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RIO DE JANEIRO — A fire raced through a hospital in Rio de Janeiro, forcing staff to wheel patients into the streets on stretchers or in wheelchairs and killing at least 11 people, many of them elderly.

Four firefighters were hospitalized after battling the overnight blaze at Badim Hospital and about 90 patients were transferred to other hospitals, the fire department said. A rope made from bedsheets and used in an attempt to escape the fire still hung from an upper floor window of the hospital Friday.

Most victims died of asphyxiation as smoke filled the wards, and some died when life support equipment stopped working in the fire, said Gabriela Graa, director of the state Institute of Forensic Medicine.

Carlos Outerelo was visiting his sick mother when the fire started Thursday night. The 90-year-old woman, Berta Gonalves Berreiros Sousa, was among the dead.

"They said to stay closed off in the rooms so the smoke couldn't get in, and that it was under control. But in reality, it wasn't under control," Outerelo said outside the morgue where his mother's body was taken.

"The smoke started coming from the air conditioning ducts and it turned black and became hard to see," he said. "It was horrible."

Daniel Freitas de Brito said his 83-year-old mother, Irene Freitas, also died in the fire.

"I lost my mom, which is awful," de Brito said at the morgue. "It*s tragic. ... I wish she had had a natural death, not to die in this way."

When firefighters arrived, they evacuated people but it was more difficult to move patients who were hooked up to medical equipment, according to reports.

Camila Donato, a police spokeswoman, said police were cleared by firefighters to enter the hospital Friday morning and had begun investigating the case.

As the fire burned, medical workers in surgical masks rolled equipment in the road as smoke billowed from the building. Television images showed staff tending to patients sitting in wheelchairs with IV poles beside them in the street, some on sheets and mattresses.

A woman carried an oxygen tank. One patient was moved into the street in a regular hospital bed.

Intensive care patients were among those rescued.

In the chaos, distraught relatives tried to track down patients, unsure of whether they had perished in the fire or had been transferred to another medical facility.

Authorities released a list of names of 10 of the dead, some in their 80s and 90s.

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