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A powerful earthquake struck a mountainous region in northwestern China just before midnight on Monday, causing buildings to collapse on sleeping people.
According to state media reports, at least 116 people were killed and 300 injured after the magnitude 6.2 quake on Tuesday morning.
The death toll is expected to rise as desperate rescue operations continued on Tuesday in freezing temperatures in remote Jishishan county, near the border between Gansu and Qinghai provinces.
Chinese state media released a video of firefighters digging through rubble looking for survivors, warning that the bitter cold and high terrain made it difficult to find people.
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Xi Jinping, China's powerful leader, called for comprehensive search and rescue operations on Tuesday morning and urged vigilance against “secondary disasters” from changing weather or aftershocks.
According to the official Xinhua news agency, basic infrastructure such as water, electricity and communications and transport networks were also damaged.
Gansu and Qinghai, on the eastern edge of the Tibetan Plateau, are among the poorest and most ethnically diverse regions in China.
Almost all of the Bonan, a predominantly Muslim people and one of China's least populous minority groups, live in Jishishan, which lies about 6,500 feet above sea level.
The average disposable income in the county is just over $2,600 per year, or about half the state average.
The devastating scenes are reminiscent of an even deadlier 2008 earthquake in Sichuan province that killed nearly 90,000 people.
Natural disasters often become a focus of public concern about regulatory failures. For many, they are a reminder that the country's poorest still live in harsh conditions and cheaply built housing.
Near the epicenter of Monday's quake, houses in Gansu villages made of bricks and wooden beams were almost completely flattened, state media reported.
The quake coincides with a cold snap and record low temperatures that have already shut down highways across much of northern China.
After escaping from dormitories, students at a middle school in Jishishan huddled together and burned their textbooks to protect themselves from the 7-degree Fahrenheit night, according to videos on Chinese social media.
Pei-Lin Wu and Vic Chiang in Taipei, Taiwan, contributed to this report.