A 7.3 magnitude earthquake has struck near Vanuatu's capital, Port Vila, causing landslides, crushing cars and flattening several buildings, including one home to many western embassies.
Power and mobile networks across the country have been cut and the extent of the damage remains unclear, but there are unconfirmed reports of at least one death.
Dan McGarry, a journalist who lives in Port Vila, said he saw "a number of visibly injured people" outside the hospital's emergency department.
Vanuatu is prone to earthquakes, but Mr McGarry told the BBC that the quake, which struck at 12:47 local time (01:47 GMT), felt like "the biggest... there more than 20 years".
"Emergency services are going to be busy for a while. We have limited equipment and capabilities here (in Vanuatu)," Mr McGarry said, adding that police at Vila Central Hospital told him that one person has died, and that he expects the death toll to rise.
One of his clips from the Facebook page of state broadcaster VBTC showed dozens of people outside Vila Central Hospitalmany lying on hospital gurneys awaiting treatment.
Michael Thomson, director of the Vanuatu Jungle Zipline adventure company, told the AFP news agency that he had seen bodies lying on the streets.
"A number of buildings have come down around the city. A major rescue operation is underway to clear people who may be alive in the building," said Mr Thompson, in a separate video posted to Facebook.
"I thought the roof (of our house) was going to come down, Mr Thompson's wife, Amanda, told the BBC.
“We often have earthquakes here but not like this.. The house has huge cracks through it, sliding glass doors are broken.
"We're feeling a lot of post-shaking now, each one takes us gently as we run out the door," she said.
But Mr McGarry said the latest disaster was something the people of Vanuatu would "get over".
"People in Vanuatu deal with natural disasters every year. It's in our blood. We'll get through this too, although not without some suffering," he said.
Western embassies among those damaged
The United States Embassy, the United Kingdom Embassy, the French Embassy and the New Zealand High Commission were among the damaged buildings, all housed in the same building.
US officials said the building had "significant damage" and would be closed until further notice.
The United States Geological Survey reported at least four aftershocks around Port Vila - with magnitudes between 4.7 and 5.5 - in the two hours after the first earthquake. The first earthquake struck at a depth of 10km (6.2mi).
Authorities in neighboring New Zealand and Australia said there was no tsunami threat to their countries.
Australia also said it is "ready to support Vanuatu as the extent of the damage is assessed".
"Vanuatu is a family and we will always be there in times of need," Foreign Minister Penny Wong wrote on X.
New Zealand said they are "very concerned" and are monitoring the situation. "Our thoughts are with the people and authorities of Vanuatu," said Foreign Minister Winston Peters.
Vanuatu, a low-lying archipelago of about 80 islands, is located in a seismically active area prone to large earthquakes and other natural disasters.