Fire crews from Duncan, Cowichan Bay and North Cowichan South End battled a fire at Parkland apartment building in Duncan on Sunday morning.
Health officials say 13 people were sent to hospital.
A medevac helicopter landed at McAdam Park in the middle of a flag football game.
Both residents and firefighters were being treated for smoke inhalation at the scene.
Two school buses were on standby to take residents away from the scene. An emergency shelter was opened in the multi-purpose hall at the Island Savings Centre.
Firefighters were also trying to best place the big fans so as to blow the heavy smoke out of the building.
For updates and additional photos, visit www.cowichanvalleycitizen.com.
– with a file from The Canadian Press