Eleven-year old Ciro, the last child to be pulled from the rubble on the Italian island of Ischia Tuesday, saved his little brother's life when the deadly earthquake struck, rescuers workers said.

Firefighters had to dig with their bare hands to reach the youngster, who had been buried along with his seven-year old brother Mattias and seven-month old half-brother Pasquale.

"It was Ciro who saved Mattias," said policeman Andrea Gentile. "He dragged him and pushed him under the bed with him, a gesture that without a doubt saved both their lives.

"Then with a broom handle he banged on the rubble so the rescuers could hear him," he explained.

Monday's 4.0-magnitude quake killed a 59-year old mother-of-six in Casamicciola, on the north of the small tourist island, after debris fell from a church. The other victim was a 65-year old Italian tourist discovered in the rubble of a collapsed house, local media said.

But as a dusty Mattias was pulled free from the rubble, firefighters broke into applause. Ciro, rescued after 16 hours in the dark, was loaded into a waiting ambulance.

"Don't leave me, don't let me die," he had begged his saviours, Italy's AGI news agency reported.

- Miraculous escape -

The boys' father, his hands in bandages after a night digging through the rubble alongside the firefighters, tearfully hugged relatives as his eldest son was saved.

Earlier, after hours of digging overnight, emergency workers had recovered the baby, Pasquale. He was saved by kitchen cabinets that toppled over him, shielding him from the debris of the collapsing house, they said.

Two small communes, Casamicciola and neighbouring Lacco Ameno, bore the brunt of the quake, according to the civil protection agency.

The quake hit the northwest of the island at 8:57pm (1857 GMT) on Monday, at a depth of just five kilometres (three miles).

Italian officials first put the quake at a 3.6 magnitude, but later revised it upward to 4.0 -- in seismic terms, a modest event.

The main earthquake was followed by 14 smaller aftershocks. Several buildings collapsed while others had large, ominous cracks. And as well as the two deaths, 42 people were injured, one seriously.

"Italy is united with Ischia in sorrow for, and solidarity with, the victims," Prime Minister Paolo Gentiloni said on Twitter.

"We stand side-by-side with those taking part in the rescues."

- 'A nightmare' -

Many holidaymakers packed their bags and rushed to catch special overnight ferries back to the mainland.

The quake struck just days ahead of the first anniversary of the 6.0 magnitude quake that killed nearly 300 people in and around Amatrice in central Italy. In October 2016 and January 2017 three other earthquakes hit the same region.

Francesco Peduto, head of Italy's National Geologists Association, on Tuesday slammed shoddy construction and a lack of earthquake prevention measures, saying a 4.0-magnitude quake should not have brought down buildings.

"It's frankly extraordinary that people continue to die for earthquakes of this size," he said.

The quake response benefited from the presence of emergency responders already on the island to fight the forest fires that have plagued Italy this summer.

"I was on the couch watching TV. Blackout, shaking, something fell on my head. I scream, my mother grabs me and we ran outside," one witness wrote on Twitter.

Ischia's only hospital was also hit and had to be partially evacuated, with five patients transferred to another medical facility by helicopter.

Restaurants were packed and many stores were still open when the shaking began, witnesses said on Twitter.

"A horrible experience, everything was shaking, plunged into darkness, houses were collapsing... a nightmare," one wrote.

Ischia is often hit by earthquakes, with its worst dating back to July 1883, when an estimated 5.8-magnitude quake killed more than 2,000 people.

Italy straddles the Eurasian and African tectonic plates, making it vulnerable to seismic activity when they move.

Source: AFP