The earthquake caused extreme damage in Ashgabat and nearby villages, where almost all brick buildings collapsed, concrete structures were heavily damaged and freight trains were derailed. Damage and casualties also occurred in the Darreh Gaz area, Iran. Surface rupture was observed both northwest and southeast of Ashgabat. Many sources list the casualty total at 10,000, but a news release on 9 December 1988 advised that the correct death toll was 110,000. A 2007 report by the State News Agency of Turkmenistan gives a total number of up to 176,000.

It was this earthquake that killed future Turkmen dictator Saparmurat Niyazov's mother (his father having died during World War II) and the rest of his family, leaving him an orphan.