Kunduz hospital airstrike

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Kunduz hospital airstrike
Part of Battle of Kunduz and the War in Afghanistan (2015–present)
Kunduz MSF Trauma Center - location map - 01.png
Location of Kunduz MSF Trauma Center within Kunduz
Type Airstrike
Target Kunduz Trauma Centre, Médecins Sans Frontières hospital
Date3 October 2015 (2015-10-03)
Executed by Flag of the United States.svg AC-130U, call sign "Hammer", assigned to 4th Special Operations Squadron, United States Air Force [1]
Casualties42 killed
33 missing, over 30 injured

On 3 October 2015, a United States Air Force AC-130U gunship attacked the Kunduz Trauma Centre operated by Médecins Sans Frontières (MSF), or 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 42 people were killed and over 30 were injured. [2] [3] [4] [5] [6] [7]

United States Air Force Air and space warfare branch of the United States Armed Forces

The United States Air Force (USAF) is the aerial and space warfare service branch of the United States Armed Forces. It is one of the five branches of the United States Armed Forces, and one of the seven American uniformed services. Initially formed as a part of the United States Army on 1 August 1907, the USAF was established as a separate branch of the U.S. Armed Forces on 18 September 1947 with the passing of the National Security Act of 1947. It is the youngest branch of the U.S. Armed Forces, and the fourth in order of precedence. The USAF is the largest and most technologically advanced air force in the world. The Air Force articulates its core missions as air and space superiority, global integrated intelligence, surveillance, and reconnaissance, rapid global mobility, global strike, and command and control.

Lockheed AC-130 gunship aircraft based on the C-130 Hercules

The Lockheed AC-130 gunship is a heavily armed, long-endurance ground-attack variant of the C-130 Hercules transport fixed-wing aircraft. It carries a wide array of anti-ground oriented weapons that are integrated with sophisticated sensors, navigation, and fire-control systems. Unlike other military fixed-wing aircraft, the AC-130 relies on visual targeting. Because its large profile and low operating altitudes make it an easy target, it usually flies close air support missions at night.

The Kunduz Trauma Centre was a hospital operated by Médecins Sans Frontières (MSF) in Kunduz, Afghanistan from 29 August 2011 until 3 October 2015 when it was destroyed in an airstrike by a United States Air Force AC-130U gunship.


Médecins Sans Frontières condemned the incident, saying 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. [8] [9]

International humanitarian law (IHL) is the law that regulates the conduct of war. It is that branch of international law which seeks to limit the effects of armed conflict by protecting persons who are not participating in hostilities, and by restricting and regulating the means and methods of warfare available to combatants.

The United States military initially said the airstrike was carried out to defend U.S. forces on the ground. Later, the United States commander in Afghanistan, General John F. Campbell, said the airstrike was requested by Afghan forces who had come under Taliban fire. Campbell said the attack was "a mistake", and "We would never intentionally target a protected medical facility." [10] [11] Campbell said the airstrike was a US decision, made in the US chain of command. In the 15-6 report generated by US Central Command military investigators cited General Campbell's own lack of direction and failure in providing guidance as contributing factors leading to the command and control breakdown prior to the strike. [12] Anonymous sources alleged that cockpit recordings showed the AC-130 crew questioned the strike's legality. [13]

John F. Campbell (general) US Army General

John Francis Campbell was the commander of the Resolute Support Mission and United States Forces - Afghanistan. He was the last commander of the International Security Assistance Force. Prior to this, he served as the 34th Vice Chief of Staff of the United States Army. He is currently a member of the board of directors of BAE Systems.

Taliban Islamic fundamentalist political movement in Afghanistan

The Taliban or Taleban, who refer to themselves as the Islamic Emirate of Afghanistan (IEA), are a Sunni Islamic fundamentalist political movement and military organization in Afghanistan currently waging war within that country. Since 2016, the Taliban's leader is Mawlawi Hibatullah Akhundzada. The leadership is based in Quetta, Pakistan.

A command hierarchy is a group of people who carry out orders based on others authority within the group. It can be viewed as part of a power structure, in which it is usually seen as the most vulnerable and also the most powerful part.

On 7 October 2015, President Barack Obama issued an apology and announced the United States would be making condolence payments to the families of those killed in the airstrike. [14] [15] Three investigations of the incident were conducted by NATO, a joint United States-Afghan group, and the United States Department of Defense. The Department of Defense released its findings on 29 April 2016. MSF has called for an international and independent probe, saying the armed forces who carried out the airstrike cannot conduct an impartial investigation of their own actions. [15]

Barack Obama 44th president of the United States

Barack Hussein Obama II is an American attorney and politician who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, he was the first African American to be elected to the presidency. He previously served as a U.S. senator from Illinois from 2005 to 2008.

NATO Intergovernmental military alliance of Western states

The North Atlantic Treaty Organization, also called the North Atlantic Alliance, is an intergovernmental military alliance between 29 North American and European countries. The organization implements the North Atlantic Treaty that was signed on 4 April 1949. NATO constitutes a system of collective defence whereby its independent member states agree to mutual defence in response to an attack by any external party. NATO’s Headquarters are located in Haren, Brussels, Belgium, while the headquarters of Allied Command Operations is near Mons, Belgium.

United States Department of Defense United States federal executive department

The Department of Defense is an executive branch department of the federal government charged with coordinating and supervising all agencies and functions of the government concerned directly with national security and the United States Armed Forces. The department is the largest employer in the world, with nearly 1.3 million active duty servicemen and women as of 2016. Adding to its employees are over 826,000 National Guardsmen and Reservists from the four services, and over 732,000 civilians bringing the total to over 2.8 million employees. Headquartered at the Pentagon in Arlington, Virginia, just outside Washington, D.C., the DoD's stated mission is to provide "the military forces needed to deter war and ensure our nation's security".

The attack


On 28 September 2015, 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. However, fighting continued, and on 3 October, a US-led airstrike struck and badly damaged Kunduz Trauma Centre operated by Médecins Sans Frontières (MSF), killing doctors, staff members and patients.

Médecins Sans Frontières organization

Médecins Sans Frontières, also known in English as Doctors Without Borders, is an international humanitarian medical non-governmental organisation (NGO) of French origin best known for its projects in conflict zones and in countries affected by endemic diseases. In 2015, over 30,000 personnel—mostly local doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers and administrators—provided medical aid in over 70 countries. The vast majority of staff are volunteers. Private donors provide about 90% of the organisation's funding, while corporate donations provide the rest, giving MSF an annual budget of approximately US$1.63 billion.

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. [16] Two days prior to the attack Carter Malkasian, adviser to the Joint Chiefs of Staff, emailed MSF asking if the facility had Taliban militants "holed up" inside. [17] [18]

Geographic coordinate system Coordinate system

A geographic coordinate system is a coordinate system that enables every location on Earth to be specified by a set of numbers, letters or symbols. The coordinates are often chosen such that one of the numbers represents a vertical position and two or three of the numbers represent a horizontal position; alternatively, a geographic position may be expressed in a combined three-dimensional Cartesian vector. A common choice of coordinates is latitude, longitude and elevation. To specify a location on a plane requires a map projection.

Joint Chiefs of Staff body of senior uniformed leaders in the U. S. Department of Defense who advise the President on military matters

The Joint Chiefs of Staff (JCS) is a body of senior uniformed leaders in the United States Department of Defense who advise the President of the United States, the Secretary of Defense, the Homeland Security Council and the National Security Council on military matters. The composition of the Joint Chiefs of Staff is defined by statute and consists of the Chairman of the Joint Chiefs of Staff (CJCS), Vice Chairman of the Joint Chiefs of Staff (VCJCS), the Military Service Chiefs from the Army, Marine Corps, Navy, and Air Force, and the Chief of the National Guard Bureau, all appointed by the President following Senate confirmation. Each of the individual Military Service Chiefs, outside their Joint Chiefs of Staff obligations, works directly for the Secretary of the Military Department concerned, i.e., Secretary of the Army, Secretary of the Navy, and the Secretary of the Air Force.

The 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". [10] [19] The humanitarian organization said the hospital was "hit several times" in the course of the attack, and that the building was "partially destroyed". [20] It further said 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. [21] [22] An 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. [23] [24]

Confirmation and response

The U.S. military initially said 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". [20] On 15 October NBC Nightly News reported that according to Defense Department sources, cockpit recordings from the attacking AC-130 gunship "reveal that the crew actually questioned whether the airstrike was legal". [13] 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 a US decision, contrary to earlier reports that the strike had been requested by local Afghan forces under Taliban fire. [10] [11] He specified that the decision to use aerial fire was "made within the US chain of command". [25] Campbell said the attack was "a mistake", and "We would never intentionally target a protected medical facility." [26] White House spokesman Josh Earnest defended U.S. forces, saying 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. [19] [27] 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. [27] The U.S. will offer "condolence payments" to the families of the victims, and contribute to the rebuilding of the hospital. [28] [29]

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. [30] 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. [4] [31]

Médecins Sans Frontières said 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." [32] 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." [31] 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." [19]


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. [25] Human Rights Watch said 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. [25] [33]

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. [34] MSF general director Christopher Stokes said, "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." [34]

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", 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. [35] 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." [35] 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." [36]

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. But this alone does not necessarily justify the attack on the hospital." [37] He emphasized the need for an independent investigation, noting that secrecy from the US and Afghanistan would be damaging to any investigation. [37]


Previous to 12 December when new figures were released, casualty reports listed 30 dead including 13 MSF staff (three of them doctors [38] ), 10 patients, and seven burned beyond recognition and as yet unidentified. MSF reported that six intensive care patients were burned to death in their beds, and another patient died after staff had to leave the individual on the operating table. [3] [5] [39] [40] They reported that the 12 staff killed were all Afghan nationals, and that all three of their international staff members who were present survived. [41] A review of the incident released on 7 November 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. [34]

On 12 December, MSF released a new report following an "exhaustive investigation [that] included combing through the rubble of the hospital to find further human remains, interviewing family members of missing victims and crosschecking with other hospitals." The new figure for the number of deaths is "at least 42 people", including 14 staff members, 24 patients and four relatives of patients. [42]

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. [4] 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. [43]


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. [34]

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." [34]

Calls for independent investigations

Médecins Sans Frontières called for an independent inquiry of the air attack on the hospital, accusing the United States of committing a "war crime" and calling an internal U.S. investigation insufficient. [31] [44] The call for an independent investigation was supported by The Lancet (a medical journal), [45] and the UN High Commissioner for Human Rights, Zeid Ra'ad Al Hussein. [46] MSF suggested that the International Humanitarian Fact-Finding Commission, which is based in Bern, should undertake this work. [47]

Afghan investigation

Afghan president Ashraf Ghani appointed a five-member commission to investigate the airstrike as well as the Battle of Kunduz more generally. [29]

NATO investigation

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. [2]

U.S. investigation, apology, and reparations

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. [48] [49] [50] [51] [52]

On 25 November 2015, General John F. 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." [53] Campbell said that the investigation had showed that the AC-130 gunship crew misidentified the clinic as a nearby Taliban-controlled government building. [53] 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. [53] Electronic equipment malfunctions on the gunship prevented it from accessing email and images, while a navigation error meant its targeting equipment also misidentified the target buildings. [54] The aircraft fired 211 shells at the building in 29 minutes, before American commanders realized the mistake and ordered the attack to stop. [54] The report found that the MSF facility "did not have an internationally-recognized symbol to identify it as a medical facility,". [55] This finding was contested by Joe Goldstein stating that the facility had a MSF symbol on it. [56] 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. [54]

A final report, released 29 April 2016, reaffirmed the incident as an accident, and said it thus did not amount to a war crime. [57] Sixteen members of the U.S. military were disciplined as a result of the investigation, though none were criminally charged. [58] Twelve personnel involved in the strike were punished with "suspension and removal from command, letters of reprimand, formal counseling and extensive retraining". The U.S. government said that more than 170 condolence payments had been made, $3,000 for wounded people and $6,000 for dead, and $5.7 million was set aside for the hospital's reconstruction. [57]

Accusations of biased press coverage

Glenn Greenwald of The Intercept accused CNN and The New York Times of "deliberately obscuring who perpetrated the Afghan hospital attack" during the first thirty-six hours after the airstrike, alleging that their reporting was "designed to obfuscate who carried out this atrocity." [59]

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Coordinates: 36°43′05″N68°51′44″E / 36.7180°N 68.8623°E / 36.7180; 68.8623