The train, traveling to Taitung, came off the rails in a tunnel just north of Hualien causing some carriages to hit the wall of the tunnel, the fire department said in a statement.
The train was carrying about 350 passengers in eight carriages, according to Taiwan's official news agency, Central News Agency (CNA).
60 people have been safely evacuated from the first three cars of the train and 27 have been sent to the hospital for treatment, CNA reported.
"Is everyone out in carriage four?" a woman is heard shouting from inside the tunnel, in images provided by the fire department.
CNA said a truck that was "not parked properly" was suspected of sliding into the path of the train. The fire department showed a picture of what appeared to be the truck's wreckage lying next to part of the derailed train.
Images of the crash scene show carriages inside the tunnel crumbled and ripped apart from the impact, passengers gathering suitcases and bags in a tilted, derailed carriage and others walking along the tracks littered with wreckage.
The accident occurred at the start of a long weekend for the traditional Tomb Sweeping Day hospital.
Taiwan's mountainous east coast is a popular tourist destination.
In 2018, 18 people died and 175 were injured when a train derailed in northeastern Taiwan, in the island's worst rail disaster in more than three decades.
This is a breaking story. Updates to follow.
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April 02, 2021 at 10:57AM
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Train derails in Taiwan, with at least four dead and many injured - CNN
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