Giuseppe Carotenuto was in Rome early Wednesday when a magnitude-6.2 earthquake shook the ground in central Italy. The photojournalist already had a go-bag ready: boots for climbing over rubble, a helmet for safety and a keffiyeh to cover his mouth from the dust. He left Rome at 4:30 a.m. and headed for the picturesque small town famous for a pasta dish.

He arrived close to 6:30, following updates on the radio along the way. He expected the town, and its centuries-old homes and buildings that likely had not been reinforced, to be completely destroyed. “It is what I found,” he tells TIME.

The earthquake has left at least 250 people dead in the region. Amatrice, where he had visited three years ago for an assignment, is the hardest-hit towns with at least 193 fatalities as of Thursday afternoon. The toll is expected to rise as search-and-rescue operations continue.

Carotenuto, from Pompeii, has covered everything from Europe’s refugee crisis and Italy’s army in Afghanistan to the conflict in Libya and 2009 earthquake in L’Aquila that left more than 300 people dead. “There is one thing in common in all: the death,” he says. “The death as a result of errors caused by humans.”

He began to shoot shortly afterward and worked through the day. Beautiful homes and buildings crumbled onto streets that were no longer recognizable. There were residents looking through the rubble, first-responders hunting for survivors and many people who could not comprehend the scale of the tragedy.

“The survivors I met in the streets of Amatrice [were] shocked. Some did not understand what had happened and why they suddenly found themselves in the street,” he says. “The silence was broken by the screams of the first rescuers, the phones ringing in the rubble, the smell of cement dust.”

One man who Carotenuto met was seated alone on the rubble of his home. He came back following several aftershocks to see what remained, and stayed there for about 10 minutes in silence. “This man didn’t have words.”

Giuseppe Carotenuto is a photographer based in Rome. Follow him on Instagram @guiseppe_carotenuto.

Michelle Molloy, who edited this photo essay, is a senior international photo editor at TIME.

Andrew Katz is TIME’s International Multimedia Editor. Follow him on Twitter @katz.

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