Patients had to be evacuated from the San Salvatore hospital
The extent of the destruction caused by the L'Aquila earthquake is being blamed at least in part on a failure to make buildings in the area earthquake-proof.
Experts have pointed to the number of modern buildings that collapsed in and around the medieval city, and to a hospital that was badly damaged.
Italy seemed worse prepared than other earthquake-prone countries, they said.
Italy has a long history of earthquakes and there are existing regulations for protecting buildings against them.
The L'Aquila earthquake was the most deadly in Italy since 1980, when more than 2,500 people were killed near Naples.
After that laws were introduced obliging construction to be carried out according to anti-earthquake standards, says Thomas Braun, a seismologist at Italy's National Institute of Geophysics and Vulcanology.
But those laws are often quietly ignored, observers say.
"We have some buildings that collapsed in and near L'Aquila that were constructed after 1980," Mr Braun told the BBC.
"This is very strange because there were also older buildings that resisted."
The San Salvatore hospital, which according to one Italian media report was finished in 2000, should have been able to withstand the 6.3 magnitude quake, he said.
Part of the hospital collapsed and many of the patients had to be evacuated or treated outdoors.
The UN's International Strategy for Disaster Reduction office also noted in a statement following the L'Aquila earthquake that "many old structures did not meet modern seismic standards".
"Buildings are the main killers when earthquakes strike, which is why constructing resilient buildings in earthquake-prone zones is vital," it said.
Questioned about the issue, Prime Minister Silvio Berlusconi said there could be "no magic wand with which we transform our old buildings into earthquake-proof ones."
He said L'Aquila would receive the first of a series of "new towns" planned for provincial capitals, and the old town will also be rebuilt.
All that would be done using modern anti-earthquake technology, he added.
But Mr Braun said the promise had arrived too late, and that political failures had trumped such pledges in the past.
"The Italian engineers and architects I think are some of the best engineers in the world because already in medieval times they constructed churches and buildings much better than anyone," he said.
"So it's not the technological know-how that is missing, it's a political problem."
Franco Barberi, a geologist and disaster expert, was among those complaining about what he said was Italy's failure to protect buildings that were at risk.
"What makes one angry is, if this happened in California or in Japan or some other country where for some time they have been practicing anti-seismic protection," a similar earthquake "wouldn't have caused a single death", he said.