The earth moved with enough force to create a small island visible off the southern coast after the magnitude 7.7 quake struck in the remote district of Awaran in Pakistan's Baluchistan province Tuesday.
At least 446 people were also injured in the quake, said the head of the National Disaster Management Authority, Maj. Gen. Muhammad Saeed Aleem, who also gave the latest death toll.
The quake flattened wide swathes of Awaran. Most of the victims were killed when their houses collapsed.
In the hard-hit village of Dalbadi, Noor Ahmad said he was working when the quake struck but swiftly rushed home, only to find his house leveled to the ground and his wife and son dead.
He said he pulled their bodies from the rubble and helped other family members who were injured.
"I'm broken. I have lost my family," he said.
Dalbadi was completely flattened. No one knew exactly how many people the quake had killed.
Men, women and kids were sitting in makeshift shelters. Doctors were treating people, but due to a scarcity of medicine and staff, they were mostly seen comforting the residents.
The remoteness of the area and the lack of infrastructure have hampered the relief efforts.
"We are finding it very difficult to reach the affected remote areas," said a spokesman for the provincial government, Jan Mohammad Bulaidi. "We need more tents, more medicine and more food."
He described a horrific scene of people who lost limbs in the quake and who will need to be sent to hospitals in major cities of Quetta, the capital of Baluchistan province, and Karachi along the Arabian Sea.
Associated Press images from the village of Kaich showed the devastation the quake had wrought. Houses made mostly of mud and handmade bricks had collapsed, walls and roofs caved in and people's possessions were scattered on the ground. A few goats roamed through the wreckage as men dug through the rubble.
In images shown on Pakistani television, an unidentified man who appeared to be injured in his leg was shown supported by two men helping him walk. He said he was drinking tea when he heard a loud bang: "It shook everything."
The Pakistani military said it had rushed almost 1,000 troops to the area overnight and was sending helicopters as well. A convoy of 60 Pakistani army trucks left Karachi early Wednesday, carrying supplies for those affected by the quake.
Pakistani forces have evacuated 174 people from various villages around Awaran to the district hospital, the military said in a statement.
Local officials said they were sending doctors, food and 1,000 tents for people who had nowhere to sleep as strong aftershocks continued to shake the region.
Pakistani officials were investigating a small island that appeared off the coast of Pakistan after the quake, apparently the result of earth and mud pushed to the surface by the quake.
The head of the Geological Survey of Pakistan confirmed that the mass was created by the quake and said scientists were trying to determine how it happened. Zahid Rafi said such masses are sometimes created by the movement of gases locked in the earth under the sea, pushing mud and earth up to the surface in something akin to a mud volcano.
"When such a strong earthquake builds pressure, there is the likelihood of such islands emerging," he said. "That big shock beneath the earth causes a lot of disturbance."
To get a better idea of what the island is made of and how permanent it is, scientists will have to get samples of the material to see if it's mostly soft mud or rocks and harder material. He said these types of islands can remain for a long time or eventually subside back into the ocean, depending on their makeup.
A Pakistani Navy team reached the island by midday Wednesday, navy geologist Mohammed Danish told the country's Geo Television. He said the mass was about 60 feet (18 meters) high, 100 feet (30 meters) long and 250 feet (76 meters) wide.
"There are stones and mud," he said, warning residents not to try to visit the island. "Gasses are still emitting."
But dozens of people had already visited the island, said the deputy commissioner of Gwadar district, Tufail Baloch, who traveled by boat himself to the island Wednesday morning.
Water bubbled along the edges of the island, in what appeared to be gas discharging from under the surface, Baloch said. He said the area smelled of gas that caught fire when people lit cigarettes.
Dead fish floated on the water's surface while local residents were visiting the island and taking stones as souvenirs, he added.
Such land masses have appeared before off Pakistan's Makran coast, said Muhammed Arshad, a hydrographer with the navy. After quakes in 1999 and 2010, new land masses rose up along a different part of the coast about 282 kilometers (175 miles) east of Gwadar, he said.
He said each of those disappeared back into the sea within a year during the monsoon season, a period of heavy rain and wind that sweeps Pakistan every summer. He said that in the area where the island was created on Tuesday, the sea is only about six to seven meters (23 feet) deep.
Baluchistan is Pakistan's largest province but also the least populated and most impoverished. Medical facilities are few and far between and often poorly stocked with medicine or qualified personnel. Awaran district has about 300,000 residents spread out over 29,000 square kilometers (11,197 sq. miles).
Many residents are believed to be involved in smuggling fuel from Iran, while others harvest dates.
The area where the quake struck is at the center of an insurgency that Baluch separatists have been waging against the Pakistani government for years. The separatists regularly attack Pakistani troops and symbols of the state, such as infrastructure projects.
Baluchistan and neighboring Iran are prone to earthquakes. A magnitude 7.8 quake centered just across the border in Iran killed at least 35 people in Pakistan last April.
Sattar reported from Quetta. Associated Press writers Asif Shahzad and Rebecca Santana in Islamabad and Adil Jawad in Karachi contributed to this report.
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