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By Kathryn Armstrong
BBC News
Syria's war-torn city of Aleppo is among the areas to have borne the brunt of a deadly earthquake, which also devastated parts of southern Turkey.
More than 1,000 people have been reported dead so far in northern Syria following the quake.
Emergency rescue teams said many buildings are damaged or destroyed and that people remain trapped under the rubble.
The region is home to millions of refugees displaced by the civil war.
Control of northern Syria is divided between the government, Kurdish-led forces and other rebel groups. They remain embroiled in conflict.
Even before the earthquake the situation in much of the region was critical, with freezing weather, crumbling infrastructure and a cholera outbreak causing misery for many of those who live there.
According to separate figures from the Syrian government and the White Helmets rescue group, which operates in rebel-controlled areas, more than 1,000 people have died in the region so far after the earthquake.
A video published on social media, and verified by the BBC, showed a building in Aleppo crashing to the ground as onlookers rushed to safety.
The 7.8 magnitude earthquake struck at 04:17 local time (01:17 GMT) at a depth of 17.9km (11 miles) near the Turkish city of Gaziantep. Twelve hours later, a second quake, which was nearly as large, struck 130km (80 miles) to the north.
A spokesperson for the White Helmets described north-western Syria as a "disaster area" and said that families remain trapped under the rubble.
In government-controlled areas, all of the country's emergency services have been made available, including the army and student volunteers. However, BBC Monitoring's Hesham Shawish, a Middle East specialist, says this is not enough to deal with the scale of the destruction.
The International Rescue Committee, a charity with more than 1,000 members of staff on the ground in opposition-held areas of Syria, said it was already dealing with the region's first cholera outbreak in a decade and preparing for approaching snowstorms when the quake hit.
Freezing conditions and torrential rain were hampering rescue efforts.
Mark Kaye, the organisation's Middle East advocacy director, described the situation as a "crisis within a crisis within a crisis" and said vast swathes of the region are beyond contact because of damage to communication networks.
Some people in remote areas are said to have been displaced as many as 20 times due to the civil war, which broke out in 2011 when a peaceful uprising against President Bashar al-Assad turned into violence.
Hundreds of thousands of civilians and fighters have been killed in the conflict and the resulting humanitarian crisis has been compounded in recent years by an unprecedented economic downturn.
Entire neighbourhoods and vital infrastructure, including hospitals, across Syria were already in ruins as a result of the fighting before the earthquake struck.
The government has called for international assistance - appealing specifically to United Nations member states, the International Committee of the Red Cross and other humanitarian groups.
However, it has reportedly rejected claims that it has asked for Israel's aid. The two countries are still technically at war and don't currently have any diplomatic relations.
Dozens of other nations have promised help, including the United Arab Emirates, Kuwait and Qatar. The UN said it has teams on the ground that are assessing the situation and providing assistance.
Russia, which already has a military presence in Syria due to its involvement in the civil war on the government's side, has also pledged its support.