The patients of the small psychiatric hospital in a Russian village were asleep or under sedation as the clock neared 2 a.m. The windows were barred and the nearest firefighters were miles away, with some impeded by rough roads and others not able to cross a nearby canal.
When a blaze broke out and spread through the wooden rafters, all of this made for a prescription for tragedy: 38 people died and only three escaped.
The one-story brick-and-wood hospital building that caught fire long before dawn Friday housed patients with severe mental disorders, Health Ministry officials said. The fire started in a wooden annex, emergency authorities said, and then spread to the 1950s main brick building, which had wooden beams.
Health Minister Veronika Skvortsova said half of the patients took sedatives at night. She insisted the patients weren't tied to their beds and were not given any medication that would leave them unconscious and unable to escape.
At least 29 of the dead were burned alive, federal Investigative Committee spokeswoman Irina Gumennaya said.
Fire trucks took about an hour to reach the scene, coming from a town 50 kilometers (30 miles) away and struggling over roads in poor condition. Firefighters from a slightly nearer town also were dispatched, but found that a ferry crossing a canal near the hospital was out of service because of high water.
Investigators said the 38 dead included 36 patients and two doctors. They said a nurse managed to escape and save one patient, while another patient got out on his own. The Emergencies Ministry also posted a list of the patients indicating they ranged in age from 20 to 76. Gumennaya told Russian news agencies that most of the people died in their beds.
Moscow region Governor Andrei Vorobyev said some of the hospital windows were barred. Gumennaya cited the surviving nurse as saying that the doors inside the hospital weren't locked.
Investigators said they are looking at violations of fire regulations and a short circuit as possible causes for the blaze that engulfed the hospital in the Ramensky settlement, about 85 kilometers (50 miles) north of Moscow.
Vorobyev told Russian state television that the fire alarm seems to have worked, but the fire spread too quickly.
Skvortsova told state TV the hospital had all the necessary fire equipment, but conceded mental hospitals should be better equipped for emergencies than the current law requires.
President Vladimir Putin called for a thorough investigation into the deadly fire and asked regional authorities to pay more attention to safety regulations.
Russia has a poor fire safety record, with about 12,000 deaths reported in 2012. By comparison, the U.S., with a population double Russia's, recorded around 3,000 fire deaths in 2011.
A 2006 fire at a drug treatment facility with barred windows and locked doors in Moscow killed 45. In one of the most high-profile cases of negligence, more than 150 people died in a nightclub in the city of Perm after a pyrotechnic show ignited a wooden ceiling.
Nataliya Vasilyeva contributed to this report.