Thousands of displaced residents slept overnight in tents or school gyms and officials said 365 others had been hospitalized — but the exact number of dead and missing in Wednesday's disaster remained unclear because the region's population was swelled by tourists.
One of the worst-hit towns, Amatrice, was full for this weekend's planned festival honoring its native bacon-and-tomato sauce dish — spaghetti all' amatriciana.
Five bodies were pulled from the wreckage of a hotel late Wednesday but rescue work was suspended when conditions became too dangerous. Among those killed was an 11-year-old boy who had initially shown signs of life.
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Elsewhere in the town, onlookers clapped and cheered as a young child was pulled from the rubble in a moment captured by La Repubblica newspaper.
"Piano, piano, piano, piano," a woman could be heard ordering — "gently, gently, gently, gently" — as the child was hurried away on a stretcher.
Italy's National Institute of Geophysics and Volcanology said at least 460 aftershocks had shaken the region since the original quake. One of the biggest stuck early Thursday close to the epicenter of the original earthquake and was described by the U.S. Geological Survey as magnitude-4.7.
Immacolata Postiglione, director of emergencies at Italy's civil protection agency, said early Thursday that rescuers found "many bodies" hidden in the rubble overnight. She put the death toll at 247, but it was later revised down to 241 according to state news agency, ANSA.
More than 4,000 tents have been erected for homeless survivors, Postiglione said, and 1,060 firefighters, 1,000 police officers and 400 soldiers were working in the affected area. The Italian Red Cross said it had 462 volunteers and had set up two field tents with kitchens.
Also involved were nine helicopters, 200 emergency vehicles and 50 canine rescue squads.
In the damaged town of Pescara del Tronto, a 10-year-old girl was also pulled alive from the rubble. In video of the rescue posted by Sky TV, two women can be seen running up the street yelling, "She's alive!"