Four ISIS gunmen, disguised as doctors, broke into the Afghan military hospital in the capital city of Kabul today, blowing up a gate and forcing their way in, before opening fire on staff and patients alike, leaving a huge casualty toll.

Exact figures are still coming in, but early reports said more than 30 people killed and more than 50 others wounded. Later reports showed the death toll rising substantially, with most recent figures putting it at 49 killed and 63 wounded. The Taliban was quick to condemn the attack, and to disavow any involvement. ISIS later confirmed it was their fighters who carried out the attack.

This is the latest in a growing series of recent attacks around Kabul, but marks the first time ISIS forces have directly attacked security forces in one of the incidents, with previous capital attacks involving infiltration of secure sites and carrying out high-profile bombings.

While Afghan officials naturally condemned the move as ISIS sinking to a new low, the real story is that even a military hospital is not defended enough to prevent such an attack, as despite the gunmen wearing disguises, they bombed the gate, which clearly would give a signal that they weren’t proper doctors.