The Indonesian island of Lombok has been shaken by a third big earthquake in little more than a week as an official said the death toll from an earlier quake had topped 220.
The strong aftershock, measured at magnitude 5.9 by the US Geological Survey, caused panic and damage.
It was centred in the northwest of the island and didn't have the potential to cause a tsunami, said Indonesia's geological agency.
Videos showed rubble strewn across streets and clouds of dust enveloping buildings.
In northern Lombok, some people leapt from their vehicles on traffic jammed roads while an elderly woman standing in the back of a pick-up truck wailed "God is Great."
The aftershock had caused more "trauma," said national disaster agency spokesman Sutopo Purwo Nugroho.
Nyoman Sidekarya, chief of the provincial search and rescue agency that covers Lombok, told The Associated Press that the death toll from Sunday's magnitude 6.9 quake was now 227.
Several agencies have been releasing higher death toll figures than the 131 announced on Wednesday by the National Disaster Mitigation Agency, which has a coordinating role in disaster relief.
The agency says it is has not verified these other figures but expects the toll to climb.
Grieving relatives were burying their dead and medics tended to people whose broken limbs hadn't yet been treated in the days since Sunday's quake.
The Red Cross said it was focusing relief efforts on an estimated 20,000 people yet to get any assistance.
In Kopang Daya village in the hard-hit Tanjung district of north Lombok, a distraught family was burying their 13-year-old daughter who was struck by a collapsing wall and then trampled when the quake caused a stampede at her boarding school.
Villagers and relatives prayed outside a tent where the girl's body lay inside covered in a white cloth.
"She was praying when the earthquake happened," said her uncle Tarna, who gave a single name.
"She was trying to get out, but she got hit by a wall and fell down. Children were running out from the building in panic and she was stepped on by her friends," he said.
Thousands of homes were damaged or destroyed in Sunday's quake and more than 150,000 people are homeless. The earlier earthquakes also left cracks in walls and roofs, making the weakened buildings susceptible to collapse.
In Kopang Daya, injured villagers got their first proper treatment Thursday after medics arrived with a portable X-ray and other supplies.
A July 29 quake on Lombok killed 16 people.