KABUL: Medical aid group Medicins Sans Frontieres (MSF) said on Thursday it was hard to believe a United States (US) airstrike on an Afghan hospital last month was a mistake, as it had reports of fleeing people being shot from an aircraft.

The following events were taken from a Public release of MSF Kunduz.

On September 28 at 6 pm, two Taliban combatants arrived at the hospital gates to inform MSF that they were in control of the area.

On September 29, MSF met with a Taliban representative to discuss the need to free beds for other critical patients due to the ongoing fighting, and therefore for some patients to be discharged and for those who required nursing follow-up to be referred to the MSF Chardara medical post.

Due to the increased intensity of fighting in Kunduz, MSF reaffirmed the well-known location of the Kunduz Trauma Centre (KTC) by once again emailing its GPS coordinates to US Department of Defence (DoD), Afghan Ministry of Interior and Defence and US Army in Kabul.

The GPS coordinates provided for the KTC were: 36°43'4.91"N 68°51'43.96"E for the main hospital building and 36°43'4.29"N 68°51'42.62"E for the administrative office building within KTC.

Confirmation of receipt was received from both US DoD and US Army representatives, both of whom assured us that the coordinates had been passed on to the appropriate parties. Oral confirmation was received from the Afghan Ministry of Interior.

On September 30, out of 130 patients in the KTC on Wednesday, there were approximately 65 wounded Taliban combatants that were being treated.

Starting this same day, a large number of patients discharged from the hospital, including some against medical advice. It is unclear whether some of these patients discharged themselves due to the discussion to free some beds between MSF and the Taliban representative or whether there were general concerns about security as rumours were circulating of a government counter-offensive to reclaim Kunduz city.

By Wednesday, MSF was aware of two wounded Taliban patients that appeared to have had higher rank.

This was assumed for multiple reasons: being brought in to the hospital by several combatants, and regular inquiries about their medical condition in order to accelerate treatment for rapid discharge.

On Thursday October 1, MSF received a question from a US Government official in Washington DC, asking whether the hospital or any other of MSF’s locations had a large number of Taliban "holed up" and enquired about the safety of our staff.

MSF replied that our staff were working at full capacity in Kunduz and that the hospital was full of patients including wounded Taliban combatants, some of whom had been referred to the MSF medical post in Chardara.

MSF also expressed that we were very clear with both sides to the conflict about the need to respect medical structures as a condition to our ability to continue working

On Friday October 2, two MSF flags were placed on the roof of the hospital, in addition to the existing flag that was being flown at the entrance to the Trauma Centre.

The KTC was also one of the only buildings in the city that had full electricity from generator power on the night of the airstrikes.

Read: The murder of hope in Kunduz

Throughout the night before the airstrikes began, all MSF staff confirm that it was very calm in the hospital and its close surroundings.

No fighting was taking place around the hospital, no planes were heard overhead, no gunshots were reported, nor explosions in the vicinity of the hospital.

Some staff mention that they were even able to stand in the open air of the hospital compound, which they had refrained from doing in the days prior, for fear of stray bullets from fighting in the neighbourhood around the hospital.

All staff confirm that the gate of the hospital was closed and that the MSF unarmed guards were on duty. From approximately 12:20 am to 1:10 am, the MSF coordinator conducted the nightly security round of the hospital compound.

The coordinator reported that the KTC was calm, with no armed combatants present, nor any fighting on the hospital grounds or within the audible vicinity.

All MSF guards were on duty and MSF was in complete control of the compound.

All of the MSF staff reported that the no weapons policy was respected in the Trauma Centre.

In the week prior to the airstrikes, the ban of weapons inside the MSF hospital Kunduz was strictly implemented and controlled at all times and all MSF staff positively reported in their debriefing on the Taliban and Afghan army compliance with the no-weapon policy.

On October 3, the US airstrikes started between 2:00 am and 2:08 am.

Despite it being in the middle of the night, the MSF hospital was busy and fully functional at the time of the airstrike.

Medical staff were making the most of the quiet night to catch up on the backlog of pending surgeries. When the aerial attack began, there were 105 patients in the hospital. MSF estimates that between three and four of the patients were wounded government combatants, and approximately 20 patients were wounded Taliban combatants.

One hundred and forty MSF national staff and nine MSF international staff were present in the hospital compound at the time of the attack, as well as one International Committee of Red Cross (ICRC) delegate.

Also read: US military air strike hits MSF hospital in Kunduz

It is estimated that the airstrikes lasted approximately one hour, with some accounts saying the strikes continued for one hour and fifteen minutes, ending approximately between 3:00 am and 3:15 am.

A call log of the calls made from the hospital. — Photo courtesy MSF Kunduz Public release.

A series of multiple, precise and sustained airstrikes targeted the main hospital building, leaving the rest of the buildings in the MSF compound comparatively untouched.

This specific building of the hospital correlates exactly with the GPS coordinates provided to the parties to the conflict.

Those who survived the US airstrikes were direct witnesses of the attack from the different locations inside the MSF compound.

MSF staff recall that the first room to be hit was the Intensive Care Unit (ICU), where MSF staff were caring for a number of immobile patients, some of whom were on ventilators.

Two children were in the ICU. MSF staff were attending to these critical patients in the ICU at the time of the attack and were directly killed in the first airstrikes or in the fire that subsequently engulfed the building.

Immobile patients in the ICU were burned in their beds. After hitting the ICU, the airstrikes then continued from the east to west end of the main hospital building. The ICU, archive, laboratory, ER, X-ray, outpatient department, mental health and physiotherapy departments as well as the operating theatres were all destroyed in this wave after wave of strikes.

The airstrikes continued with many staff referring to a propeller plane, which could be heard throughout. This sound is consistent with the reported AC-130 Specter gunship circling the MSF hospital.

Many of those interviewed describe massive explosions, sufficient to shake the ground. These bigger explosions were most frequently described as coming in concentrated volleys.

MSF staff also described shooting coming from the plane. Many staff describe seeing people being shot, most likely from the plane, as people tried to flee the main hospital building that was being hit with each airstrike.

Some accounts mention shooting that appears to follow the movement of people on the run. MSF doctors and other medical staff were shot while running to reach safety in a different part of the compound.

Though it is clear from the staff debriefings and photos that the main hospital building was the principal target of the attack, other locations within the MSF compound were also struck, including in the southern area of the hospital compound where two unarmed MSF guards were found dead as a result of shrapnel wounds.

An image showing the MSF Kunduz hospital before and after damages. — Photo courtesy MSF Kunduz Public release.

The circumstances of the incident, one of the worst of its kind during the 14-year conflict, are still unclear.

MSF General Director Christopher Stokes told reporters the organisation was still awaiting an explanation from the US military, reported Reuters.

"From what we are seeing now, this action is illegal in the laws of war," Stokes said.

"There are still many unanswered questions, including who took the final decision, who gave the targeting instructions for the hospital."