Kunduz hospital airstrike

On 3 October 2015 a United States Air Force AC-130U gunship attacked the Kunduz Trauma Centre operated by Médecins Sans Frontières (MSF) (English name: Doctors Without Borders) in the city of Kunduz, in the province of the same name in northern Afghanistan. It has been reported that at least 30 people were killed and over 30 were injured.

Médecins Sans Frontières condemned the incident, stating that all warring parties had been notified of the hospital's location ahead of time, and that the airstrike was deliberate, a breach of international humanitarian law and MSF is working on the presumption of a war crime.

The United States military initially stated the airstrike was carried out to defend U.S. forces on the ground. Later, the United States commander in Afghanistan, General John F. Campbell, stated the airstrike was requested by Afghan forces who had come under Taliban fire. Campbell stated that the attack was "a mistake", saying "We would never intentionally target a protected medical facility." Campbell stated that the airstrike was a US decision, made in the US chain of command.

On 7 October 2015, President Barack Obama issued a rare apology. Three investigations have been begun into the incident by NATO, a joint United States-Afghan group, and the United States Department of Defense, all of which are conducted by United States government and military officials. Doctors without Borders has called for an international and independent probe, stating that the armed forces who carried out the airstrike cannot conduct an impartial investigation of their own actions.

Background
On 28 September, Taliban militants seized the city of Kunduz, driving government forces out of the city. After the reinforcements arrived, the Afghan army, backed by U.S. airstrikes, began an offensive operation to regain control of the city; after several days of fighting, Afghan forces claimed to have retaken the city. But fighting continued, and on 3 October, a US-led airstrike struck and badly damaged the hospital, killing doctors, staff members and patients.

MSF had informed all warring parties of the location of its hospital complex. MSF personnel had contacted U.S. military officials as recently as 29 September to reconfirm the precise location of the hospital. MSF's report after the action claims that they were contacted by an official from the U.S. Government, who inquired if the location had significant numbers of Taliban militants inside.

Incident
Médecins Sans Frontières reported that between 02:08 and 03:15 local time (UTC+04:30) on the night of 3 October, the organization's Kunduz hospital was struck by "a series of aerial bombing raids". The humanitarian organization said the hospital was "hit several times" in the course of the attack, and that the building was "partially destroyed". They further stated that the hospital had been "repeatedly & precisely hit" and that the attack had continued for 30 minutes after MSF staff contacted U.S. and Afghan officials during the strike.

Confirmation and response
The U.S. military initially stated that there had been an airstrike in the area to defend U.S. forces on the ground, and that "there may have been collateral damage to a nearby medical facility". On NBC Nightly News on October 15, Pentagon correspondent Jim Miklaszewski reported that, based on the accounts of Defense Department sources, cockpit recordings from the AC-130 gunship involved in the incident "reveal that the crew actually questioned whether the airstrike was legal". U.S. and NATO Commander John F. Campbell later confirmed that a U.S. AC-130 gunship made the attack on the hospital and that it was an US decision, contrary to earlier reports that the strike had been requested by local Afghan forces under Taliban fire. He specified that the decision to use aerial fire was "made within the US chain of command". Campbell stated that the attack was "a mistake", saying "We would never intentionally target a protected medical facility." White House spokesman Josh Earnest defended U.S. forces, stating that the U.S. Department of Defense "goes to greater lengths and places a higher premium on avoiding civilian casualties" than any other military in the world, and hinted the U.S. may compensate victims and their families. U.S. President Barack Obama apologized to MSF president Joanne Liu for the incident, saying it was a mistake and was intended to target Taliban fighters. The U.S. will offer "condolence payments" to the families of the victims, and contribute to the rebuilding of the hospital.

The Afghan Interior Ministry spokesman Sediq Sediqi confirmed an airstrike on 3 October, saying that "10–15 terrorists were hiding in the hospital" and confirming that hospital workers had been killed. The Afghan Ministry of Defense and a representative of the police chief in Kunduz also said that Taliban fighters were hiding in the hospital compound at the time of the attack, the latter claiming that they were using it as a human shield.

Médecins Sans Frontières stated that no Taliban fighters were in the compound. Christopher Stokes, general director of Médecins Sans Frontières, said in a statement late 4 October 2015: "MSF is disgusted by the recent statements coming from some Afghanistan government authorities justifying the attack on its hospital in Kunduz. These statements imply that Afghan and U.S. forces working together decided to raze to the ground a fully functioning hospital – with more than 180 staff and patients inside – because they claim that members of the Taliban were present. This amounts to an admission of a war crime." Stokes said, "If there was a major military operation going on there, our staff would have noticed. And that wasn't the case when the strikes occurred." On 5 October, the organization released a statement saying, "Their [U.S.] description of the attack keeps changing -- from collateral damage, to a tragic incident, to now attempting to pass responsibility to the Afghanistan government...There can be no justification for this horrible attack."

Legality
Attacks on medical facilities are forbidden under international humanitarian law unless the facilities "are being used, outside their humanitarian function, to commit acts harmful to the enemy". Even if enemy combatants are inappropriately using the facility for shelter, the rule of proportionality usually forbids such attacks because of the high potential for civilian casualties. Human Rights Watch stated that the laws of war require the attacking force to issue a warning, and wait a reasonable time for a response, before attacking a medical unit being misused by combatants.

At the time of the airstrikes, MSF was treating women and children and wounded combatants from both sides of the conflict. MSF estimates that of the 105 patients at the time of the attack, between 3 and 4 of the patients were wounded government combatants, while approximately 20 patients were wounded Taliban. MSF general director Christopher Stokes stated, "Some public reports are circulating that the attack on our hospital could be justified because we were treating Taliban. Wounded combatants are patients under international law, and must be free from attack and treated without discrimination. Medical staff should never be punished or attacked for providing treatment to wounded combatants."

Hospitals in war zones are protected under the Fourth Geneva Convention. Former International Criminal Tribunal prosecutor M. Cherif Bassiouni suggested that the attack could be prosecuted as a war crime under the Conventions if the attack was intentional or if it represented gross negligence noting, "even if it were proven that the Kunduz hospital had lost that right of protection due to infiltration by Taliban, the U.S. military personnel responsible for the attack would have to prove it was a military necessity to strike that hospital." He said U.S. military officials would have to demonstrate that it was a military necessity to strike the hospital, even if Taliban forces were indeed using it as a human shield, or else claim that the military was unaware of the hospital's location, risking prosecution for negligence. Nonetheless, he said it is unlikely that the case will ever be tried in an international court, because "the U.S. is unlikely to turn any of their service members over to an outside body for prosecution even after facing its own military legal system." Erna Paris speculated that concern over violation of international law may be the cause of the United States' delay in publishing its own report on the attack. She commented, "To leave MSF dangling would seriously undermine the established laws of war."

Writing about the attack, human rights lawyer Jonathan Horowitz noted of that "under certain specific and narrowly tailored conditions, individuals can be attacked even when their actions fall short of carrying weapons or opening fire on the enemy." He emphasized the need for an independent investigation, noting that secrecy from the US and Afghanistan would be damaging to any investigation.

Casualties
Among the casualties, 13 of the 30 dead were MSF staff and 10 were patients, including three children. Seven of the dead were burned beyond recognition and have not been identified as yet. Six intensive care patients were burned to death in their beds, and another patient died after staff had to leave them on the operating table. MSF reported that the 12 staff killed were all Afghan nationals, and that all three of their international staff members who were present survived. A review of the incident released on November 7 by MSF reported that some medical staff were decapitated and lost limbs to shrapnel and others were shot from the air as they tried to flee the burning building.

Facility evacuation and shutdown
The attack made the hospital unusable. All critical patients were referred to other providers, and all MSF staff were evacuated from Kunduz. Before the bombing, the MSF's hospital was the only active medical facility in the area. It has been the only trauma center in northeastern Afghanistan. In 2014, more than 22,000 patients were treated at this emergency trauma center and more than 5,900 surgeries were performed.

Investigations
NATO, the U.S., and Afghanistan have all launched investigations, with U.S. President Barack Obama stating, "The Department of Defense has launched a full investigation, and we will await the results of that inquiry before making a definitive judgment as to the circumstances of this tragedy. [...] I ... expect a full accounting of the facts and circumstances." Obama also gave his "deepest condolences". The top U.S. commander in Afghanistan, John F. Campbell said, "While we work to thoroughly examine the incident and determine what happened, my thoughts and prayers are with those affected. [...] As always, we will take all reasonable steps to protect civilians from harm." U.S. officials stated that U.S. Army Brigadier General Richard Kim would lead the investigation, and that two other investigations will be conducted by NATO and by U.S. military and Afghan security officials. Campbell stated that the U.S. Army would "coordinate" other investigations if necessary. Afghan president Ashraf Ghani appointed a five-member commission to investigate the airstrike as well as the Battle of Kunduz more generally. On Saturday, NATO said it was continuing its inquiry into the bombing and had appointed three US military officers from outside the chain of command to handle the investigation to ensure impartiality. Campbell had appointed US Army Maj. Gen. William Hickman and two brigadier generals to continue the investigation begun by Brig. Gen. Richard Kim, NATO said in a statement. The results of the NATO investigation had been expected last week but appear to have been held up by difficulties in identifying the remains of bodies in the hospital. When the aerial attack began, there were 105 patients in the hospital.

Eleven days after the attack, MSF said an American tank entered the hospital: "Their unannounced and forced entry damaged property, destroyed potential evidence and caused stress and fear." The tank smashed the gate of the hospital complex. The MSF executives who happened to be in the hospital at the time were told that the tank was carrying a US-Nato-Afghan team investigating the attack. The soldiers were unaware of any remaining MSF staff at the site and were in the process of doing damage assessment.

Associated Press report
Associated Press reports that US Special Forces were a half mile away from the hospital at the time of the attack, defending the governor of Kunduz province. Likewise, Afghan forces were a half mile away. However, AC-130 procedures require ground forces to have visual contact with any potential target.

MSF's internal review
MSF does not ask the allegiance of its patients. However, judging from their patients' clothing and other indications, MSF estimated that of the 105 patients at the time of the attack, between 3 and 4 of the patients were wounded government combatants, while approximately 20 patients were wounded Taliban.

MSF's investigation confirmed that "the MSF's rules in the hospital were implemented and respected, including the ‘no weapons’ policy; MSF was in full control of the hospital before and at the time of the airstrikes; there were no armed combatants within the hospital compound and there was no fighting from or in the direct vicinity of the trauma centre before the airstrikes." They asserted that "wounded combatants are patients and must be free from attack and treated without discrimination; medical staff should never be punished or attacked for providing treatment to wounded combatants."

US Military internal investigation
On November 25 2015, General John Campbell, the American commander in Afghanistan, spoke about the results of the investigation and described the incident as "the direct result of avoidable human error, compounded by process and equipment failures." Campbell said that the investigation had showed that the AC-130 gunship crew misidentified the clinic as a nearby Taliban-controlled government building. The American gunship had identified the building based on a visual description from Afghan troops, and did not consult their no-strike list, which included the co-ordinates of the hospital as provided by MSF. Electronic equipment malfunctions on the gunship prevented it from accessing email and images, while a navigation error meant it targeting equipment also misidentified the target buildings. The aircraft fired 211 shells at the building in 29 minutes, before American commanders realized the mistake and ordered the attack to stop. According to the report, 12 minutes into the operation, the US military was contacted by MSF, but the faulty electronics on the plane prevented the message from getting through until the attack was over.

Although the report did not deal with the accusation of war crimes, a Campbell stated that American rules of engagement had been violated and the involved soldiers were suspended and awaiting discipline. MSF said the report was evidence of "gross negligence" on the part of the American armed forces.

Calls for independent investigations
Médecins Sans Frontières called for an independent inquiry of the air attack on the hospital. The organization's general director, Christopher Stokes, stated, "We need an investigation that's as independent and as transparent as possible, and we don't only want the findings to be shared, we want – as well – to be able to read the full report." He also said that, "Relying only on an internal investigation by a party to the conflict would be wholly insufficient. [...] Under the clear presumption that a war crime has been committed, MSF demands that a full and transparent investigation into the event be conducted by an independent international body." The medical journal, The Lancet, supported this call for an independent investigation.

The UN High Commissioner for Human Rights, Zeid Ra'ad Al Hussein, also demanded an investigation, saying, "This event is utterly tragic, inexcusable, and possibly even criminal. 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."

The MSF has demanded that an independent investigation be conducted into the attack. The charity has specified that the International Humanitarian Fact-Finding Commission, which is based in Bern, should undertake this work.

Jason Cone, MSF's U.S. executive director, said an armored vehicle full of investigators arrived unannounced on 15 October at the hospital facility and crashed through its gates. In a statement, MSF said the investigators destroyed "potential evidence." A U.S. coalition spokesman told NBC, "We are aware of the incident and are looking into what happened." A Pentagon spokesman, Captain Jeff Davis, said the troops were in an "Afghan, tracked vehicle", but not a tank, and crashed through a locked gate. "They did it, they shouldn't have."

Allegations of bias and self-censorship
Journalist Glenn Greenwald condemned The New York Times and CNN for initially describing the attack as under investigation by U.S. forces, but unlike other media, failing to mention that U.S. forces had themselves attacked the hospital.