The passenger train was traveling on a route between two popular tourist cities, Athens and Thessaloniki, when it collided with the freight train about 400 kilometers north of Athens. Some of the injured were taken to hospitals in the nearby town of Larissa, and at least 150 firefighters and dozens of emergency vehicles were sent to the scene.

“The evacuation process is underway and being carried out under very difficult conditions due to the severity of the collision between the two trains,” fire spokesman Vassilis Varthakoyiannis said during an emergency briefing.

Footage from the crash site showed flames surrounding the derailed train cars, as well as the swirling lights of nearby fire trucks and ambulances. At least two train cars appeared to have tipped sideways near the tracks, while one train car had severely dented and gaping windows as firefighters worked to free passengers.

The damage to the train cars was so severe that crane trucks were used to help free vehicles, Varthakoyiannis said. He added that search and rescue operations were still underway just before dawn on Wednesday morning and rescuers concentrated on two overturned passenger trains.

Authorities transported bodies to hospitals for identification, and at least 194 surviving passengers, including those seeking treatment, were transferred by bus to Thessaloniki.

The cause of the collision is unknown, as is the nationality of those killed.

The US Embassy in Athens tweeted Wednesday morning that it was “deeply saddened by the news of the tragic collision.”

Railway safety in Greece has come under scrutiny in recent years and Tuesday night’s accident marks one of the country’s deadliest in decades. A 1968 train collision in the ancient coastal city of Corinth left at least 34 dead and dozens injured.

Greece had the highest overall rail fatality rate of the 29 countries studied in a 2022 European Union Agency for Railways safety report, and the seventh highest passenger fatality rate. At least 11 fatal train collisions or derailments have been recorded in Greece between 1980 and 2019, according to an analysis of Europe’s major rail lines by Imperial College London’s Center for Transport Studies.

At least three people were also killed on a route from Athens to Thessaloniki in 2017, according to Reuters, after a train derailed and crashed into a house.