Emergency services were combing through the rubble of shattered buildings after an earthquake in the city of Hualien in Taiwan killed at least four people. Another 200 are also missing following the magnitude 6.4 tremor, which hit the popular coastal resort just before midnight on Tuesday.

Many are believed to be trapped inside buildings, including a military hospital, after the quake hit about 22 km northeast of Hualien on Taiwan’s east coast. The 10-storey Marshal Hotel, which is popular with tourists, was left shattered and listing at a 30-degree angle.

“We know there are people who are trapped inside – we can see lights inside the hotel,” Zeena Starbuck, an eyewitness at the scene, told the BBC. “People with phones are shining their lights to let people know they’re there.”

Residents stared in disbelief as emergency workers dressed in fluorescent orange and red suits and wearing helmets searched for people trapped in apartment blocks.

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A hotel has collapsed in Taiwan’s northeastern city of Hualien late Tuesday after a 6.4 magnitude earthquake struck offshore. Photo: Twitter

About 40,000 homes are without water, and highways and bridges have been closed. The army has also been called in to help with emergency rescues.

Even the Taiwanese President Tsai Ing-wen rushed to the scene of the earthquake early on Wednesday to help direct rescue operations.

“The president has asked the cabinet and related ministries to immediately launch the ‘disaster mechanism’ and to work at the fastest rate on disaster relief work,” the president’s office said in a statement after the Tuesday earthquake.

“Armed forces & government agencies are responding,” Taiwan’s president, Tsai Ing-wen, wrote on Twitter. “Relief measures are underway. Stay safe.”

Hualien is home to about 100,000 people, and its streets were left buckled by the force of the tremor.

Emergency workers surrounded the damaged military hospital after the windows collapsed, leaving the building wedged into the ground at a 40-degree angle.

“We were still open when it happened,” Lin Ching-wen, who operates a restaurant near the military hospital, told Reuters. “I grabbed my wife and children and we ran out and tried to rescue people.”

The earthquake hit at 11:50 pm on Tuesday night just over two days after a 6.1-magnitude earthquake struck the same area, causing some damage but no casualties. City residents said the quake felt stronger.

Located along a major fault line, Taiwan is often hit by moderate to strong earthquakes. A 7.6-magnitude earthquake devastated central Taiwan in September of 1999, killing nearly 2,300 people and injuring almost 9,000 others.

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Map of Taiwan shows the epicenter of Taiwan’s 6.4 Magnitude earthquake located offshore at a depth of 1 km. Photo: Twitter