38 died in a mental hospital fire in the Ramenskoye region north of Moscow at 2:00 a.m. local time early Friday morning, as firefighters were slow to respond to the blaze after a ferry crossing was blocked. Federal Investigative Committee spokeswoman, Irina Gumennaya, said 29 of the dead burned alive as the fire made its way from the annex to the main building of the mental hospital, suffocating some and killing others in their beds.

The Associated Press reports that Russian Health officials claim the blaze started as the result of a short circuit in the wooden annex building that quickly spread to the brick main building. Unfortunately, the main building was also composed of wooden beams, which rapidly caught fire. Investigations are ongoing as to whether there were violations of fire regulations.

Russian Health Minister, Veronika Skvortsova, said that half the patients took sedatives at night, but she insisted the patients were not tied to their beds and were not given any medication that would leave them unconscious and unable to escape. The mental hospital housed patients with severe mental issues.  

There were only three reported survivors, say investigators, after a nurse managed to escape and save one patient, while another patient got out on their own. The dead patients came from a variegated age range, with some as young as 20 and others as old as 76.

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 were not locked.

Vadim Belovoshin, of the Emergencies Ministry, said it took firefighters an hour to get to the hospital because a ferry across the canal was closed forcing emergency personnel to detour. Vorobyev told Russian state television that the fire alarm seems to have worked, but the fire spread from the annex to the main building too quickly.

The hospital had all the right equipment, according to Vorobyev, but he also admitted mental hospitals should be better equipped to handle emergencies like the fire in the early Friday morning.

Russian President Vladimir Putin called for a thorough investigation into the fire and asked regional authorities to pay more attention to safety regulations.

This has been an on-going problem in Russia, which has a poor safety record, after about 12,000 such deaths were reported in 2012. In one high-profile case of negligence, more than 150 died in a night club in the city of Perm after a pyrotechnic show ignited a wooden ceiling.