A 7.7-magnitude earthquake struck central Myanmar on Friday, shaking buildings across a vast expanse of Southeast Asia and causing a skyscraper under construction to collapse hundreds of miles away in Bangkok, in neighboring Thailand. At least 20 people were killed in Myanmar, and three in Thailand, the authorities said.

Bleeding victims rushed to hospitals by ambulance, car and motorbike after the temblor — only the third of its size to hit the region in the past century — struck Mandalay, Myanmar’s second-largest city, around 12:50 p.m. local time. An aftershock of magnitude 6.4 was recorded about 11 minutes later.

Buildings were left in ruins, and a doctor at Mandalay General Hospital said so many people had arrived for treatment that nurses had run out of cotton swabs and he had no place to stand. Dozens of patients from the hospital — the main medical facility in the city, which has more than a million people — were forced to flee to a nearby parking lot. Many were still hooked up to intravenous drips and oxygen tanks.

Outside the hospital, Daw Kyi Shwin, 45, said her 3-year-old daughter had been killed when their house began to collapse while they were having lunch. “I tried to run to her,” she said, bleeding heavily, “but before I could, bricks fell on me too.”

The disaster added to the monumental challenges facing Myanmar’s military rulers, who overthrew an elected government in a 2021 coup. The junta has been steadily weakened, losing ground to rebels amid a bloody civil war that had left nearly 20 million people without enough food or shelter even before the quake, according to U.N. officials.

Myanmar’s military spokesperson, Gen. Zaw Min Tun, called on other countries to provide aid, a rare international appeal by the junta, which is under heavy sanctions by the United States, Britain and others. That indicated that the death toll and scale of damage could rise significantly.

Here’s What Else to Know:

• Myanmar damage: Details of the damage in much many parts of Myanmar were not immediately available. Humanitarian groups said they were trying to assess the situation but were having difficulty because electricity and communication lines were down. Bridges and several buildings in Myanmar had collapsed, including in Naypyitaw, the capital, The Global New Light of Myanmar, a state-owned newspaper, reported.
• Censorship: Information about the toll in Myanmar was also limited because Myanmar’s junta has repeatedly shut off the internet and cut access to social media, digitally isolating the country from the world. The blocks have been intended to thwart dissent and prop up the junta, but in an emergency like the earthquake, where power outages and damage can already hinder internet access, such restrictions can further limit what information is available and can potentially affect the delivery of aid.
• Thailand chaos: In Bangkok, more than 600 miles from Mandalay, videos showed water surging from pools atop high-rise hotels and residential towers. Videos verified by The New York Times showed the collapse of a 30-story skyscraper that was under construction as workers and passersby ran for safety. At least three people had died in the collapse, according to a rescue worker, and an official told reporters at the site that 70 people were still missing. Another 20 were stuck in an elevator, the official said, and it was unclear if they were still alive.
• Active quake zone: Myanmar is in one of the world’s most seismically active regions. A magnitude 6.8 earthquake in eastern Myanmar killed more than 70 people and shattered hundreds of buildings in 2011. The shaking was felt as far away as Bangladesh, Vietnam and southern China, where state news media said an unspecified number of people had been injured in Ruili, near the Myanmar border.

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This article originally appeared in The New York Times.

By John Yoon and Sui-Lee Wee/The New York Times
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