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A head-on crash between a passenger bus and truck in the Sindh province of Pakistan killed at least 56 people, including women and children, and injured 20 on Tuesday morning, according to local police and doctors.

The Karachi-bound coach was headed from the northwestern city of Swat and stopped for refueling near Khairpur city in Sindh province at about 5 a.m., said Faisal Chachar, a senior official with the National Highway and Motorway Police. When the bus driver left the gas station he apparently drove on the wrong side of the road and collided with a coal container, killing 56 people, he said.

“It took us one and a half hours to rescue the injured and get out bodies from the bus. We cut some parts of bus to rescue people,” said Chachar, who described the bus as completely destroyed.

Local media reported that bus was overloaded and driver was also issued a ticket a couple of hours before the accident.

The injured and dead were transported to a civil hospital in Khairpur city, Chachar said.

Khairpur Civil Hospital Medical Superintendent Jaffar Soomro told local media that the dead included 18 children, 21 women and 17 men.

“Majority of dead and injured belong to Swat. At least two injured are in critical conditions. They have been shifted to the intensive care unit of the hospital,” Soomro said.

Road accidents are frequent in Pakistan and claim many lives annually due to poor roads, badly maintained vehicles and reckless driving. The Global Status Report on Road Safety 2013 published by the World Health Organization said road accidents in Pakistan are a leading cause of death for young people ages 15 to 29. There were 5,192 deaths in 2010 due to road accidents, according to the report.

The Pakistani government or other majority authorities have not set a fatality reduction target, and there are no tangible efforts underway to make roads safer, according to the WHO report.

Aoun Sahi is a special correspondent.