Four severe flood warnings are in place in England, with officials warning of an “immediate risk to life”.
Worcestershire, Shropshire and Herefordshire have been badly hit by Storm Dennis.
About 100 properties in Tenbury Wells have flooded, with some people rescued from their homes by emergency crews.
A relief centre has been set up at a school in the Worcestershire town, and the Environment Agency urged residents to “take extreme care”.
The River Teme was predicted to peak at an “unprecedented level” for Tenbury on Sunday, at 6.7m at about 1800, by Hereford & Worcester Fire and Rescue Service.
Warnings are in place on the Teme, including for Tenbury Wells and Burford and Eardiston in Worcestershire.
They also apply to Little Hereford and Ashford Carbonel near the Herefordshire border and Ludlow in Shropshire.
Dave Throup, from agency, said people should “begin to think about moving out” if advised to.
“If they have any flood arrangements in the house such as barriers fitted to them or covers for air bricks, then they need to activate those now because they’re going to need them later on today.”
He advised people to travel only “if absolutely essential”.
Graham Stephens, from the Little Meadow Animal Rescue charity shop on Market Street, Tenbury, said: “All the main streets are covered. You cannot go through it at all. The town’s just dead, nobody can get in or out.
“It’s going to be like starting from scratch again with the shop, with everything just ruined, but we’ll come through it.”
The town’s high school, the Ormiston Academy, has been turned into a refuge for people who have had to leave their homes.
Christine Sheppard, from the school, said: “Yesterday we took some delivery of sleeping bags, air beds, torches, towels… We’ve got some basic supplies.
“It’s warm, it’s dry, we’ve got tea, coffee, biscuits.”
Tenbury resident Daniel Hughes said: “I got woken up by neighbours about half four this morning that our car was going under by the hedge out front.
“So [we] had to take it up the high school. The water went up very quick.”
There was “unprecedented” flooding on some of the rivers and streams in Worcestershire, the Environment Agency said.
The Teme is the worst affected and levels are also very high on the Severn and Wye.
All trains run by West Midlands Trains between Shrewsbury and Birmingham New Street have been cancelled.
Emergency sand bag stations have been set up in Ironbridge by Telford and Wrekin Council.
Follow BBC West Midlands on Facebook, on Twitter, and sign up for local news updates direct to your phone.