The accident happened on a single stretch of track between the towns of Corato and Andria.
Rescue workers pulled victims from the wreckage, including a small child who was alive.
Twenty people have been killed after two trains collided head-on in southern Italy.
Dozens of other passengers were injured, some seriously, in the crash near the town of Andria.
One official appealed for blood donations and said: "There could still be someone in the wreckage."
The four-carriage passenger trains, thought to be mainly carrying commuters, collided in the middle of an olive grove in the Puglia region of Italy.
The daughter of one of the passengers went to the scene of the crash to try and find her father.
"We hope he is alive," she said. "Because at the moment we have no news. This kind of thing shouldn't happen.
"My dad was on this train, he was supposed to be on this train, and at the hospital they don't know anything so we'll have to see what will happen. But at the hospital they have no news.
"I just want to stay calm and remain positive. I have no news."
Local police chief Riccardo Zingaro said: "Some of the cars are completely crumpled and the rescuers are extracting people from the metal, many of them injured."
The Mayor of Corato, Massimo Mazzilli, said the scene was horrific and the rescue work was ongoing with firefighters, civil protection officials and volunteers.
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