Albanian rescuers scoured rubble into the night on Tuesday in search of survivors trapped in buildings toppled by the strongest earthquake in decades, with at least 20 lives lost and hundreds of people injured.

Tormented families watched with trepidation as soldiers, police and emergency workers sifted through the debris of shredded apartment blocks and hotels in towns near Albania's northwest Adriatic coast, close to the epicentre of the 6.4 magnitude earthquake that hit the country before dawn. By evening the toll was 20 dead, according to the defence ministry.

Most were pulled from wreckage in the coastal city of Durres and Thumane, a town north of the capital Tirana.

In neighbouring Kurbin a man in his fifties died after jumping from his building in panic. Another perished in a car accident after the earthquake tore open parts of the road, the ministry said.

Some 42 people have been rescued alive in efforts that continued after the sun went down with headlamps and spotlights.

Earlier in Thumane, locals watching emergency workers comb over a collapsed building shouted the names of their loved ones still inside: "Mira!", "Ariela!", "Selvije!".

Dulejman Kolaveri, a man in his 50s in Thumane, told AFP he feared his 70-year-old mother and six-year-old niece were trapped inside the five-storey apartment, because they lived on the top floor. "I don't know if they are dead or alive. I'm afraid of their fate... only God knows," he said with trembling hands.

There were also brief bursts of joy during the day as rescuers delicately extracted survivors.

One, a thin middle-aged man covered in a film of grey dust, was seen being carried out of the rubble on a stretcher in Thumane.

In Durres, onlookers cheered "Bravo!" as a team rescued a young man from the wreckage of a toppled seaside hotel in a two-hour operation.

Afraid to return home after a series of powerful aftershocks, hundreds of people in Durres took shelter in tents set up in the city's football stadium.

The health ministry said that more than 600 people have received first aid for injuries, mostly minor. Some 300 soldiers and 1,900 police were sent to Durres and Thumane to assist with the rescue efforts, according to authorities. Aid also poured in from around Europe, with teams from Italy, Greece and Romania among those deployed to help.