The shallow 7.7-magnitude tremor hit northwest of the city of Sagaing, central Myanmar, and was followed minutes later by a 6.4-magnitude aftershock, toppling buildings, rupturing roads and collapsing the well-known Ava bridge.
The devastation prompted a rare request for international aid from Myanmar's isolated military junta, which has lost swathes of territory to armed groups, as it declared a state of emergency across the six worst-affected regions.
Hundreds of casualties were taken to a hospital in the capital Naypyidaw, with the wounded being treated outside because of damage to the building. The emergency department's entrance had collapsed on top of a car.
A hospital official ushered journalists away, saying: "this is a mass casualty area."
"I haven't seen (something) like this before. We are trying to handle the situation. I'm so exhausted now," a doctor told AFP.
AFP reporters saw junta chief Min Aung Hlaing arrive at the hospital as the ruling military called for foreign help.
"We want the international community to give humanitarian aid as soon as possible," junta spokesman Zaw Min Tun told AFP at the hospital.
The rare plea from the junta raises the prospect that damage and casualties may be on a large scale, with Myanmar's medical system and infrastructure ravaged by four years of civil war.
- Skyscraper collapse -
Across the border in Thailand, a 30-storey building under construction collapsed in Bangkok.
Deputy Prime Minister Phumtham Wechayachai told reporters at least three workers had been killed, with 81 more trapped inside.
Rescuers were surveying the tangle of rubble and twisted metal for a safe way to search for survivors, an AFP photographer at the scene said.
"I heard people calling for help, saying 'help me'," Worapat Sukthai, deputy police chief of Bang Sue district, told AFP.
"We estimate that hundreds of people are injured," he said.
Across Bangkok and the northern tourist destination of Chiang Mai, where the power briefly went out, stunned residents hurried outside, unsure of how to respond to the unusual quake.
"I quickly rushed out of the shop along with other customers," said Sai, 76, who was working at a minimart in Chiang Mai when the shop started to shake.
"This is the strongest tremor I've experienced in my life."
- Buildings damaged -
Thai Prime Minister Paetongtarn Shinawatra declared an emergency zone in Bangkok, where some metro and light rail services were suspended, further snarling the city's already notorious traffic.
Airports were operating as normal.
The quake was felt across the region, with China, Cambodia, Bangladesh and India all reporting tremors.
India, France and the European Union all said they stood ready to provide assistance.
A livestream broadcast by the state-linked Beijing News showed around a dozen emergency workers in orange jumpsuits and helmets on a street strewn with fallen masonry in the city of Ruili, on the Chinese border with Myanmar.
A shop worker interviewed on the livestream showed phone footage of people running out of stores with their hands over their heads as tremors swept through the street.
A video posted on Douyin, the Chinese version of TikTok, and geolocated by AFP showed a torrent of water and debris cascading from the roof of a high-rise block in Ruili as people fled through a street market below.
Earthquakes are relatively common in Myanmar, where six strong quakes of 7.0 magnitude or more struck between 1930 and 1956 near the Sagaing Fault, which runs north to south through the centre of the country, according to the United States Geological Survey (USGS).
A powerful 6.8-magnitude earthquake in the ancient capital Bagan in central Myanmar killed three people in 2016, also toppling spires and crumbling temple walls at the tourist destination.
burs-pdw/rsc
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