Pope Benedict XVI prayed "for the victims, in particular for children," and sent a condolence message to the archbishop of L'Aquila, the Vatican said. Condolences poured in from around the world, including from President Barack Obama.

Parts of L'Aquila's main hospital were evacuated due to the risk of collapse, and only two operating rooms were in use. Bloodied victims waited in corridors or a courtyard, and many were being treated in the open. A field hospital was being set up.

The four-star, 133-room Hotel Duca degli Abruzzi in L'Aquila's historic center was heavily damaged but still standing, said Ornella De Luca of the national civil protection agency in Rome.

Though not a major tourist destination like Rome, Venice or Florence, L'Aquila boasts ancient fortifications and tombs of saints.

Many Romanesque, Gothic, Baroque and Renaissance landmarks were damaged, including part of the red-and-white stone basilica of Santa Maria di Collemaggio. The church houses the tomb of its founder, Pope Celestine V – a 13th-century hermit and saint who was the only pontiff to resign from the post.

The bell tower of the 16th-century San Bernardino church and the cupola of the Baroque Sant'Agostino church also fell, the ministry said. Stones tumbled down from the city's cathedral, which was rebuilt after a 1703 earthquake.

"The damage is more serious than we can imagine," said Giuseppe Proietti, a Culture Ministry official. "The historic center of L'Aquila has been devastated."

The city's own cultural offices, housed in a 16th-century Spanish castle, were shut down by damage, Proietti said. The damaged fortifications, once perfectly preserved, are also home to a museum of archaeology and art.