After the Taliban swept through the north Afghan city of Kunduz last autumn, and the government launched a bloody offensive to retake it, only one hospital offered real hope of survival to those caught by bullets, rockets or grenades.

So in the early hours of 3 October, the wards of the Médecins Sans Frontières trauma centre were full, and its exhausted surgeons were working late into the night to tackle a backlog of major surgeries. They were tired but not overly frightened. The raging battles of the last week seemed to have calmed slightly and, while war is always unpredictable, the doctors inside the walled compound had considered themselves as safe as anyone can be near heavy fighting.

Medical facilities are protected under international humanitarian law, and the charity has won the Nobel peace prize for its work across the world’s conflict zones.

Foreign forces had registered the hospital’s location and were expected to know the rules of war. All weapons were banned in hospital grounds, and both government and Taliban fighters sought treatment inside its walls, meaning neither had an incentive to attack it. But at around 2am, a blast ripped apart the intensive care unit, where patients included two children. It was the start of around an hour of airstrikes on the buildings, and strafing attacks on doctors, patients and staff desperately seeking shelter in corners of the compound.

As the attack planes returned again and again, and the hospital collapsed and burned, MSF staff inside the hospital, in Kabul and in the United States put in frantic calls to contacts in the US military from Afghanistan to Washington DC. They appeared to have no effect. As the attack wound down, a representative of Nato’s Resolute Support mission in the Afghan capital sent a text to the charity saying: “I’ll do my best, praying for you all.”

By then at least 30 people were dead or dying, some burned beyond recognition; others were killed on the operating table. Dozens more were horribly injured.

The top US general in Afghanistan described the attack as a “tragic mistake” and said the gunship’s targeting systems failed. MSF called for an independent investigation into the airstrikes, pointing to a string of discrepancies between the official US military account and witness reports of how the horror unfolded.

Dr Kathleen Thomas is an intensive care doctor from Australia, and was on her first trip with MSF at the time of the attack. Here, she offers an eyewitness account of the bombing – and its aftermath. Emma Graham-Harrison





Dr Kathleen Thomas: ‘The plane hit with alarming precision’

Kathleen Thomas with the Kunduz hospital team. Photograph: MSF

It was about two in the morning when I was woken by the sounds of intense fighting. Having been in Kunduz for five months of the “fighting season” I had grown accustomed to the sounds of war … but this was different. It was close, heavy, and coming from all directions. So, as had also become a habit when fighting became audible, I waited for the phone call from the ER announcing the onslaught of patients and the request for help. It took hours for that phone call to arrive – the fighting was too heavy for anyone injured to actually get to the hospital… but then, as the sun rose on Monday, 28 September, the fighting slowed momentarily, the call came, and began what would be the longest week of my life.

The first day was chaos – more than 130 patients poured through our doors in only a few hours. Despite the heroic efforts of all the staff, we were completely overwhelmed. Most patients were civilians, but some were wounded combatants from both sides of the conflict. When I reflect on that day now, what I remember is the smell of blood that permeated through the emergency room, the touch of desperate people pulling at my clothes to get my attention begging me to help their injured loved ones, the wailing, despair and anguish of parents of yet another child lethally injured by a stray bullet whom we could not save, my own sense of panic as another and another and another patient was carried in and laid on the floor of the already packed emergency department, and all the while in the background the tut-tut-tut-tut of machine guns and the occasional large boom from explosions that sounded way too close for comfort.

At about 10pm that night, the hospital slowed enough for me to sit down with some of the senior staff. We realised that it was not safe to move in or out of the hospital. This meant that no new staff could relieve the exhausted doctors, nurses, cleaners, stretcher-bearers, lab technicians, guards etc, many of whom had already worked for more than 24 hours straight. So we began what would become the twice-daily ritual of organising a roster of sleeping shifts, reluctantly accepting that this was likely to be a marathon, not just a quick sprint.

At the time of the airstrike, there were patients on the tables being attended to by surgeons and anaesthetists. Photograph: Dan Sermand/MSF

The hospital swelled far beyond our capacity that week. On the wards, all the beds were pushed close together to place additional mattress on the floor. The OT ran all day and night to accommodate the ever-expanding list of injured patients. The demand for intensive care treatment was constant. We did our best with our limited resources, but helplessly watched numerous patients die who, in normal circumstances, would have survived. Dr Osmani was my right hand man in the intensive care unit that week, a bright young doctor, full of energy. He took great interest in his country and the rest of the world. He had actually resigned from the hospital several months earlier to start ophthalmology training in Kabul, but had agreed to return to Kunduz every weekend to work in ICU.

Dr Osmani was the senior doctor in the unit the night the fighting started and decided to stay with us, camping out in the hospital throughout the week. He had nothing with him except the clothes on his back, not even a toothbrush. His family were extremely worried for his welfare. He had a constant flow of phone calls checking on him, probably asking him to leave. We all knew that at times, our hospital was in the middle of the rapidly changing front line – we could feel it. When the fighting was close - the shooting and explosions vibrated the walls. I was scared – we were all scared. When a loud “BOOM” would sound a bit closer to the hospital, we would all drop to the floor away from the large windows that lined the ICU walls. We also tried to move the patients and large (flammable) oxygen bottles away all from the windows, but the layout of the ICU prohibited doing this effectively. I worried constantly about the exposure from those windows – yet never thought to worry about the exposure from the roof.

By the end of the week we were physically, mentally and emotionally exhausted. There were moments when a sense of hopelessness overwhelmed us. Dr Osmani expressed these sentiments on the final day, following a tragic incident where a family trying to escape Kunduz was caught in crossfire, killing several children at the scene, then two more dying in our ER and OT. The remaining children were being treated with severe injuries, he stated: “the people are being reduced to blood and dust. They are in pieces.”

I will never forget a few hours later I was passing through ER when Dr Sohrab, the ER supervisor, called me over. He was holding a six-month-old baby. After five months working side-by-side, it was the first time I had ever seen him look distressed. He told me that he had just declared the baby’s mother dead. When a bomb exploded in the road she had thrown herself over the baby, taking her life but saving his. As we walked towards the female ward to leave this beautiful baby in the female nurses’ care, he confessed to me, “It’s too much Kass, it’s just too much. This was the first time I couldn’t hold back my tears.” Day five, the final day, was also one of unexpected optimism in ICU. Most of our patients were recovering from their serious injuries and were on track for imminent departure from ICU. Wahidullah in bed eight was my miracle boy. He was a 12-year-old, the “top of his class”, his father had proudly told me, who had suffered a traumatic brain injury about two weeks earlier from a car accident. Despite our best efforts, he had remained in a coma with no signs of recovery. He had been moved to the ward prematurely due to the demand for ICU beds and the need to rationalise our limited resources to those who had the best chance of survival. Unfortunately, we didn’t think he would.

MSF response Guardian

That morning, Dr Osmani and I were called to the ward for a cardiac arrest. My heart sank when I saw that it was Wahidullah. Resuscitation had already started so we debated the futility of the situation. His father begged us to continue. To our surprise, he was quickly revived and somewhat reluctantly we agreed to take him back to ICU for a limited, short period of treatment.

That afternoon, the miracle happened. His father got his mother on the phone, put it to Wahidullah’s ear and his mother spoke to him for some time. Immediately after that conversation, he woke up. He literally opened his eyes, starting mouthing words, followed commands appropriately and shook my hand. Everyone from the ICU gathered round to watch. It was a miracle. Flabbergasted, I told his father that we would remove his airway the following morning and he would then go to the ward. We smiled together, stunned but so happy. Tomorrow would be a good day.

But tomorrow never came for most of those patients. Nor did it come for most of the ICU staff working that night. When the US military’s aircraft attacked our hospital, its first strike was on the ICU. With the exception of one three-year-old, all the patients in the unit died. The caretakers with the patients died. Dr Osmani died. The ICU nurses Zia and Strongman Naseer died. The ICU cleaner Nasir died. I hope with all my heart that the three sedated patients in ICU, including our ER nurse Lal Mohammad, were deep enough to be unaware of their deaths – but this is unlikely. They were trapped in their beds, engulfed in flames.

The remains of a bed in the main outpatient department building. Photograph: Andrew Quilty/MSF

The plane hit with alarming precision. Our ER nurse Mohibulla died. Our ER cleaner Najibulla died. Dr Amin suffered major injuries but managed to escape the main building, only to then die an hour later in the arms of his colleaguesas we desperately tried to save his life in the makeshift operating theatre set up in the kitchen. The OT nurse Abdul Salam died. The strikes tore through the outpatients department, which had become a sleeping area for staff. Dr Satar died. The medical records officer Abdul Maqsood died. Our pharmacist Tahseel was lethally injured. He also made it to safety in the morning meeting room, only to die soon after. He bled to death. Two of the watchmen, Zabib and Shafiq, also died.

Our colleagues didn’t die peacefully like in the movies. They died painfully, slowly, some of them screaming out for help that never came, alone and terrified, knowing the extent of their own injuries and aware of their impending death. Countless other staff and patients were injured; limbs blown off, shrapnel rocketed through them, burns, pressure-wave injuries of the lungs, eyes and ears. Many of these injures have left permanent disability. It was a scene of nightmarish horror that will be forever etched in my mind.

Three-year-old Shaista (with her family) was in the hospital. She was was the sole survivor of the ICU attack Photograph: Aurelie Baumel/MSF

Back home now in Australia, I sip a cappuccino in a café overlooking the ocean. I hear a plane above but don’t bother to look up – there is no need – I know it is just a standard commercial plane and I am safe. How easy it is to adjust to the luxury of peace. My eyes tear up as the raw grief I feel tugs at my heart. And the patients. Oh, the patients. So many bright young lives ripped viciously from this world. But it’s so much more than that; it’s the grief of the families of those lost on 3 October; it’s the grief of all the Kunduz people who have suffered so many losses over their long history of conflict; it’s the loss of the four years of hard work by both the national and international staff to make the hospital what it was.

Every day the hospital is a burnt-out shell is a day that could have seen dozens of lives saved and hundreds of patients treated. What will the survivors and future injured patients of Kunduz do? Who will save the lives of all the people needing complex trauma care? Who will put their crumpled bodies back together? I can only force my mind to move on before I fall too far into that bottomless dark pit of loss.