ASCOLI PICENO - Italy held a tear-drenched funeral Saturday for dozens of its earthquake victims as the country mourned the victims of a disaster that has claimed nearly 300 lives.

President Sergio Mattarella, Prime Minister Matteo Renzi and other leaders were among hundreds of mourners in a sports hall in Ascoli Piceno.

The hall in the capital of the central Marche region had been converted temporarily to a place of worship for the funeral of most of the people who perished in the villages of Arquata del Tronto and Pescara del Tronto in the region's mountainous interior.

Hundreds more stood silently outside, the sombre proceedings of the mass relayed to them by loudspeakers, three days after the deadly quake struck before dawn, killing 291 people according to the latest count.

Relatives of the dead sat alongside the flower-bedecked coffins, some draping themselves across them and sobbing inconsolably.

Others hugged each other tight as Giovanni D'Ercole, the bishop of Ascoli, implored them not to lose faith.

"Don't be afraid to scream your suffering, but do not lose courage," he said.

"Together we will rebuild our houses and churches, together above all we will give life back to our communities ... the village bells will ring once more."

Among the coffins was a small, white casket for nine-year-old Giulia, whose body protected her younger sister, Giorgia, for long enough for the five-year-old to be pulled from the rubble virtually unscathed.

Giorgia was one of the last survivors to be rescued and there have been no reports of anyone else being found alive since late Wednesday.

On Giulia's coffin a little note had been left: "Ciao little one. Sorry that we arrived too late." It had apparently been written by one of the firemen who rescued Giorgia.

Away from the TV cameras, the tiny hamlet of San Benedetto, near Amatrice, buried one its sons, 13-year-old Sergio Giustiniani.

The strains of three exhausting days were apparent as a woman screamed at a man who had been stopped by police, presuming he was a thief.

"I have lost everything and they come to rob us," she cried as a hearse pulled up behind her to collect a corpse from a neighbouring house.

Head of state Mattarella vowed "we will not abandon you," after a mourner begged him: "Don't leave us alone."

The president had earlier paid tribute to the "extraordinary effort" of more than 4,000 rescue professionals and volunteers on a brief visit to Amatrice, the small mountain town hit hardest by the quake.

Some 230 of the quake's 291 confirmed victims were buried under tonnes of collapsed masonry in the popular beauty spot's devastated centre.

Three more bodies were plucked from the town's Hotel Roma overnight and there are fears still more bodies will be recovered. An elderly man from Arquata died in hospital, taking the toll in that area to 50.

Emergency services are confident they have accounted for everyone in the smaller outlying hamlets to the north of Amatrice - some of which have been so badly damaged there are doubts as to whether they will ever be inhabited again.

Many victims were from the Rome area, where former inhabitants of the mountains have moved for work, returning to family homes only at the height of summer.

At least 16 foreigners died: 10 Romanians, three Britons and one each from Canada, El Salvador and Spain.

Sixteen Romanians are unaccounted for, the foreign ministry in Bucharest said Saturday.

The government has pledged to support immediate reconstruction.

But the clear-up operation needed first has been hampered by powerful aftershocks - more than 1,300 since Wednesday - which have closed winding mountain roads, damaged key bridges and made life dangerous for exhausted emergency services.

Renzi has declared a state of emergency for the regions affected, releasing an initial tranche of 50 million euros ($56 million) in emergency aid.

The total rebuilding operation is forecast to cost over a billion euros.

Another major commemoration service has been scheduled for Wednesday in Amatrice. Once that is over, the government and local authorities will face intense scrutiny over why so many people died, just seven years after an earthquake in the nearby city of L'Aquila left more than 300 people dead.

That disaster, just 50 kilometres (30 miles) to the south, underscored the region's vulnerability to seismic events - but preparations for a fresh quake have been partial at best.