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Near simultaneous blasts hit Atocha station in the centre of the Spanish capital and two smaller stations, Santa Eugenia and El Pozo.
Early reports say that two bombs exploded on one intercity train as it pulled into Atocha station at 0730 local time.
Blasts were also believed to have taken place on two suburban trains on the rail line leading into the station. The government said there were four explosions altogether.
Juani Fernandez, 50, who was on a platform waiting for a train, said: "People started to scream and run, some bumping into each other. I saw people with blood pouring from them, people on the ground."
Paramedics have set up an emergency field hospital outside Atocha, which is a major railway station used by commuter, intercity and subway trains.
Madrid rescue services official Cesar Gomez said there was "a multitude" of injured at the station.
Emergency services are trying to rescue commuters trapped on the trains. Hospitals in the city have appealed for people to come forward to give blood.
A vast morgue has been set up in an exhibition hall and busloads of relatives are arriving to try to identify remains. Authorities have warned it is almost impossible to match body parts.
All trains in and out of the Spanish capital have been cancelled.
Spain's national telephone operator, Telefonica, has urged people to send text messages instead of making calls to take the pressure off the network, which has collapsed.
No group has admitted carrying out the attacks but the Spanish government blames Basque separatist group Eta for the bombings, which come three days ahead of Spain's general election.
Campaigning for the election has been suspended for the time being.
"There is no doubt Eta is responsible," said Spain's interior minister Angel Acebes following an emergency cabinet meeting. "Eta had been looking for a massacre in Spain," Mr Acebes added.
Mr Acebes said there was no prior warning of the explosions.
The leader of one outlawed Basque party linked to Eta denied the Madrid bombings were the work of the separatist group. He suggested "Arab resistance" elements could be behind the attacks.
Some experts on Eta said the bombings did not fit the group's usual profile for attacks. Eta have frequently phoned warnings ahead of attacks in the past.
Police are reported to be hunting for two men seen jumping on and off trains further down the line from the sites where the explosions happened.
The final figure for the number of dead was 191 and at least 1,800 people were injured.
There had been fears of a terrorist attack in the run-up to the Spanish elections.
Twelve days earlier, police had intercepted a van bound for Madrid which was packed with explosives. They blamed Eta.
The government had reported there were four bombs in the Madrid attacks although it later emerged there were 10.
Eta was seen as the prime suspect but the day after the blasts an Arabic tape with Koranic quotes was found in a suspect van near Madrid. At least one group claiming links to al-Qaeda said it planted the bombs.
A letter purporting to be from al-Qaeda was also sent to a London newspaper and referred to the attacks as Operation Death Trains.
A parliamentary commission was set up to investigate the train bombings as Spaniards demanded to know how the attacks were possible. The inquiry lasted five months and more than 30 people were called to testify.
The conservative government lost power in the election three days after the attacks, amid suspicions that they misled the public by claiming that Eta was to blame.
Several weeks after the train bombings, seven suspects blew themselves up when police tried to arrest them in a flat in Leganes in Spain.
Twenty-nine people are on trial in Spain in connection with the bombings.
In March 2007 Britain extradited a Syrian-born Spanish citizen, Moutaz Almallah Dabas, to Spain - he is charged with recruiting the bombers.
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