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Durres, Albania – Rescue crews with excavators searched for survivors trapped in toppled apartment buildings and hotels Tuesday as the death toll from a powerful pre-dawn earthquake in Albania climbed to 20, with more than 600 people injured.

The magnitude-6.4 quake was felt across the southern Balkans and was followed by multiple aftershocks, with several above magnitude 5. In nearby Bosnia, another temblor with a preliminary magnitude of 5.4 struck southeast of the capital Sarajevo, causing only minor damage.

The quake in Albania knocked down apartment buildings and hotels while people slept, and rescue crews worked into the evening to free more people believed trapped. There was no indication as to how many people might still be buried in the rubble, as neighboring countries and European Union nations sent search-and-rescue crews to help.

Local television stations showed footage in the early hours after the quake of a young boy being rescued from a collapsed building in the coastal town of Durres, 33 kilometers (20 miles) west of the capital Tirana. An excavator moved a broken slab of concrete and the boy cried and shouted in pain as local men pulled mangled reinforcement bars out of the way trying to try to free his leg from the rubble.

Hours later, live TV footage showed people cheering as another child was found alive in a collapsed building in Durres where a body had been located earlier. In total, 43 people had been rescued from the rubble of buildings by Tuesday evening.

Health Minister Ogerta Manastirliu said more than 600 people had been treated for injuries, including nine hospitalized with life-threatening injuries.

“It is a dramatic moment where we should preserve calm, (and) stay alongside each other to cope with this shock,” Prime Minister Edi Rama said.

The U.S. Geological Survey said the quake, which struck just before 4 a.m. local time, had an epicenter 30 kilometers (19 miles) northwest of the capital, Tirana, at a depth of 20 kilometers (12 miles). Scores of aftershocks were recorded, including three with preliminary magnitudes of between 5.1 and 5.4.

The worst-hit areas were Durres, where 11 of the dead were found in collapsed buildings, the Defense Ministry said, and the northern town of Thumane, where another seven bodies were pulled from the rubble of a destroyed apartment building. In total at least three hotels, a residential villa and an apartment building collapsed in Durres, and one apartment building in Thumane.

One person died after jumping from his home to escape in Kurbin, 50 kilometers (30 miles) north of the capital, while another person was killed on a road that collapsed in the northern town of Lezha.

“Search and rescue work continues at all sites where buildings have collapsed,” Defense Minister Olta Xhacka said in a televised statement. “But these are extremely difficult operations, where you have to work slowly because there is a high risk of further collapse, endangering not only residents, but also those trapped, and the rescuers themselves.”

Seismologist Rrapo Ormeni of Albania’s Institute of Geosciences, Energy, Water and Environment, said a 6.4 quake was considered a strong one.

“Damage at the epicenter will be considerable because of its high energy, the magnitude it has,” Ormeni said. “Such quakes are felt in a wider area due to (their) major depth and magnitude. It has been felt all around the territory of our country but also abroad, up to Bulgaria, Bosnia, Italy and other (countries).”

The quake was also felt in neighboring Kosovo, Montenegro, North Macedonia, Greece, and parts of southern Serbia.

Authorities called on people in the most affected areas to stay out of their homes and avoid driving to allow emergency vehicles free access. Many residents reported cracks in their apartment walls.

All government agencies were on alert and “intensively working to save lives at the fatal spots in Durres and Thumane,” Rama said. About 400 soldiers set up tents in Durres and in Fushe Kruje near Thumane in the north to house survivors left homeless by the quake.

Rama said neighboring countries, the European Union and the United States had offered help. By Tuesday evening, rescue teams from neighboring Kosovo, Montenegro, Italy, Greece and Romania had arrived.

Serbia, North Macedonia, Croatia, Hungary, Germany, France, Estonia, Turkey and the Czech Republic also offered help, while the EU delegation to Albania said additional EU assets were on standby should they be needed.

“My thoughts are with the victims and all the people affected by the disaster,” EU Commissioner for Humanitarian Aid and Crisis Management Christos Stylianides said.

At least three apartment buildings and the power distribution station were damaged in Thumane, knocking out power in the morning. The electricity supply was restored later in the day.

An earthquake in September in roughly the same area damaged hundreds of homes.

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Semini reported from Tirana. Elena Becatoros and Derek Gatopoulos in Athens, Greece, contributed to this report.

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