MOSCOW — When flames shot out of Psychiatric Hospital No. 14 at 2 a.m. on Friday, people in the village of Ramensky crept as close as they could, knowing that patients and medical staff were probably trapped inside. But fire raged through the 73-year-old wooden building, and there was nothing to put it out with.

“What could you do?” one neighbor told a television crew. “You couldn’t help them with a bucket of water from a ditch. There was no hose, no hydrant.”

An alarm had sounded at the nearest fire station 30 miles away, across a rain-swollen canal with a ferry that will not operate until summer. So the firefighters took a long detour, and arrived an hour later.

By morning, the hospital was nothing but black walls and a row of bed frames filled with ashes. A spokeswoman for the Investigative Committee said many of the dead had been burned alive.