A report by Medecins Sans Frontieres (MSF) has given a gruesome account of how medical staff were killed and severely wounded by a US gunship as they treated patients at a hospital in the northern Afghan city of Kunduz early last month.
The death toll was originally estimated at 22, but MSF said at least 30 staff and patients were killed when they came under “relentless and brutal aerial attack” from the US gunship circling above.
The attack began at 2:00am on October 2 and lasted more than an hour, despite frantic efforts by MSF staff to alert the US, NATO, the UN and other authorities to end the assault.
“Patients burned in their beds, medical staff were decapitated and lost limbs, and others were shot by the circling AC-130 gunship while fleeing the burning building,” the report said.
MSF’s internal review of the attack describes the assault as a war crime.
“The view from inside the hospital is that this attack was conducted with the purpose to kill and destroy,” MSF’s general director Christopher Stokes said.
“We are still expecting and hoping to get a really detailed version of what happened that night and a clear explanation. Because all the information that we have provided so far, shows that a mistake is quite hard to understand and believe at this stage.”
The US later apologised, but MSF is demanding a full and independent investigation.
NATO sent SMS during attack: ‘Praying for you all’
The report recounts a series of desperate phone calls and text messages sent between 2:19am and 3:18am, alerting military and civilian authorities to the airstrikes and demanding the attack stop.
At 2:52am an SMS reply was sent from the NATO-led Resolute Support saying “I’m sorry to hear that”.
MSF staff sent another text at 2:56am alerting Resolute Support that the hospital had sustained heavy casualties. A reply came back at 2:59am saying “I’ll do my best, praying for you all”.
In graphic detail the report describes how the hospital was full and very busy on the night of the attack, with 105 patients, including about 20 Taliban and 34 wounded government combatants.
About 150 MSF staff were inside the hospital at the time. Many were in operating theatres carrying out surgery when “a series of multiple, precise and sustained airstrikes” suddenly hit the main hospital building.
MSF staff recalled the first room to be hit was the Intensive Care Unit (ICU) where medical staff were caring for a number of immobile patients, some of whom were on ventilators. Two of the patients were children.
“The ICU, archive, laboratory, ER, X-ray, outpatient department, mental health and physiotherapy departments as well as the operating theatres were all destroyed in this wave after wave of strikes,” the report said.
“After the first strike, MSF medical teams working in the operating theatres ran out of the OT and sought shelter in the sterilisation room. The two patients on the operating table in the OTs were killed in the airstrikes.
“The MSF international staff members sleeping in the administrative building were woken up by the sound of the first explosions.
“An MSF nurse arrived at the administrative building covered from head to toe in debris and blood with his left arm hanging from a small piece of tissue after having suffered a traumatic amputation in the blast.
“The MSF nurse was bleeding from his left eye and oropharynx. Immediate treatment was provided in an attempt to stabilise the nurse by the medical team in the administrative building.”
People shot as they tried to escape, patient in wheelchair felled by shrapnel
Many staff described seeing people shot, “most likely from the plane”, as they tried to flee.
They recounted how the shooting appeared to deliberately follow the movement of people as they ran from the hospital.
“One MSF staff member described a patient in a wheelchair attempting to escape from the in-patient department when he was killed by shrapnel from a blast,” the report said.
“An MSF doctor suffered a traumatic amputation to the leg in one of the blasts. He was later operated on by the MSF team on a make-shift operating table on an office desk where he died.
“Other MSF staff describe seeing people running while on fire and then falling unconscious on the ground. One MSF staff was decapitated by shrapnel in the airstrikes. The US airstrikes stopped between 3:00am and 3.13am.”
MSF said there were no weapons, armed combatants or fighting inside the compound in Kunduz before the bombing started.
It said the GPS coordinates for the hospital provided to all armed groups were accurate.
“Our hospital was definitely, all the rules that we had negotiated to have no arms inside the hospital, was respected. So that’s first of all. Second, what we knew already of course, was that it was a full, functional hospital, full with sick people. Third, that there was no fighting in or in the near vicinity of the hospital,” MSF president Meinie Nicolai said.
The US initially said its forces had come under fire, but later said the airstrikes were requested by Afghan forces under Taliban fire during fighting in the city.
In its conclusion, the MSF report said there was an urgent need for a widely agreed upon and unambiguous recognition of the practical rules under which hospitals operate in conflict zones.
“A functioning hospital caring for patients, such as the one in Kunduz, cannot simply lose its protection and be attacked,” it said.
“Wounded combatants must be treated without discrimination and cannot be attacked. Medical staff cannot be punished or attacked for providing treatment to wounded combatants.
“There are still many unanswered questions including who took the final decision, who designated, who gave the target and instruction for the hospital,” MSF general director Christopher Stokes said.
“For the moment we still have not received reassuring, clear explanations as to what happened and that is why we are not in the position also to restart the hospital for the moment.”