A 7.8 magnitude quake knocked down multiple buildings in southeast Turkey and Syria, where it is early Monday, and many casualties are feared.
At least 10 deaths were reported initially in Turkey.
Turkish President Recep Tayyip Erdogan said on Twitter that "search and rescue teams were immediately dispatched" to the areas hit by the quake.
"We hope that we will get through this disaster together as soon as possible and with the least damage," he wrote.
There were at least six aftershocks, and he urged people not to enter damaged buildings due to the risks, Interior Minister Suleyman Soylu said.
"Our priority is to bring out people trapped under ruined buildings and to transfer them to hospitals," he said.
In northwest Syria, the opposition's Syrian Civil Defense described the situation in the rebel-held region as "disastrous," adding that entire buildings have collapsed and people are trapped under the rubble. The civil defense urged people to evacuate buildings to gather in open areas.
The U.S. Geological Survey said the quake was centered about 20 miles from Gaziantep, a major city and provincial capital. It was centered 11 miles deep, and a strong 6.7 aftershock rumbled about 10 minutes later.
Turkey's Disaster and Emergency Management agency, AFAD, said the quake measured 7.4 and was centered in the town of Pazarcik, in Kahramanmaras province.
In Sanliurfa, at least 10 deaths have been confirmed, according to Gov. Salih Ayhan.
Several buildings tumbled down in the neighboring provinces of Malatya, Diyarbakir, and Malatya, HaberTurk television reported. There was no immediate reports on casualties.
Syria's state media reported that some buildings collapsed in the northern city of Aleppo and the central city of Hama.
In Damascus, buildings shook and many people went down to the streets in fear.
The quake jolted residents in Lebanon from beds, shaking buildings for about 40 seconds. Many residents of Beirut left their homes and took to the streets or drove in their cars away from buildings.
The earthquake came as the Middle East is experiencing a snowstorm that is expected to continue until Thursday.
Turkey sits on top of major fault lines and is frequently shaken by earthquakes.
Some 18,000 were killed in powerful earthquakes that hit northwest Turkey in 1999.
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