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Eight people are feared dead and 13 are missing after a mudslide triggered by heavy rains swept away homes on the island of Ischia, near Naples.
The torrent of mud and debris dislodged trees, engulfed buildings and dragged cars into the sea as it reached the coast early on Saturday.
A 25-year-old woman and a family including a newborn baby are reportedly among the missing.
Bad weather is said to be hampering efforts to reach the island.
The mayor of Lacco Ameno, one of the island's towns, said dozens of families were still cut off and that a number of buildings had collapsed. Several people are also reportedly stuck inside a hotel on the island.
Heavy rains have been battering Campania, the region surrounding Naples and Ischia, and a weather warning for rainfall and strong winds is in place until Sunday.
Local authorities are urging residents to stay home to avoid hindering emergency services.
Italy's infrastructure minister Matteo Salvini said eight people had died in the landslide, adding: "From north to south, this country needs to be protected because it is the most beautiful country in the world."
But a top official in the nearby city of Naples told reporters that no deaths had yet been confirmed.
Like nearby Capri, Ischia, in the Tyrrhenian Sea, is a popular holiday destination for tourists and Italians alike.