners were among the dead, according to media reports and updates from foreign ministries.
