ITALY EARTHQUAKE.jpg
A relative of a victim is seen in front of the coffin before the mass funeral in Ascoli Piceno, Marche region, Italy, 27 August 2016 for some of the victims of the earthquake that devastated central Italy on 24 August.
Photograph: EPA/MASSIMO PERCOSSI

Victims of the massive earthquake in central Italy were given state funerals in an emotional ceremony Saturday, in a day of national mourning that saw the provisional death toll from the tragedy rise to 291.

The magnitude-6 quake struck a rugged mountain area between the regions of Umbria, Lazio and Marche early Wednesday, spreading death in three municipalities roughly 150 kilometres north-east of the capital Rome.

Amatrice was the worst-affected town, with 230 dead. There were also 11 victims in nearby Accumoli and 50 in Arquata del Tronto, including a man who died in hospital on Saturday, Italy's civil defence agency, Protezione Civile, said in a statement.

In the provincial capital of Ascoli Piceno, 35 coffins were lined up inside a sports hall, including one for the sister of Giorgia, the four-year-old girl who survived 16 hours under the rubble and whose rescue has provoked a nationwide swell of emotion.

Leading a funeral service packed with hundreds of mourners, Bishop Giovanni D'Ercole said he turned in anguish to God and asked: "And now, what do we do?" He went on to say: "The answer that we can give is silence, hugging and, for me, prayer."

He spoke in front of a crucifix retrieved from Pescara del Tronto, the hamlet where the Giorgia and her dead sister Giulia lived. Amid sweltering heat, a relative of one of the victims fell ill and was brought out on a stretcher, the ANSA news agency reported.

The names of the dead were read out during Mass, and at the end, coffins were sprinkled with water and incense. The smallest coffin was for Marisol, a 20-month-old girl, who was due to be given a second funeral when her mother is released from hospital.

President Sergio Mattarella and Prime Minister Matteo Renzi attended the service. At the end, they stayed on to consult local authorities and talk individually to grieving relatives. A teenage boy could be seen crying profusely while he hugged Mattarella.

The 35 commemorated Saturday were among the 50 dead from Arquata. Amatrice, where rescuers were still looking for people under the rubble, was due to hold its own memorial service on Tuesday, while other private funerals have been held in Rome and elsewhere.

Mattarella started the day flying by helicopter to Amatrice, the town with the highest death count. He then made a stopover in Accumoli and, after the funeral, visited more survivors at the hospital of Ascoli Piceno, including baby Giorgia.

Flags on public buildings across Italy were flown at half mast, and public broadcaster RAI suspended all advertising on its radio and television channels.

The Protezione Civile said aftershocks were continuing to plague the earthquake area. More than 1,300 have been counted since Wednesday, including 92 starting from midnight on Saturday, which did not cause any additional damage.

It also said a solidarity campaign via SMS raised more than 6.1 million euros (6.8 million dollars), more than double the amount collected Friday. The surge came after the agency urged people to send money, rather than food and clothes, to the affected areas.

More aid could be forthcoming from a European Union fund for natural disasters. The Protezione Civile said it would make an application for financial assistance "in the coming weeks," after coordinating with the affected regions.

Some 2,500 people have been left homeless by the quake, and authorities said the priority was to allow them to continue living in their communities, where basic services and accommodation will have to be provided by temporary structures.

On Friday, Mayor Sergio Pirozzi said wooden houses would be built near destroyed buildings in Amatrice to stop it turning into a ghost town, while the government in Rome pledged to reopen schools as soon as possible "to give a signal" that life would continue.

Meanwhile, prosecutors are investigating whether the flouting of building safety regulations aggravated the tragedy, amid outrage over the collapse of a recently renovated elementary school in Amatrice.

No suspects have been identified, but according to the La Repubblica newspaper prosecutor Giuseppe Saieva presumed foul play. "What happened cannot be considered just a fatality," as it looks like some destroyed homes were built "with more sand than cement," he was quoted as saying.

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