A magnitude 4.3 aftershock has rattled the town of Amatrice in Italy just one day after the earthquake that has claimed the lives of 267 people.
The aftershock crumbled already cracked buildings, rattled residents and closed already clogged roads.
It was only one of the more than 470 tremors that have followed Wednesday's pre-dawn quake.
Firefighters and rescue crews using sniffer dogs worked in teams around the hard-hit areas in central Italy, pulling chunks of cement, rock and metal from mounds of rubble where homes once stood.
Rescuers refused to say when their work would shift from saving lives to recovering bodies, noting that one person was pulled alive from the rubble 72 hours after the 2009 quake in the nearby town of L'Aquila.
"We will work relentlessly until the last person is found, and make sure no one is trapped," said Lorenzo Botti, a rescue team spokesman.
Many were left homeless by the scale of the destruction, their homes and apartments declared uninhabitable. Some survivors, escorted by firefighters were allowed to go back inside homes briefly Thursday to get essential necessities for what will surely be an extended absence.
"Last night we slept in the car. Tonight, I don't know," said Nello Caffini as he carried his sister-in-law's belongings on his head after being allowed to go quickly into her home in Pescara del Tronto.
Caffini has a house in nearby Ascoli, but said his sister-in-law was too terrified by the aftershocks to go inside it.
"When she is more tranquil, we will go to Ascoli," he said.
Premier Matteo Renzi has pledged a preliminary 50 million euros in emergency funding to rebuild.
The government also cancelled taxes for residents, pro-forma measures that are just the start of what will be a long and costly rebuilding campaign.
Renzi said that it was absurd to think that Italy could build completely quake-proof buildings.
"It's illusory to think you can control everything," Renzi said.
"It's difficult to imagine it could have been avoided simply using different building technology. We're talking about medieval-era towns."
Those old towns do not have to conform to the country's anti-seismic building codes. Making matters worse, those codes often aren't applied even when new buildings are built.
Armando Zambrano, the head of Italy's National Council of Engineers, said the technology exists to reinforce old buildings and prevent such high death tolls when quakes strike every few years.
He estimated that it would cost up to €93 billion to reinforce all of the historic structures across the country.
"We are able to prevent all these deaths. The problem is actually doing it," Zambrano said.
"These tragedies keep happening because we don't intervene. After each tragedy we say we will act but then the weeks go by and nothing happens."
Some experts estimate that 70 per cent of Italy's buildings aren't built to anti-seismic standards, though not all are in high-risk areas.
Italy's civil protection agency said the death toll had risen to 250 by Thursday afternoon, with more than 180 of the fatalities in Amatrice.
At least 365 others were hospitalised, and 215 people were pulled from the rubble alive since the quake struck. A Spaniard and five Romanians were among the dead, according to their governments.
There was no clear estimate of how many people might still be missing, since the rustic area was packed with summer vacationers.
Emergency services set up tent cities around the quake-devastated towns to accommodate the homeless, housing about 1,200 people overnight. In Amatrice, 50 elderly people and children spent the night inside a local sports facility.