Pakistan's army airlifted hundreds of soldiers to help with the aftermath of the worst earthquake in the country since 2005, when about 75,000 people were killed in the country's north.
Tuesday's earthquake of magnitude 7.7 struck Baluchistan, a huge earthquake-prone province of deserts and rugged mountains, and was felt across South Asia.
It destroyed houses and cut communications with the worst affected district of Awaran and was so powerful it caused a small island to emerge from the Arabian Sea, just off the Pakistani coast.
Rescue teams found it hard to reach the remote location quickly and some officials said the death toll was likely to rise as emergency workers fanned further into the mountains to assess the damage.
Mohammad Shabir, a journalist, described scenes of grief and chaos in villages, saying survivors were digging rows of graves and picking through the debris.
"As far as the human eye can see, all the houses here have been flattened," he told Reuters from Awaran, adding that rescue teams were distributing supplies.
On the beach near Gwadar port, bewildered residents gathered to look at the island the quake thrust up out of the sea.