A 7.8 magnitude earthquake struck southern Turkey and northern Syria early Monday, killing more than 640 people and taking down buildings.
The earthquake prompted a search for survivors in the rubble in cities and towns across the region. The death toll is expected to rise.
Residents in both countries were awakened by the quake several hours before dawn and rushed outside to cold, rain and snow. Dozens of buildings in cities in the area were toppled.
Rescue workers and residents searched for survivors under the rubble of destroyed buildings in multiple cities in both countries.
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In the Turkish city of Adana, witnesses said they heard one person calling for help from beneath the rubble of a building.
“I don’t have the strength to carry on,” the person reportedly said.
In Diyarbakir, cranes and rescue teams worked through a pile of pancaked concrete floors that once made up an apartment building.
In Syria, the quake crushed opposition-held regions packed with about 4 million people displaced from other parts of Syria because of the country’s continued civil war. Many live in decrepit conditions with limited health care.
At least 11 people were killed in the town of Atmeh, and many more were buried in the rubble, according to a doctor in the town, Muheeb Qaddour.
“We fear that the deaths are in the hundreds,” Qaddour said of the rebel-held northwest. “We are under extreme pressure.”
The quake could be felt as far away as Cairo. It was centered about 60 miles from the Syrian border.
At least 20 aftershocks followed the initial quake hours later, with the strongest measuring a magnitude of 6.6, Turkish authorities said.
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Turkish President Recep Tayyip Erdogan wrote on Twitter that search and rescue teams were immediately dispatched to impacted areas.
“We hope that we will get through this disaster together as soon as possible and with the least damage,” he wrote.
Turkey’s Disaster and Emergency Management agency reported at least 76 people dead in seven Turkish provinces, as well as 440 people injured. The death toll in government-held areas of Syria rose to 237 with at least 630 injured, according to Syrian state media. At least 47 people were reportedly killed in rebel-held areas.
Authorities in Turkey urged residents not to drive on the roads, as people attempting to leave the damaged areas caused traffic jams, hindering rescue efforts. Mosques around the region have opened up as a shelter for people unable to return to damaged homes as temperatures are around freezing.
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In northwest Syria, the opposition’s Syrian Civil Defense said the situation in the rebel-held region was “disastrous” and that entire buildings have collapsed and people are trapped under the rubble. The civil defense advised people to evacuate buildings and to gather in open areas.
The U.S. Geological Survey said the quake was centered about 20 miles from Gaziantep. It was centered 11 miles deep.
The quake also woke up residents in Lebanon, shaking buildings for about 40 seconds. Many residents of Beirut ran out of their homes and took to the streets or drove in their cars away from buildings.
The Associated Press contributed to this report