Marija and her sister went on a night out to a concert. Only one of them made it home.

For Marija Taseva and her sister, Saturday night was meant to be an evening of fun spent dancing the night away at a concert for hip-hop band DNK.

Instead, only one of the women made it home. She has been left with scars that she may never heal from.

The pair were caught up in a devastating fire that ripped through a packed nightclub in the North Macedonian town of Kočani, killing 59 people and injuring more than 150.

People as young as 16 were among the casualties, officials said.

Marija is haunted by her final moments with her sister.

As the flames quickly spread across the roof, hundreds of people scrambled for the club's only exit.

"We even tried to get out through the bathroom, only to find bars (on the windows)," Marija told The Associated Press.

"I somehow managed to get out. I fell down the stairs and they ran over me, trampled me ... I barely stayed alive and could hardly breathe."

In the rush, she lost contact with her sister, who did not make it out.

Marija managed to escape with only an injury to her face. But it's the mental scars she's facing now — the trauma of the terrifying evening only compounded by the loss of her sister.

"My sister died," she said, breaking into tears.

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One video from the event, verified by Reuters, showed the band playing on stage flanked by two flares. Suddenly, white sparks set a patch of ceiling alight and the fire quickly spread.

Panicked, the crowd rushed to escape, and the band urged everyone to flee.

Interior Minister Pance Toskovski confirmed the fire, which began at around 3am Sunday local time, was caused by "pyrotechnic devices" whose sparks triggered the blaze. He said 500 people were in the club when the fire started.

About 148 people were hospitalised in Skopje, Kočani and surrounding towns, Health Minister Arben Taravari said.

The death toll may rise further, with 20 of the people injured in critical condition, Taravari said.

People searched for missing loved ones online and at hospitals across the country.

The fire tore through the nightclub. Image: Getty.

Authorities arrested about 20 people in connection with the fire, including government officials and the manager of the Pulse nightclub, which did not have a legitimate licence, Toskovski told a press conference.

"We have a reason to suspect graft and corruption were involved in this case," he said, without providing details.

Officials said the venue had only one emergency exit, which was locked during the concert; two fire extinguishers and no fire alarm or sprinkler system. Its ceiling was made of flammable materials and the plasterboard walls were not fire-resistant.

"It did not have two exit doors, but only one single improvised metal door at the back of the building, which was locked and without a handle on the inside," North Macedonia's state prosecutor Ljupco Kocevski said.

Residents are demanding justice and an end to the corruption they believe is to blame for the fire. Image: Getty.

The incident has devastated the town of 25,000 people.

North Macedonia Prime Minister Hristijan Mickoski said on Facebook: "This is a difficult and very sad day for Macedonia! The loss of so many young lives is irreparable, the pain of the families, loved ones and friends is immeasurable."

After visiting the injured in a hospital in Skopje, North Macedonia's President Gordana Siljanovska Davkova, dressed in black and fighting tears, said authorities were ready to do everything to help all affected.

"I simply cannot comprehend this ... what a disaster, what a tragedy."

Sporadic violence broke out in the area on Monday as thousands of people demanded justice and an end to the corruption they say was behind the deaths.

People used rocks to smash the windows of a pub that protestors said was run by the same individual who owned Pulse. Meanwhile, hundreds of people descended on the mayor's home, throwing rocks and smashing windows.

-With AAP

Feature image: AAP.