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A fire that killed 36 patients at a dilapidated wooden psychiatric facility has exposed Russia's failure to move on from the old Soviet system of punitive psychiatry used against political dissidents.
Two staff and 36 patients -- apparently too sedated or disorientated to escape from their mass dormitory with barred windows -- perished in the fire that broke out on Friday.
In the wake of the tragedy, Russia's national rights ombudsman Valery Lukin reiterated a call for "urgent measures to be taken to ensure real transparency in places where mentally ill people are being held."
"These people are one of the least protected groups in society," Lukin said in his annual rights report last year.
Russia has almost 150,000 beds in in-patient psychiatric facilities, according to 2011 data.
And human rights activists say most of these facilities in Russia were built in the Soviet period when the main construction aim was to provide isolation and direct observation of the patients.
The government has failed to modernise these units, complained the president of the independent psychiatric association, Yury Savenko, in Saturday's Moskovsky Komsomolets daily.
"Back in 2000, the authorities admitted that a third of all psychiatric hospitals in Russia were unusable according to public health regulations. They should really have closed them down and built new ones.
"Instead they took the Western route, pouring money into out-patient services, seeing that as the future. As a result most of the repairs in hospitals were just cosmetic."
Moscow's rights ombudsman Alexander Muzykantsky reported last year that in many cases patients were spending 10 to 20 years in overcrowded hospitals intended for diagnosis and initial treatment, simply because there was nowhere else for them to go.
Friday's fire was the latest in a long list of deadly blazes in state institutions.
In 2006, a fire in a Moscow drug rehabilitation clinic killed 45 women. Many of the victims were trapped by metal bars on the windows that staff could not open and an emergency exit was boarded up, officials said.
"Flaming psychiatry," Kommersant business daily wrote in a headline on Saturday, complaining that no one was likely to be brought to justice for the fire in the village of Ramensky around 100 kilometres (62 miles) from Moscow.
"Doctors were obliged to keep mentally incapable people who were also slowed down by tranquillisers in a wooden building that was a fire-trap," Kommersant wrote.
"The patients were absolutely defenceless against the fire."
Health minister Veronika Skvortsova described the people there as alcoholics, drug addicts and schizophrenics. The eldest were in their 70s but the youngest only in their 20s.
Eleven had no known relatives to identify their remains, she said.
The health ministry said the one-storey wing of Hospital No. 14 where the patients died dated from 1940. It stood in an inaccessible village that firefighters took an hour to reach.
"The windows of all the wards had bars with the medical staff keeping the keys," Komsomolskaya Pravda daily reported, citing the investigation.
The wing did have smoke alarms which woke one nurse who helped two patients escape, but investigators said almost all the dead were found lying in their beds as if they had failed to wake before deadly fumes overcame them.
On Friday, Skvortsova denied speculation the patients could have been tied to their beds or that any other "means of immobilisation" had been used.
This is only done when patients arrive in a disturbed state, a nurse at the facility told Moskovsky Komsolets daily on Saturday.
"They tie up the wild ones, but we didn't have any wild ones yesterday."