Such was the violence of the impact, rescuers were faced with the task of searching for the dead and wounded through a maze of twisted metal.
Many of the injured, having been flung around inside the carriage, then had to wait several hours in freezing conditions to be cut free.
euronews Brussels correspondent Sergio Cantone said: “This is the forward medical centre at Halle station where 50 of the most seriously wounded were given first aid. They were then distributed to 14 hospitals around the region. Rescuers say their job was made particularly difficult because the trains’ sheet metal bodywork had been so badly deformed.
And there are still bodies in the wreckage which have not yet been fully identified.”
Another factor that hampered the rescue efforts – the wintry weather conditions.
The snow which had been falling when the collision happened got heavier throughout the morning.
And temperatures struggled to reach freezing point.
“I was dozing slightly and felt a major jolt. I felt that the train was tipping over and there was debris everywhere. I saw someone had been thrown below me and had stopped lying on his side,” said one survivor.
Another added: “There was a violent shock. It was brutal. I had no feeling of braking at all. Then everything was chaos. It was the third compartment which was virtually on its side, and we stayed like that for about three quarters of an hour.”
Rescuers faced with freeing the dead from the wreckage have also been collecting clothing that has been strewn around the crash scene, in the hope that it will help in the identification of bodies.