http://www.nytimes.com/2015/10/04/world/asia/afghanistan-bombing-hospital-doctors-without-borders-kunduz.html

OCT. 3, 2015

Airstrike Hits Doctors Without Borders Hospital in Afghanistan

By ALISSA J. RUBIN

KABUL, Afghanistan -- A crowded hospital in the embattled city of Kunduz that treats war wounded came under attack on Saturday and the American military acknowledged that it may have killed 19 patients, staff members and others at the facility while firing on insurgents nearby.

The attack, which the military said in a statement might have been "collateral damage" that occurred while engaging militants, drew a fierce international outcry. The head of the United Nations, Ban Ki-moon, condemned it and called for a "thorough and impartial investigation." It also renewed scrutiny of the United States military's record of causing civilian casualties, which has alienated the Afghan public and often undermined relations with the government here.

At least 12 staff members and seven patients -- including three children -- were killed when the hospital, run by Doctors Without Borders, was badly damaged in the airstrike early Saturday in Kunduz. At least 37 were wounded, and some were flown to Kabul for treatment.

The United States military, in a statement, confirmed an airstrike at 2:15 a.m., saying that it had been targeting individuals "who were threatening the force" and that "there may have been collateral damage to a nearby medical facility."

One American official, who requested anonymity to discuss early reports of an event now under official investigation, said the attack may have been carried out by an American AC-130 gunship that was supporting Special Operations forces on the ground in Kunduz. The top United States commander in Afghanistan, Gen. John F. Campbell, said that American troops had come under fire in the vicinity of the hospital and that an investigation into the airstrike had begun.

President Obama issued a statement offering condolences to the victims in what he called "the tragic incident" in Kunduz. However, noting the Defense Department investigation, he said "we will await the results of that inquiry before making a definitive judgment as to the circumstances of this tragedy."

The attack will bring renewed criticism of the United States for failing to minimize civilian casualties. The military has been playing an increasingly active role in Afghanistan amid a Taliban resurgence, particularly in the northern province of Kunduz.

The airstrike on Saturday set off fires that were still burning hours later, and a nurse who managed to climb out of the debris described seeing colleagues so badly burned that they had died.

Another nurse, Lajos Zoltan Jecs, described looking into the intensive care unit and seeing the bodies of six patients burning in their beds. "There are no words for how terrible it was," he said in a statement issued by the aid organization.

The group, which is also known by its French initials, MSF, said the bombing continued for 30 minutes after the United States and Afghan militaries were informed by telephone that the hospital was being bombed.

"All parties to the conflict including in Kabul and Washington were clearly informed of the precise location [GPS Coordinates] of the MSF facilities -- hospital, guesthouse, office," the group said in a statement.

"MSF urgently seeks clarity on exactly what took place and how this terrible event could have happened," it said. Doctors Without Borders is highly respected for its work in conflict zones and was awarded the Nobel Peace Prize in 1999.

President Ashraf Ghani's office released a statement on Saturday evening saying that General Campbell had apologized for the strike. However, General Campbell said in a statement that he was "aware of an incident that occurred at a Doctors Without Borders hospital in Kunduz" but suggested that it was justified, saying that the airstrike "was conducted against insurgents who were directly firing upon U.S. service members advising and assisting Afghan Security Forces."

However, General Campbell said the military opened a formal inquiry into the attack known as a 15-6 investigation. The results will be sent up the chain of command and can lead to administrative or nonjudicial punishments, or to court-martial.

Airstrikes resulting in civilian casualties have caused tensions verging on hostility between the Afghan government and the United States for years. The former president, Hamid Karzai, was often in the uncomfortable position of explaining to his countrymen why Afghanistan's biggest ally was killing innocent Afghans.

Mr. Ghani has been largely spared such confrontations since taking power last year. Although the United States military has kept up a steady stream of airstrikes, it has mostly targeted small groups. And with greatly reduced troop levels there have been far fewer mistakes.

The United Nations high commissioner for human rights, Zeid Ra'ad al-Hussein, called the airstrike "utterly tragic, inexcusable, and possibly even criminal." Mr. al-Hussein also said, "International and Afghan military planners have an obligation to respect and protect civilians at all times, and medical facilities and personnel are the object of a special protection. These obligations apply no matter whose air force is involved, and irrespective of the location."

The strike came as the United States, for the first time since it began withdrawing most of its soldiers from Afghanistan, has begun to play an increasingly active role in the fight there. It is trying to support Afghan troops overwhelmed by the Taliban in Kunduz Province.

The Taliban took control of Kunduz City on Monday and despite sporadic but often intense fighting over the last three days, their white flag is still flying over the main square.

Accounts differed as to whether there had been fighting around the hospital that might have precipitated the strike. Three hospital employees, an aide who was wounded in the bombing and two nurses who emerged unscathed, said that there had been no fighting in the hospital's immediate vicinity and no Taliban fighters in the hospital.

But a Kunduz police spokesman, Sayed Sarwar Hussaini, said Taliban fighters had entered the hospital and were using it as a firing position. The hospital treated the wounded from all sides of the conflict, a policy that has long irked Afghan security forces. In a Twitter post, Arjan Hehenkamp, [1] director of Doctors Without Borders in the Netherlands, denied that Taliban fighters had been in the hospital, saying that only staff, patients and caretakers had been inside.

Video of the hospital grounds posted Saturday showed fires still burning, blackened walls and, in one building, a collapsed ceiling. One side of one building appeared to be pockmarked by bullets or possibly shrapnel, suggesting that there could have been fighting there. But it was impossible to tell whether the marks were new.

The organization described the facility as "very badly damaged."

The United States Embassy in Kabul said it "mourns for the individuals and families affected by the tragic incident at the Doctors Without Borders hospital, and for all those suffering from the violence in Kunduz." A hospital nurse, who asked not to be identified because he had instructions not to speak to reporters, said that two nurses had been killed, as well as at least three doctors, a pharmacist and two guards. "Most of my colleagues died in the fire after the bombing," he said.

"When the bombing occurred we were treating patients, then we lost our way. Everyone stumbled and fumbled to escape," the nurse said. "I don't even remember how I got out."

Another nurse described treating himself because there was no one to help him.

Doctors Without Borders said 105 patients and caretakers had been at the hospital, along with 80 staff members. The hospital was "partially destroyed" in the bombing, the group said, adding that it had been "hit several times."

When the military describes a single airstrike, it can mean that more than one bomb was dropped on a single target. Similarly, if an attack is carried out by helicopters or drones, there may be more than one missile or rocket fired, but if there is a single target, it is often described as just one airstrike, according to the military.

The Afghan Army has also been using helicopters to attack targets in Kunduz, and a spokesman for the brigade in Kunduz, Ghulam Hazrat, said that Afghan helicopters were "maneuvering and targeting enemies." It was not yet clear whether Afghan aircraft had been involved in the attack.

The International Committee of the Red Cross condemned the bombing.

"This is an appalling tragedy," said Jean-Nicolas Marti, the head of the organization's delegation in Afghanistan. "Such attacks against health workers and facilities undermine the capacity of humanitarian organizations to assist the Afghan people at a time when they most urgently need it."

Kunduz has been the scene of heavy fighting since Thursday, when Afghan government security forces began a counterattack against the Taliban.

Although the hospital was overwhelmed in recent days by civilians wounded in the fighting and was running short of supplies, staff members continued to work. Early on, the Taliban had respected the hospital's request not to bring weapons inside, according to staff members, and the hospital had been a refuge in the shattered city.

The United States began dropping bombs on the Kunduz area on Tuesday in an effort to aid Afghan forces.

The civilian deaths in the Saturday airstrike, and the discrepancies in the accounts of what led to the bombing, were painful reminders of scores of earlier mistakes by American forces as they hit civilians. Among them: women, children and the elderly at weddings, travelers on roads, villagers and Afghans gathering firewood.

Although such mistakes have accounted for an ever smaller fraction of civilian deaths in the war, each one has taken on magnified significance in the eyes of many Afghans because it is the fault of a foreign power. That has done much to alienate the Afghan population, which in turn has hurt the United States-led forces and their Afghan government allies.

The most recent report from the United Nations found that the United States is now responsible for just 1 percent of civilian casualties.

Civilian casualties from coalition airstrikes have also engendered support for the insurgency. Whatever the Taliban's atrocities, and there have been many, the insurgents do not have aircraft and the devastating capability to kill from above. Nonetheless, in the first half of 2015, the Taliban and other antigovernment forces were responsible for 70 percent of civilian casualties.

In 2012, the United States military reached an agreement with then-President Hamid Karzai to sharply limit the circumstances in which air support was used, and to avoid population centers and Afghan homes almost entirely.

At the time, exceptions were allowed for extraordinary circumstances: for instance, when Afghan government forces requested help. It was unclear whether those rules remained in place.

The United Nations says that 19,368 civilians have been killed in fighting in Afghanistan since 2009, when the world body began to keep detailed statistics. Nearly 33,300 have been wounded.

Reporting was contributed by Jawad Sukhanyar and Ahmad Shakib from Kabul; an employee of The New York Times from Baghlan Province, Afghanistan; and Eric Schmitt from Washington.

[1] https://twitter.com/Arjan_Hehenkamp/status/650421356216061952