The fire in the one-story hospital in the village of Luka in the northwestern Novgorod region erupted at around 3 am today and quickly engulfed the mostly wooden structure dating back to the 19th century, the Emergency Situations Ministry said.
Emergency had demanded the facility be closed, but the hospital administration won permission to use it until next year.
Officials said the blaze was likely sparked by a smoking patient, and state Rossiya 24 television reported that a witness account confirmed that. It said that the man who triggered the fire was saved.
More than 34 people have remained unaccounted for and feared dead. Emergency workers were combing a nearby forest for patients who may have fled the blaze.
Russia has a poor fire safety record, with about 12,000 deaths reported in 2012. By comparison, the US, with a population roughly double Russia's, recorded around 3,000 fire deaths in 2011.
A similar fire at a psychiatric hospital near Moscow killed 38 people in April.
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