The earthquake struck Pakistan's thinly populated province of Baluchistan on Tuesday and was felt across South Asia.
It destroyed houses and cut communications with the worst affected district of Awaran, and was so powerful that it caused a small island to emerge from the sea just off the coastline in the Arabian Sea.
"We have started to bury the dead," Abdul Rasheed Gogazai, the deputy commissioner of Awaran, a town of 200,000, told Reuters by telephone from the affected area.
Jan Mohammad Bulaidi, a spokesman for the Baluch government, said at least 239 were killed and 400 injured.
The army deployed helicopters and hundreds of soldiers to help deal with the rescue effort in the huge, earthquake-prone province of deserts and rugged mountains bordering Iran and Afghanistan.
The United States Geological Survey said the quake was 7.8 in magnitude.
On the coast near Gwadar port, crowds of bewildered residents gathered to witness the rare phenomenon of the island that the quake forced out of the sea.
BA/BA