Rescuers in Albania dug through the rubble of collapsed buildings in search of survivors on Tuesday, after a 6.4-magnitude earthquake struck the Balkan nation, killing at least 23 people and injuring 6 50.

Using everything from earth-moving equipment to their bare hands, local residents and emergency crews in cities across the country had pulled 45 people alive from under mounds of debris by the evening, the government said. Thirty people were hospitalized.

The deadly quake was the strongest to hit Albania in decades, in a region known for its devastating temblors, and came just two months after the country was struck by another strong quake that damaged hundred of homes. Across the country, buildings crumbled, fallen facades left structures ripped open to the elements, and many others had ominous cracks snaking across their walls.