A man carries a boy, who was injured in an earthquake, at the Lady Reading hospital in Peshawar, Pakistan October 26, 2015.

A powerful 7.5 magnitude earthquake has killed over 200 people in Pakistan and neighboring Afghanistan on Monday, officials said.

The quake rippled across South Asia, with shock waves felt as far away as the Indian capital New Delhi. An earlier tally from local and provincial authorities in Pakistan put the death toll there at 118, while at least 31 were confirmed dead in Afghanistan.

The death toll could climb in coming days because communications were down in much of the rugged Hindu Kush mountain range area where the quake was centered.

In the northern Afghan province of Takhar, at least 12 girls were killed after a stampede broke out in their school.

Tremors were also felt as far away as Islamabad in Pakistan and the Afghan capital Kabul, but not in neighboring Nepal which was hit by a major quake in April.

Hundreds of people raced from buildings onto the streets in Delhi while the quake was also felt in the Himalayan region of Kashmir, according to an AFP reporter.

Shockwaves were felt in northern India and in Pakistan, where hundreds of people ran out of buildings as the ground rolled beneath them.

“We were very scared … We saw people leaving buildings, and we were remembering our God,” Pakistani journalist Zubair Khan said by telephone from the Swat Valley northwest of the capital, Islamabad.

“I was in my car, and when I stopped my car, the car itself was shaking as if someone was pushing it back and forth.”

The quake was 213 km deep and centered 254 km northeast of Kabul in Afghanistan’s Badakhshan province.

In Pakistan, the northern area of Chitral, where 20 people were killed, was particularly hard hit.

Journalist Gul Hammad Farooqi, 47, said his house had collapsed. “I was thrown from one side of the road to the other by the strength of the earthquake. I’ve never experienced anything like it,” he told Reuters.

“There is a great deal of destruction here, and my house has collapsed, but thankfully my children and I escaped.”

Further south, the city of Peshawar reported two deaths and at least 150 injured people were being treated at the city’s main hospital, the provincial health chief said.

In Afghanistan, international aid agencies working in northern areas reported that cell phone coverage in the affected areas remained down in the hours after the initial quake.

“The problem is we just don’t know. A lot of the phone lines are still down,” said Scott Anderson, deputy head of office for the U.N. Office for the Coordination of Humanitarian Affairs in Kabul.

Badakhshan provincial governor Shah Waliullah Adib said about 1,450 houses had been destroyed.

The earthquake struck almost exactly six months after Nepal suffered its worst quake on record on April 25. Including the toll from a major aftershock in May, 9,000 people lost their lives there and 900,000 homes were damaged or destroyed there.

The Hindu Kush mountain region is seismically active, with earthquakes the result of the Indian subcontinent driving into and under the Eurasian landmass. Sudden tectonic shifts can cause enormous and destructive releases of energy.

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