A powerful earthquake hit southern Turkey near the Syrian border early Monday, followed by aftershocks, and was felt in Syria and as far as Lebanon, Cyprus, Iraq and Egypt.

At least 641 were reported dead and hundreds more injured from the quake, The Associated Press reported. Dozens of buildings collapsed in cities across the border region.

The epicenter of the magnitude 7.8 quake was about 33 kilometers (20 miles) from Gaziantep, according to the U.S. Geological Survey. Its center was 18 kilometers (11 miles) deep.

Images shared on social media from southern Turkey and northeastern Syria show panicked families in rain and snow, among the rubble of collapsed buildings. In Lebanon, an earthquake was strong enough to shake entire buildings.

The quake also hit parts of northeastern Syria, causing several buildings to collapse. Footage from a local journalist showed a panicked family running in the rain and darkness, in the rubble of a destroyed home.

“Frankly, the situation is devastating,” Reid Saleh, head of the White Helmets civil protection group operating in northern Syria, told NPR. said to have been affected. “Buildings are collapsing in all these areas, teams are working on it, and people are lying under the rubble in all these buildings. Hospitals are full. The situation is truly tragic. 

“We can’t estimate the damages or know how many people have been killed,” he said. He said he saw three collapsed buildings “with families under the rubble” while on his way to the group’s operations room. Rescue teams are helping them as he coordinates the broader search and rescue mission. “I’m sending out calls for the people to stay outside their houses in the streets because of the damage. It might not be safe for them to stay at home as these buildings could collapse. But there’s a storm ongoing with rain and snow.”

Hamid Qutayni, a rescue worker with the White Helmets told NPR there are “tens of families” trapped under collapsed buildings. He listed how many people are known to have died in different towns and villages. “In Sarmada there are seven deaths; Ma’arrat Misrin has two deaths; Darkush has three deaths including a child. In Deres, there are also three children who have diedk villages in the northern Aleppo countryside have reported deaths and in the Idlib countryside too. The reports are coming in from everywhere because the situation is very bad.”

The earthquake in northern Syria hit parts of the country that have been already been devastated by more than a decade of civil war. In Idlib and Aleppo provinces, basic infrastructure has already been badly damaged by the war. The area is also home to millions of Syrians who fled the fighting in other parts of the country. Many live in refugee camps or basic tented settlements established amid the olive groves that run along the border with Turkey.

The Union Of Medical Care And Relief Organizations (UOSSM), an organization that provides health care in rebel-held areas of Northwest Syria, said “so far our hospitals in northwest Syria have received 91 dead and treated more than 500 severely injured victims of the earthquake. Four of our hospitals were damaged and evacuated. The remaining ones are overwhelmed.

Jomah al Qassim, a Syrian living across the border in the Turkish town of Gazientep works for Bahar Organisation, a charity that operates in Syria and in Iraq.

“According to our team in Syria, there are many casualties and damage to the buildings. Many are reported dead,” he told NPR. “This is the last thing people need in Syria. There has been crisis after crisis. People are already exhausted.”

The United Nations monitoring body, the OCHA, says of the population of 4.6 million people in northwest Syria, some 4.1 million people are in need of humanitarian aid. More than three million residents of the area are food insecure.

Hospitals in the region were severely damaged by the conflict. Idlib is outside Syria’s government-controlled area. The hospital has been repeatedly hit by airstrikes by the Syrian regime’s air force or its ally Russia. Airstrikes were so frequent that doctors and relief organizations set up underground medical facilities to protect themselves from attacks.