A magnitude 5.7 earthquake shook the already devastated tourist town in the early hours of Thursday, Taiwan's official news agency CNA said, the largest in a series of aftershocks.
Eight people were still unaccounted for in Hualien on Thursday afternoon, all of whom were believed to have been living or temporarily staying at the now badly damaged and tilting Yun Men Tsui Ti building, officials said.
Emergency workers used enormous beams, raised with a crane, to prop up the building -- a large residential and commercial complex -- which leaned ominously over the street below.
Rescuers were digging "nonstop on the backside of the building" to try to find people feared trapped on the lower floors, Hualien County fire commander Zhu Zhe-min said. No one is any longer believed trapped above the second floor, he said.
The missing people were all connected to the Yun Men Tsui Ti building, officials said. Seven had been staying at a bed-and-breakfast called the Beauty Inn inside the building.
Melinda Yu, a resident of the fifth floor on the now-listing side, said she was marking her 50th birthday in her apartment when the quake struck. The floors below her seemed to collapse, and when the dust had cleared, she said, she looked out a broken window and found she essentially was on the ground floor.
"Someone was waiting for me outside, (saying), 'Give me your hand,' and pulled me out," she said.
One of her neighbors is missing, she said early Thursday.
Worker found alive in collapsed hotel
The Yun Men Tsui Ti is one of four buildings in the city that were either tilting or had collapsed, authorities said.
At the flattened Marshal Hotel in downtown Hualien, rescuers reached two workers who had been trapped near the main counter in the lobby, Taiwan's official news agency, CNA, reported Wednesday.
One appeared dazed as rescue workers escorted him out. The other didn't survive.
Meanwhile, 600 military personnel and more than 750 firefighters combed through rubble and helped with rescue efforts, according to Taiwan's Central Emergency Operation Center.
One of the dead was a Chinese tourist who was visiting with her son, according to CNA. She passed away Wednesday evening after suffering a head injury during the quake, the news agency reported.
Nine Japanese were injured and taken to the hospital, authorities said, but they have all been released. In total, 31 foreigners were affected, including 14 South Koreans, two Czechs, two Singaporeans and one Filipino, CNA reported.
Hualien is close to Taiwan's famous Taroko Gorge, a popular tourist destination.
Photos on state media showed the narrow highway in and out of the gorge on Wednesday morning covered in rocks, rubble and other debris from the earthquake.
Hundreds of Hualien residents whose homes were destroyed took shelter at a local stadium, with relief organizations providing emergency supplies.
Some 1,900 households lost power in the wake of Tuesday's quake, but most had it restored by Wednesday morning, according to the Central Emergency Operation Center.
However, an estimated 35,000 residents were still without water, the center said.
Pacific Ring of Fire
The quake struck late Tuesday in the East China Sea, north of Hualien, an eastern county that's home to more than 350,000 people.
The temblor was felt as far away as the capital, Taipei,
about 120 kilometers (74 miles) to the north, according to reports sent to the US Geological Survey.
Taiwanese President Tsai Ing-wen visited the scene of the earthquake Wednesday. Tsai thanked the island's first responders in a message on her official Twitter account.
Taiwan is situated on the Pacific Ring of Fire
, which runs around the edge of the Pacific Ocean and is known for causing massive seismic and volcanic activity from Indonesia to Chile.
The island is regularly rocked by earthquakes. A magnitude 6.4 quake hit in 2016, killing 40 people
. The biggest earthquake in recent memory was a 7.3 temblor
that killed 2,400 people in 1999.
'We're going to sleep in the tent'
Jason Grenier, a Canadian living with his Taiwanese wife and daughter just south of Hualien, said Wednesday that their home is intact and they have power and water. But the family was poised to spend a second straight night sleeping outside, wary of possible aftershocks.
Tuesday night's quake was the most violent he's felt in his 17 years on the island, he said. It jolted his family awake and sent him scrambling for his 7-year-old daughter and running outside.
"Sometimes (earthquakes) kind of slam you up and down -- it's like the whole house jumps. Sometimes it's like a rocking. This was like a combination of everything all at once ... you could hear the earth groaning," Grenier, an instructor at National Dong Hwa University, said Wednesday.
The Greniers spent the rest of the night in a vehicle. On Wednesday, they pitched a tent on their property.
"Even tonight, we're going to sleep in the tent, I think," Grenier said. "Because every time there is a temblor, you have to get up and decide if you're going to bolt. It doesn't make for a restful sleep."