Iraqi men flagellate themselves with swords during the mourning procession on the tenth day of Muharram which marks the day of Ashura, in the Iraqi capital Baghdad on September 10, 2019.
In the "Tuwairij run" thousands of pilgrims symbolically re-trace the steps of the maternal cousins of Imam Hussein's half-brother al-Abbas who ran from the ancient village of Tuwairij to Karbala to aid the imam in the 7 century battle.
Tens of thousands of pilgrims are in the city for the Ashoura procession to mark the death of revered Imam Hussein.
A Health Ministry spokesman said the preliminary death toll was expected to rise.
It was the deadliest stampede in recent history during Ashoura commemorations, when hundreds of thousands of people converge on the city, some 80 kilometers (50 miles) south of Baghdad, for the occasion every year.
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However, the Associated Press said the stampede began after a walkway collapsed.
In 2004, more than 140 people were killed in a series of near-simultaneous bombings at shrines in Karbala and Baghdad during Ashura.
Tuesday is the climax of the ritual of Ashura, which means "10" in Arabic, as the killing of Imam Hussein took place on the 10th day of Muharam, the first month in the Islamic lunar calendar.
Streets across the country were shuttered Tuesday to allow for funeral-style processions and elaborate re-enactments of the Battle of Karbala.
The following year, 2005, during a different religious holiday, rumors of a suicide bomber caused a mass stampede on a Baghdad bridge crossing the Tigris River. Numerous faithful beat their chests and lashed themselves with chains in a symbolic expression of grief and regret for not being able to help Hussein before his martyrdom.