The two trains were travelling on a single-track line between the coastal towns of Bari and Barletta in the country’s olive region when they crashed into each other around 11.30 am local time.
Emergency services are at the scene near the town of Andria and are trying to free passengers from the wrecked carriages.
An image of the crash showed the carriages had been badly damaged and forced off the rails at sharp angles, with debris strewn across either side of the tracks.
“Unfortunately the death toll has risen to 20,” said Giuseppe Corrado, the deputy head of the local province. He said four people had been “seriously” injured and appealed for blood donors to go to local hospitals.
He said other passengers had been taken to hospital with less severe injuries.
A field hospital was set up in the nearby countryside to treat the injured, who are also being transported to hospitals.
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“We are working with dozens of rescue teams to open up the carriages,” said Luca Cari, a fire service spokesman.
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