A minivan ran through an intersection and struck pedestrians in a tourist-packed area of Kyoto on Thursday, killing eight people including the vehicle's driver, and injuring another eight.
The crash happened in the western Japanese city's main geisha district, packed with tourists and cherry blossom viewers.
Rescue officials and witnesses said the minivan went through a traffic light and entered a main intersection in the Gion district, knocking over pedestrians and smashing into a pole before stopping. TV footage showed pools of blood and belongings scattered on the ground as paramedics treated the injured.
The 30-year-old driver and seven pedestrians died, Kyoto prefectural police spokesman Akira Koga said. Eight other people were injured, including several in serious condition. The van did not have any passengers, Koga said.
Kyodo news agency said many of the dead and injured were Japanese visitors to the city.
The cause of the accident is still under investigation. Public broadcaster NHK quoted the driver's sister as saying that he had an epilepsy-like illness and his doctors saying they warned him not to drive because of his condition.
It was not immediately known whether that was considered a factor in the crash. Japan has had a series of deadly crashes recently in which the drivers had epilepsy, a brain disorder marked by seizures.
A court in December sentenced a man to seven years in prison for fatally running over six children in Tochigi, near Tokyo, when he had epileptic seizures while driving a crane without taking necessary medication.
People with epilepsy are often descriminated against in Japan and they often hide the problems, even when they get driver's license. Japan bans them from driving unless medical authorities confirm they have not had attacks in the past two years and the condition is under control.
The Japanese Epilepsy Association appealed this week to the Justice Minister and the National Public Safety Commission chairman to seek ways to eliminate prejudice against epileptic patients but take effective measures to raise awareness among themselves about the dangers of driving. The association says about 1 million Japanese have epilepsy.