No fewer than 18 people, including three children, were killed and more than 600 others injured in earthquakes that struck a densely populated part of the Albanian coast on Tuesday, the Defence Ministry said.
There were 12 confirmed deaths in the port city of Durres, where several buildings collapsed, among them an 18-floor skyscraper and two hotels.
Five bodies have been recovered so far in the smaller town of Thumana, just to the north of Durres.
One person was killed in Kurbin after jumping from a high balcony in panic.
Rescue teams pulled 43 survivors from the rubble in the area, some of them children, TV Klan reported, citing the Defence Ministry.
Injuries have been reported as far away as Shkodra, near the border with Montenegro.
“The powerful earthquake which hit has caused serious consequences and unfortunately we have lost lives,” Prime Minister Edi Rama said.
“All structures of the state were put in place from the very first moments after the earthquake … and are working intensely to save every possible life in Durres and Thumana,” Rama tweeted.
Fabio Hasani, a resident of the nearby capital of Tirana, said the tremor triggered panic when it struck at around 4 am (0300 GMT), with many people running into the street and remaining there for about an hour.
“I woke up confused, feeling my bed moving. Then I realised that everything was moving and shaking, the walls were creaking,” Hasani said. “It shook for around a minute.”
The 6.4-magnitude earthquake was the strongest in three decades, local media reports said.
The epicentre was about 10 kilometres deep and just north of Durres, about 25 kilometres west of Tirana, according to the U.S. Geological Survey.
A second, 5.5-magnitude earthquake struck the same area just after 7 am.
Another major tremor, of magnitude 5.4, struck south-western Bosnia, near the border with Croatia and its historic city of Dubrovnik at around 10 am.
Two people were reported injured in Mostar.
The ground in the region had not yet settled by late afternoon, as two more significant earthquakes, each of magnitude 3.0, hit near Durres around 4 pm.
Overall, the European-Mediterranean Seismological Centre reported more than 40 tremors, with epicentres under Albania, the Adriatic and in Bosnia.
Some damage was reported in southern Montenegro and south-western Bosnia, and tremors were felt across the Adriatic, in Italy, and throughout the Balkans.
The EU and countries in the region offered condolences and assistance to Albania, a prospective EU member and part of NATO.
“We express our deep condolences to the people and the authorities of the country,” EU Foreign Affairs spokeswoman Maja Kocijancic said.
The EU was to deploy a civil protection team to help the authorities coordinate the response and assess the damage.
Rama said that Germany, Kosovo, Serbia, Italy, Bulgaria, Greece and Turkey have offered or sent emergency teams to assist.
Prime Minister Giuseppe Conte of Italy, a quake-prone country with close historical ties to Albania, tweeted that firefighters, the Civil Protection Agency and Red Cross officials were on their way.
“Several vehicles and more than 200 men have already left for Albania,” including special teams with sniffer dogs, the Civil Protection Agency said separately.
The region was also hit in late September by a magnitude-5.8 tremor, which struck about 60 kilometres north-west of Tirana, injuring dozens.