INTERNATIONAL NEWS - One aid agency said 70,000 people needed emergency shelter after the quake, one of the largest this year.
Most of those who died were in Iran's western Kermanshah province, officials told state media.
At least six more were reported to have died in Iraq, where people fled into the streets in the capital, Baghdad.
Mosques in the city have been broadcasting prayers through loudspeakers.
"I was sitting with my kids having dinner and suddenly the building was just dancing in the air," a Baghdad mother-of-three, Majida Ameer, told Reuters news agency.
"I thought at first that it was a huge bomb. But then I heard everyone around me screaming: 'Earthquake!'"
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