At least seven people have been killed and up to 50 others injured in a 6.0-magnitude earthquake near the northern Italian city of Bologna, according to the Italian news agency ANSA.
The strong quake struck at 4:04am local time (02:04 GMT) on Sunday in the country's industrial heartland while most people were sleeping, prompting thousands to run into the streets in panic.
Hospitals were evacuated as a precautionary measure.
Al Jazeera's Sabina Castelfranco, reporting from the worst affected town of Finale Emilia, said: "Scared people are out on the street and have refused to go back to their homes."
"There are apparently 13,000 people that have been displaced, and it is unclear whether there is going to be more victims found," she said.
"The new buildings are intact but mediaeval buildings, some of the bell towers and churches, have completely collapsed. You can see huge mountains of rubble in front of these beautiful buildings."
One person, believed to be a Moroccan man working a night shift in a polyester factory, died when he was hit by falling debris.
Two men, also working a night shift, were killed when part of a modern ceramics factory made of steel collapsed in the town of Sant'Agostino.
"He wasn't supposed to be there. He changed shifts with a friend who wanted to go to the beach," the mother of one of the victims told state television.