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Amid all the images of rubble and heartbreak from Italy's worst earthquake in decades, the nation's nickname, bel paese (beautiful country), strikes a bittersweet chord. On Tuesday, the aesthetic was one of both gloom and determination as the scale of destruction came more fully into focus. Prime Minister Silvio Berlusconi received additional calls of condolences and offers of support from world leaders, though he made a point of stating that Italy was equipped to respond to the crisis on its own. Berlusconi said he got an offer of help from President Obama, and the Italian leader suggested that the Americans might help restore some of the historic buildings and basilicas damaged in Monday's predawn quake.

Attention, however, is still focused on the human toll. As the deaths climbed to at least 260, hope began to dwindle on Tuesday evening of finding additional survivors under the rubble. The previous night, just past 2 a.m., a university student identified as Marta was pulled alive from her collapsed dormitory after 23 hours, her life saved only because a fallen ceiling support had wedged across her bed in a position that protected her from all the other debris that came down. (See pictures of the earthquake.)

But Marta's smile from her ambulance stretcher was one of the only glimmers of good news, as the magnitude of the loss of life and property destruction was tallied in and around the city of L'Aquila in the region of Abruzzo, near the epicenter of the 6.3-magnitude quake. Indeed, the lifeless bodies of four other students were pulled from the rubble in the hours after Marta was rescued. The tiny town of Onna, just six miles outside of L'Aquila, was the hardest hit: 40 of its some 300 residents were killed. Across the region an estimated 1,000 people were injured, with nearly 100 in critical condition. Tens of thousands have been forced from their homes. (Read about whether the earthquake was predicted.)

Several aftershocks were registered on Tuesday, including one tremor that caused rescue workers to flee the partially collapsed buildings where they were looking for survivors. Berlusconi said the search would go on for another 48 hours, but he admitted that chances were dwindling of finding additional victims alive. More than 6,000 rescue workers and volunteers have responded since the quake struck. The immediate concern for saving lives and finding emergency shelter for the survivors will eventually be replaced by questions about retrofitting efforts. The earthquake-prone country has two major fault lines, and vast numbers of people live and work in old buildings.

There will also be the question of rebuilding, which is about much more than cultural restoration. Those who lost their homes in past quakes, including the one in 1980 that killed 2,500 in the southern town of Irpinia, have often been left in limbo for years, with unfulfilled government promises of reconstruction. The sight of new homes built for those who lost theirs in the L'Aquila quake — even if they might not have the charm of those destroyed — would add a different kind of beauty to the bel paese.

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• Jeff Israely / Rome