According to an internal report produced by Doctors Without Borders, a U.S. warplane shot at survivors attempting to escape the organization’s hospital in Kunduz, Afghanistan after the building was bombed by American forces last month.

The U.S. has not provided much explanation for the airstrikes, which killed at least thirty people, though the AP reports intelligence analysts may have believed the hospital was under Taliban control—a contention the report strongly rejects.

According to the organization, the hospital had been treating both Taliban and government fighters in the days leading up to the bombing. And by their account, it had been a quiet night until the bombing began sometime around 2 a.m. on Oct. 3.

MSF staff recall that the first room to be hit was the 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 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. After the first strike, MSF medical teams working in the operating theatres ran out of the OT and sought shelter in the sterilisation room. The two patients on the operating table in the OTs were killed in the airstrikes. The MSF international staff members sleeping in the administrative building were woken up by the sound of the first explosions. An MSF nurse arrived at the administrative building covered from head to toe in debris and blood with his left arm hanging from a small piece of tissue after having suffered a traumatic amputation in the blast. The MSF nurse was bleeding from his left eye and oropharynx.

And according to reports, the circling AC-130 gunship fired indiscriminately at survivors. One doctor lost his leg in the blasts and died in surgery, another staffer was decapitated by shrapnel.

“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. One MSF staff member described a patient in a wheelchair attempting to escape from the inpatient department when he was killed by shrapnel from a blast,” the report notes.

The report also makes clear the U.S. knew the compound was a medical facility. In fact, the hospital apparently emailed its GPS coordinates to the US Department of Defense, Afghan Ministry of Interior and Defense and US army in Kabul just days before the bombing.



Confirmation of receipt was received from both US Department of Defense 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. MSF also shared the GPS coordinates with a UN intermediary who confirmed transmission directly to Operation Resolute Support.

The U.S. has apologized for the attack, saying it was a “mistake.”