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Doctors With Enemies: Did Afghan Forces Target the MSF Hospital?


May 24, 2016
Matthieu Aikins / The New York Times

The aircraft's target, a Doctors Without Borders hospital, was lit by generators, a beacon in the blacked-out city. As they prepared to fire, the gunship's crew members radioed to the ground force commander, a United States Army Special Forces major, for more information. The US government's report has ruled the attack an accident but mounting evidence suggests that Afghans' mistrust for the nonprofit medical group might have set the tragedy in motion.

http://www.nytimes.com/2016/05/22/magazine/doctors-with-enemies-did-afghan-forces-target-the-msf-hospital.html

(May 22, 2016) -- For the last hour, the American gunship had been circling high above the city, carefully observing its target with night-vision sensors and waiting for clearance to strike. It was 2 in the morning on Oct. 3, 2015, and Kunduz City was enveloped in total darkness.

The city's power had gone out five days before -- soon after the Taliban took over the provincial capital, in a humiliating blow to the American and Afghan governments -- and it stayed off through the bitter fighting that followed, as commandos from both nations counterattacked.

The aircraft's target, a distinctively T-shaped building set on an expansive lawn, was lit by generators, a beacon in the blacked-out city. As they prepared to fire, the gunship's crew members radioed to the ground force commander, a United States Army Special Forces major, for more information.

"Looking for confirmation on which building to strike -- Confirm it is the large, T-shaped building . . . in the center of the compound.
Affirm."


An AC-130 circles its target like a ball swung from a string, raining down gunfire along the radius. At 2:08 a.m., the gunship began its assault, starting on the eastern end of the T-shaped building and working methodically west.

For half an hour, the AC-130 fired its 105-millimeter howitzer, the largest airborne gun in existence, and its 40-millimeter Bofors cannon, which shoots exploding incendiary rounds and is ideal for hunting people who flee targeted buildings by foot, often referred to by pilots as "squirters."

There were about 50 squirters at the site, the crew noted, a surprisingly high number. Through the infrared scope, the building glowed as it burned, while ghostly shapes that flitted from inside were gunned down.

"We started a fire, good effects."

At roughly the same time, 150 miles south in Kabul, Guilhem Molinie, the head of the Afghan mission for Doctors Without Borders, known by its French initials, MSF, was woken by a phone call: His hospital in Kunduz was burning. A few minutes later, he received a chilling update: It was being bombed from the air. That could mean only an American or Afghan attack.

He began frantically calling the United States military, the United Nations, anyone who might be able to make it stop. At 2:19 a.m., he spoke to an officer at the Army Special Forces headquarters at Bagram Air Base, who said he would investigate. The airstrike would continue for an additional 18 minutes. The officer later texted Molinie: "I'll do my best, praying for you all."

By the time the sun rose, the hospital's main building was a smoldering ruin. It had been leveled with devastating precision; the other buildings on the compound, some no more than a few dozen feet away, were left unharmed.

According to MSF, at least 42 people were killed in the attack and dozens injured. It was among the most shocking massacres in the American-led war in Afghanistan, and certainly the most baffling. Why would an American warplane destroy a working hospital full of doctors and patients?

On April 29, seven months after the bombing, the United States military released a heavily redacted version of its investigation into the airstrike. The report asserts that it was an accident, a result of equipment failures and bad decisions on the part of the gunship crew and the Special Forces.

"The investigation concluded that the personnel involved did not know they were striking a medical facility," Gen. Joseph Votel, the head of the military's Central Command, said at a news conference. "They were absolutely trying to do the right thing."

Even taken at face value, the report reveals more than a simple error. The circumstances that led to the destruction of the hospital are a direct result of how the Special Forces were made to bear the weight of the United States' contradictory strategy in Afghanistan, which seeks to both end its involvement in the war and prop up the struggling Afghan government.

Restricted to a supposedly noncombat role as advisers, the Special Forces in Kunduz ended up calling in the airstrike, which was in support of Afghan troops against a target a quarter-mile away, as self-defense, which meant that it bypassed many safeguards intended to prevent civilian casualties.

Moreover, there is evidence -- both buried in the report and from interviews conducted on the front lines in Kunduz -- that suggests that Afghan troops may have deliberately provided the hospital as a target.

Though the Special Forces later said they were unaware that it was the hospital, the redacted investigation documents show that they passed a description that matched the MSF compound to the AC-130 as a target -- a fact that the military elides in its summary of the bombing.

This description originated from their Afghan partners. In my conversations with them in November in the aftermath of the bombing, some of the Afghan forces in Kunduz, citing false intelligence that the hospital had been taken over by insurgents, said that it had been justifiably targeted.

Both the American military and the Afghan government declined to comment on whether Afghan forces had intended to target the hospital. But a question hangs over the Kunduz bombing, even as the military has moved to declare the matter settled: Did Afghan forces, out of longstanding mistrust of MSF, draw the United States into a terrible tragedy?

When Maj. Michael Hutchinson, known to his friends as Hutch, redeployed last year to Afghanistan, he was sure -- as he later told military investigators -- that getting outside the wire to engage in combat was mostly a thing of the past.

The Americans were there to train, advise and assist the Afghans. It was their war now. The American combat mission in Afghanistan had ended in 2014, as announced by President Obama in a Rose Garden speech that year.

The remaining American forces were supposed to be restricted to two narrow roles: A noncombat NATO training mission, called Resolute Support, was there to advise Afghan forces, while the American counterterrorism force under Freedom's Sentinel was charged with targeting Al Qaeda and the Islamic State.

"The US military will not be engaged in specific operations targeting members of the Taliban just because they're members of the Taliban," Josh Earnest, the White House spokesman, told reporters in 2014.

But as the Afghan government has begun to lose ground against the Taliban, United States forces have found themselves pulled back into combat. Since the new missions began in 2015, at least 87 American military personnel have been killed or wounded in action.

Much of that fighting has fallen to Special Operations units like Hutchinson's company, which was assigned responsibility for northern Afghanistan under a task force led by the First Battalion, Third Special Forces Group. (Hutchinson's name is redacted in the military's report, but he is referred to throughout as "the G.F.C.," for ground force commander.

His identity was confirmed by Joe Kasper, Representative Duncan Hunter's chief of staff, who has been in contact with Special Forces who were in Kunduz. The military declined to comment on Hutchinson's role or make him available for an interview.)

From the start, Hutchinson had been wary of Kunduz and its messy politics. "Ironically, I probably jinxed myself on this," he later told military investigators. "I said I did not believe that we should get involved in Kunduz any further than [training and advising] unless the provincial capital falls, because structurally it is such a political and ethnic problem. It's not something that we can effectively weigh in on."

Kunduz, a fertile wedge of rice and wheat fields tucked between the foothills of the Hindu Kush mountains and the Amu Darya river basin, is one of the provinces where the Taliban have made their biggest inroads in recent years. Yet in the months leading up to the fall of the city, neither the Americans nor the Afghans seemed particularly worried about its stability.

On Aug. 13, Brig. Gen. Wilson Shoffner, the United States military's spokesman in Afghanistan, was asked about the situation there during a news conference. "I think there's been a lot of generalization when it comes to reports on the north," he said. "Kunduz is -- is not now and has not been in danger of being overrun by the Taliban."

Roughly six weeks later, around 3 in the morning on Sept. 28, Taliban fighters attacked the city's outskirts on three fronts. "The mujahedeen were united under one command," said a Taliban commander who took part in the offensive and goes by the name Shahid. He spoke by phone from outside the city in the weeks after the attack. "We broke our enemy."

Though Kunduz City was home to thousands of Afghan army, police and intelligence personnel, its defenses quickly collapsed, the officers fleeing in disarray to the airport on a plateau overlooking the city. Within hours of their initial assault, the Taliban were freely roaming the streets, looting the abandoned bases of weapons, secret documents, Ford pickup trucks, Humvees and even two old Soviet-made T-62 tanks.

Thousands of residents jammed the highways as they fled to neighboring cities; meanwhile, hordes of Taliban fighters, some from surrounding provinces, streamed into the city, attracted by the prospect of a major victory. It was the first time since 2001 that the Taliban had captured a provincial capital.

As panic spread across northern Afghanistan, the Special Forces were tapped to help save Afghanistan's fifth-largest city. There was already one group called an Operational Detachment Alpha -- an "A team" of 12 Green Berets, plus some support troops, including joint terminal attack controllers, who direct airstrikes -- based at the Kunduz airport.

An additional Operational Detachment Alpha, plus four operators from a third one, were sent up from Bagram, the main American military base north of Kabul. They arrived around 6 in the morning on Sept. 29, a little more than 12 hours after the city fell. Hutchinson was put in command of the entire force.

Afghan reinforcements were also flown in, including a contingent of police special forces and about 200 soldiers from the Afghan Army's most elite unit, the Special Operations Force, which was also known by its Pashto initials, K.K.A., and was formerly attached to the United States military's secretive Joint Special Operations Command.

These coalition troops confronted a scene of total chaos: thousands of security forces and civilian officials clamoring for space on the few evacuation flights available, some casting aside their uniforms and weapons on the road.

When the Taliban attacked the airport plateau that evening, the defenders began fleeing the perimeter, but the Special Forces called in airstrikes, which hammered the insurgent forces, breaking their offensive and leaving dozens of dead fighters scattered through the arid hills. "If the Americans hadn't intervened," said Col. Abdullah Gard, then the head of the Kunduz police's quick-reaction force, "the airport would have fallen."

Earlier that same day, a Toyota Corolla pulled up to the main entrance of the Doctors Without Borders hospital in Kunduz. "There was a big fat guy driving," said an MSF employee who was on duty at the time. "Someone told me he's the big boss of the Taliban." It was Janat Gul, one of the most powerful Taliban leaders in northern Afghanistan.

With him was Abdul Salam, the "shadow governor" responsible for Kunduz. Salam and Gul got out and went inside, the employee recalled -- unarmed as per the hospital's strict no-weapons policy -- to meet with expatriate staff members. (Doctors Without Borders confirmed Salam's visit that day but said he didn't enter the hospital.)

According to Molinie, who was monitoring events from Kabul, the Taliban leadership pledged full cooperation and protection and asked that the hospital stay operational during whatever fighting was to come.

"The message was that we could continue our activities, that we would be safe and protected and that the patients of the hospital would be safe and protected," said Molinie, "as well as the patients from government forces." The hospital staff activated the mass-casualty plan and readied for the flood of patients that would soon arrive.

For MSF, dealing with the Taliban was a routine part of the neutral role it seeks to maintain in Afghanistan. One of the world's largest medical charities, MSF sees itself as an impartial humanitarian organization in the mold of the International Committee of the Red Cross, one that could cross front lines to provide treatment to anyone who needed it, including wounded combatants.

That role has been getting harder to play. MSF has been active in Afghanistan since 1980 and had worked with both the mujahedeen and Taliban governments. But after the terror attacks of Sept. 11, its ethos of political neutrality contrasted sharply with that of the Global War on Terror, where you were either with the United States and its allies or with the terrorists. Afghan forces have been especially resentful of the fact that as patients, insurgents in MSF facilities are entitled to the protection of international law.

In 2004, five MSF staff members were shot in an unsolved murder. A Taliban spokesman claimed responsibility, accusing the organization of serving American interests. But according to MSF, Afghan officials presented them with credible evidence that local forces were actually responsible. No action was taken against them by the government, and the organization pulled out of the country.

When MSF returned to Afghanistan in 2009, it followed the example of the Red Cross and negotiated its access in the field with the Taliban leadership. Eager for the help of humanitarian groups in responding to the worsening conflict, the United States and Afghan governments acquiesced. "The initial deal with the Afghan government, with NATO and the US," Molinie said, "was that we would reopen a mission on the condition that all parties would accept that we talk to everybody."

But balancing the demands of belligerents in a ruthless war was fraught with risk. In its zeal to help Afghans trapped behind the Taliban's lines, MSF risked souring its relationship with the Afghan government. One of its more ambitious plans called for opening a hospital in the Taliban-held northern part of Helmand Province, along with an airstrip to fly in international staff members and medical supplies behind insurgent lines.

"Personally, I thought the idea was completely insane," said a Western official who was briefed on the proposal last year. "The Afghan government would have reacted strongly against MSF"

In 2011, MSF opened the hospital in Kunduz, a location it chose because it believed, presciently, that the province's bloody past presaged a violent future. But some members of the Afghan government and security forces there had little respect for MSF's neutrality and resented its treatment of wounded Taliban.

When I visited Kunduz in November, their anger was still surprisingly raw, despite the recent destruction of the hospital. "They give them medicine; they transport and treat their injured," Gard, the commander of the quick-reaction force, told me.

"Their existence is a big problem for us." And though the hospital treated many more wounded for the government, there were rumors that MSF had carried out unnecessary amputations on them, according to Fawzia Yaftali, a member of the provincial council. "The general perception was that MSF supported the Taliban," she said.

On July 1, an episode occurred that should have been, in retrospect, a warning sign for all involved. A team of Afghan police commandos from elite units mentored by United States and NATO special forces -- the 222 and 333 Battalions, which were later part of the Afghan forces sent to Kunduz with the Green Berets -- had arrived in Kunduz Province to track a high-value target, a militant commander named Abu Huzaifa.

After targeting Huzaifa in an airstrike, the commandos believed that he had been wounded and taken to the MSF hospital in Kunduz City. They drove there and forced their way inside, where they physically assaulted the staff members and fired their weapons into the air, according to MSF Huzaifa was nowhere to be found.

"It was a kind of wild intrusion," Molinie said. After MSF phoned the governor and the police chief, the commandos were called off. Furious that the sanctity of the hospital had been violated, MSF closed it to new admissions for five days, until officials received guarantees from Kabul that it would be respected. Huzaifa would be killed seven weeks later -- by an American drone, according to a senior Afghan special forces commander -- but bitterness about the hospital raid lingered among the Kunduz security forces.

"They hid him," Gard told me, without offering any evidence. His men had accompanied the police commandos to the hospital. "The people who work there are traitors, all of them."

On Wednesday, Sept. 30, the day after the Taliban's assault on the airport was beaten back, Hutchinson started planning an operation to retake the city.

The political pressure to do so was made apparent when, before his departure, Hutchinson, along with an Afghan general, spoke by videoconference with Gen. John Campbell, then the commander of American forces in Afghanistan. Campbell, who was in Kabul, was not happy with the Afghans. "General Campbell was understandably upset," Hutchinson told investigators.

"Not only was it a shock and travesty that they had" -- what follows is redacted in the military's report but seems to refer to how Afghan forces abandoned Kunduz City without a fight. The fall of Kunduz had called into question the viability of Obama's strategy in Afghanistan, and storm clouds were gathering in Washington, where Campbell had previously been scheduled to testify before Congress.

"He was very much in a hurry to get back to D.C.," Hutchinson says in the report. "He had a lot on his plate." (Campbell, who is now retired, declined to comment for this article.)

After the video conference, Hutchinson briefed his men on what the four-star general told him. This was a strategically vital mission, and the whole world was watching. "It had to happen as soon as possible. Failure was not an option on this operation."

The operation fit awkwardly under Resolute Support, the noncombat training mission, and Freedom's Sentinel, which was supposed to engage only ISIS and Al Qaeda, not the Taliban. Indeed, while Hutchinson had submitted his operation plan to his headquarters at Bagram under Resolute Support, it came back approved under Freedom's Sentinel. Later, Hutchinson told investigators that he thought he was operating under Resolute Support's rules of engagement.

The distinction between the two -- which were both led by Campbell -- would become almost meaningless in Kunduz. The same unit could be carrying out a training mission one minute and a counterterrorism one the next.

According to the military, in the first four days of fighting in Kunduz, 13 airstrikes were conducted under Resolute Support and nine under Freedom's Sentinel. Before conducting strikes, aircrews would sometimes radio to ask under which mission they were about to shoot.

The plan Hutchinson submitted, called Kunduz Clearing Patrol, was a risky mission to strike deep into the city, where his men and the Afghan commandos would take over the police and governor's compound and set up a forward stronghold. Hutchinson later admitted that he had underestimated the number of Taliban in the city as "a small group of dedicated individuals."

The Green Berets planned to stay for only 24 hours, long enough for the local Afghan forces at the airport to rally and return to the city. "I really thought that the Afghans would see that it wasn't that big of a deal and they would all come back in," he said in the report. "We all agreed it had to happen fast, and the only people who were willing to go in, unfortunately, were people who did not know the city of Kunduz."

That same Wednesday night, around 10:30, according to the report, the Green Berets, accompanied by the Afghan police and army commandos, as well as Gard's quick-reaction force, rolled out of the airfield in a convoy of armored vehicles and fought their way into the city.

First they cleared Gard's compound, which the insurgents had captured the day before. They were hit by repeated Taliban ambushes and called in airstrikes from a circling AC-130 gunship, killing dozens of insurgents.

While entering the police compound, they set off a tripwire bomb, but no one was hurt. The Afghan and American commandos posted guards on the walls and set up a base inside. A Humvee with a single small-scale map of Kunduz spread over its hood served as the Special Forces' command post.

The city around them was still swarming with insurgents. When the sun rose, the attacks began. Hoping to overrun the police compound's defenders, the Taliban launched relentless assaults from the surrounding buildings, sometimes getting close enough for the Green Berets to use grenades.

As the insurgents rained rockets and machine-gun fire on the compound's barriers, the Special Forces called in six "danger close" gun runs from F-16s, the strikes near enough to risk friendly fire. Still, the insurgents kept coming.

"I was in a lot of effective firefights," one of the Green Berets later wrote, "but this was on a completely different level than even any of the experienced special operators on any of the detachments had seen -- particularly over such a sustained period of time. How no one was killed, or even wounded, is an absolute miracle."

An Afghan force of 500 was supposed to show up the next day from the airport to relieve them; it never did. When a few Afghan police and army personnel did arrive, they said they would abandon their positions if the Americans left. It soon became apparent to Hutchinson and his men that their 24-hour mission was going to last longer.

By sending the Special Forces to hold an isolated position deep inside a city held by the Taliban, the American military allowed the Afghan government to claim a badly needed propaganda victory.

On Oct. 1, as the Green Berets and the Afghan commandos fought for their lives at the police compound, President Ashraf Ghani held a news conference in Kabul to declare that all of Kunduz City had been retaken. "Thank God we had no fatalities," he said. (In fact, the battle to recapture the city would rage for two more weeks, and at least 38 Afghan police officers and soldiers would be killed.)

The fact that the Special Forces were surrounded by Taliban also meant that the liberal use of American air power in Kunduz could be justified as self-defense. The military went further by applying what it called Persons With Designated Special Status to the Afghan commandos in Kunduz, a designation that allows American forces to consider temporarily defending certain partnered Afghan troops as part of their own self-defense -- essentially, self-defense of someone else.

Later, investigators would conclude that Hutchinson had improperly used these self-defense rules in order to launch offensive "pre-assault fires." It was his response, perhaps, to the conundrum he faced by engaging in combat during a supposedly noncombat mission: Was he supposed to wait for the commandos to get pinned down or take casualties before striking the insurgents they had been sent into the city to fight?

"I can't expect them to assault that," he told investigators, referring to the K.K.A.'s subsequent attack on the Taliban-held intelligence headquarters. "They can't sit out there and die on the road."

Armed with this authorization and ordered to take back the city of Kunduz, the Special Forces called in air support for the Afghan commandos, who, taking advantage of their superior night-vision capabilities, would set out from the police compound to raid Taliban positions around the city at night. "Where there was heavy pressure on us," said Yaftali, the K.K.A. commander, "wherever there was heavy fighting, we told the Americans to strike there."

In a city where all other institutions had been abandoned by their staff, the MSF hospital was a lifeline for the people of Kunduz. Dr. Esmatullah Esmat had been a surgeon for eight years in Afghanistan, but he had never witnessed anything like this. "When I saw my patients after surgery and they would say, 'Dr. Esmat, you saved me,' I felt energy," he said. "We never felt tired."

A stoop-shouldered, stocky man with a shy smile, Esmat and his fellow surgeons worked in alternating 12-hour shifts. Over five days, the hospital would receive 376 patients in its emergency room, more than a quarter of them women and children. Esmat had to amputate the leg of a 3-year-old girl. "I have a daughter the same age," he said.

It was a bloody and chaotic scene. In the red room, the most critical cases were prepped -- head and torso wounds, or traumatic amputations, typically -- and then sent immediately into one of the hospital's three operating theaters. There, stripped naked under the surgeon's lamp, Taliban fighters, civilians and government soldiers alike became patients whose lives needed to be saved.

Esmat and his colleagues performed 138 operations during those days, almost a third of them emergency laparotomies -- the abdomen was cut open and internal organs were piled on the chest, so that the surgical team could go through them, painstaking inch by inch, looking for lacerations to suture.

As the wards overflowed, the staff laid down mattresses between the beds and in the hallways and stretched the 90-bed hospital to fit 130. There were gruesome and strange sights, like the Taliban fighter from a commando unit, in a distinctive camouflage-pattern robe, weeping uncontrollably while stroking the head of his body-bagged friend.

"It was a bit hopeless," said Faizullah Alokozai, the hospital's archivist. "I saw a lot of dead children."

Though the MSF hospital was crowded with fighters, whether patients or caretakers (each patient was allowed one), staff members and civilians who were present said the insurgents respected the rules. They left their weapons outside or handed them over at the gun lockers at the entrance.

One employee recalled seeing a fighter give up his weapon but forget his ammunition vest; when the employee nervously approached the fighter about it, the man apologized profusely and handed it over. "We had respect for the hospital, as they were serving the people," said Shahid, the Taliban commander. "I myself went there once when one of our men was wounded, and before entering we submitted our weapons outside."

MSF did allow caretakers and patients to keep their cellphones, however, and I was told by several staff members and civilians present that some Taliban caretakers also brought in hand-held radios. (Molinie said that while there was no specific rule against radios, he didn't believe that they were allowed in.)

According to MSF, some of the Taliban patients were high-ranking leaders. Taliban vehicles were also allowed inside the hospital grounds to drop off critically injured patients.

Unknown to MSF, Afghan forces in Kunduz were coming to the false conclusion that the hospital was being used as a Taliban stronghold and headquarters, which would have meant the loss of its protected status.

"All their most important leaders were inside the hospital, especially Tajiks, Uzbeks and high-ranking Pakistanis," Gard said. He claimed his information came from local informants who had been inside the hospital and witnessed the Taliban operating there. "They had raised their flag and established their headquarters there."

These unconfirmed reports were lent additional weight by signals intelligence. Yaftali, the K.K.A. commander, told me that his unit's Wolfhound radio direction finders, which allowed them to determine the range and bearing of enemy radios, picked up Taliban transmissions from inside the hospital. "We located about 10 to 15 radios from there," he said. "The Taliban were inside and outside the hospital."

The Afghan forces I spoke to said they relayed these reports to the American military, and it's clear that, before the strike, some Americans were aware of the concerns that the MSF hospital had been taken over by the Taliban.

On Oct. 1, Carter Malkasian, a civilian adviser to the Chairman of the Joint Chiefs of Staff at the Pentagon, emailed MSF in New York to ask about the safety of its staff and whether Taliban fighters were "holed up" inside the hospital.

Maj. Gen. Mark Quantock, Campbell's intelli­gence deputy, told investigators: "Although we assessed that there were Taliban using the hospital, you cannot shoot up a building under the current authorities. Period."

Molinie, MSF's head of mission in Kabul, said he was then unaware of the American military's suspicions, which he criticized as baseless. On Sept. 29, he provided Resolute Support with GPS coordinates for four of MSF's facilities in Kunduz, including the hospital, as a precaution. And the day before the bombing, he coordinated the delivery of three truckloads of medical supplies to Kunduz with an officer at the Special Forces' headquarters at Bagram.

"He informed me of the number of beds, number of international aid workers in the hospital, and that the Taliban were 'protecting' the hospital and were treating the government casualties well," the officer later wrote.

It's unclear from the report what, if anything, the Special Forces on the ground in Kunduz knew about the MSF hospital. Several staff members at their headquarters at Bagram told investigators that they had passed MSF's grid coordinates on two separate occasions to the Green Berets at the police compound.

"I know I read the four grids and got a read-back for accuracy," one person wrote. "I think I used the term 'Doctors Without Borders,' not 'MSF' " Hutchinson and other members of his team, however, said they never received the coordinates from Bagram and were unaware of the hospital's location before the strike, a contention the investigators accepted in their final report.

But whether they heard the Afghans' false reports before or after the strike, some of the Green Berets in Kunduz appeared to believe them. "There were enemy in there," one later wrote, according to an email excerpt provided by Representative Hunter's office. "They were using it as a [command and control] node. They had already removed and ransomed the foreign doctors, and they had fired on partnered personnel from there."

For the civilians who remained in Kunduz during the fighting -- the United Nations estimates that 13,000 families were displaced by the fighting and that 848 civilians were killed or injured -- life was a daily struggle to survive. There was no electricity, and the price of basics like bread and cooking oil had shot up, for those who could find them at all. Heading out in search of supplies meant risking your life in the crossfire on the streets.

But for people like Ismail Zahir, a floppy-haired, soft-spoken 20-year-old who worked in construction, there was no other choice. With his father deaf and disabled, his family relied on their eldest son as their breadwinner. When there were lulls in the fighting, Ismail would head out into the street, dodging sniper fire. "I was afraid," he said, "but not as afraid as I was for my family."

Once Afghan and American forces counterattacked and airstrikes began hitting the city, he grew especially worried for his sisters Morsal and Madina. Morsal, 15, was quiet and fastidious like him, while Madina, at 5 the youngest in the family, was impish and apple-cheeked. At night, they screamed in fear when bombs struck nearby. They begged the family to leave Kunduz.

Finally, on Oct. 2, the fourth day after the fall of Kunduz, Ismail and a friend set off across the city to find a car to hire, riding tandem on a borrowed bicycle through the deserted streets. Taliban fighters stopped them at a checkpoint but let them pass -- civilians were free to flee if they wished.

On the outskirts of the city, they found a taxi driver. He wanted the equivalent of $200 to take them to Kabul, five times as much as the normal rate, and they had no choice but to accept.

Returning home with the driver, he and his friend packed their families into the Toyota station wagon, 14 people in total, most of them women and children. The driver set off south, toward Kabul. As they came around a corner, they spotted an Afghan Army armored vehicle.

Perhaps thinking they were insurgents, it opened fire. As the driver wheeled around, bullets tore through the back of the car. Four of the boys were shot in the arms and legs, but the two girls, Morsal and Madina, were the most grievously wounded. Somehow, the car made it to the MSF hospital.

When Esmat arrived in the red room, he found Morsal laid out, pale and beautiful. She was dead from a head wound. Madina's abdomen was torn open, and her intestines protruded, but she was still conscious and cried out, "Mother, mother."

As Esmat looked around and saw Amin Bajawri, the emergency-room doctor, and the rest of the staff members weeping, he felt his own eyes sting and well. All the suffering he had witnessed over the previous days was overflowing inside of him. "My God, what is the sin of these people?" he cried.

Madina's liver and kidney had been badly lacerated. To survive, she needed an immediate laparotomy. Esmat composed himself and began preparing for the operation.

That night, according to the report, the K.K.A. commandos at the police compound planned a raid on the abandoned headquarters of the National Directorate of Security, the Afghan intelligence service, which had been occupied by the Taliban.

After dark, the insurgents' daily assault on the police compound had petered out, and the commandos planned to take three of their wounded comrades back to the airport, resupply and then drive back into the city toward the NDS compound, on a northbound path that would take them past the MSF hospital.

The commandos asked Hutchinson to provide them with air support, and he replied that he would take care of them. The AC-130 had already been on station above Kunduz for three hours when, around 1 in the morning, Hutchinson informed the gunship that the Afghan commandos were planning to raid the NDS headquarters and requested that the gunship perform a "defensive scan" of the area.

Hutchinson passed on the correct grid coordinates for the NDS compound, which had been given to him by the Afghans; but because the gunship was flying higher than normal to avoid surface-to-air missiles, its navigation system pointed the sensor -- a powerful night-vision telescope, essentially -- at an empty field, located between the NDS headquarters and the MSF hospital.

Confused, the sensor operator scanned around and noticed a large facility nearby with people walking around at night. He started observing it to determine if this was the target. In fact, it was the hospital. The gunship hadn't been given the building's coordinates before the mission, and although the hospital had a flag with the MSF logo on its roof, it wasn't marked with a red cross or a crescent.

The next step was crucial. Hutchinson, who had been conferring via an interpreter with the K.K.A. ground force and couldn't see the target himself, then gave the AC-130 an "updated description of the compound of interest."

He later told investigators that the Afghans described "a long T-shaped building with a small offshoot." He continued: "I can't remember the word I would have used for it. It's a walled-in compound with multiple outbuildings, and there was a gate facing to the north with an arch."

That description didn't resemble the NDS headquarters. It matched the hospital.

At 2 in the morning, the hospital was quiet. Most of the roughly 300 staff members, patients and caretakers were asleep. In the operating theater, the night shift of surgeons was taking advantage of a quiet day to carry out follow-up operations.

Esmat, who spent two hours operating on Madina, had finished his shift at midnight and collapsed, exhausted, on a cot in the outpatient department. He had been worried that she might die on the operating table, but she pulled through.

Down the hall, Faizullah Alokozai, the archivist, was sound asleep next to the hospital's deputy medical director, Dr. Abdul Satar Zaheer. Shortly after 2 in the morning, both men were woken by loud blasts and flashes of light. Realizing they were under attack, the two jumped up and ran east toward the entrance to the basement, into the high-ceilinged hallway outside the operating theater.

They didn't know it, but they were running toward danger. The gunship had started by hitting the intensive-care unit on the east end of the hospital and was working its barrage west. Esmat, who stepped into the hallway behind them, saw the passage suddenly fill with smoke, and he jumped out a window onto the lawn, where he crawled and hid safely in a deep window well for the duration of the attack.

As Faizullah and Satar reached the far side of the hallway, a shell punched through the roof and exploded on the floor in front of them. They fell to the ground. Satar's right arm had been blown off at the shoulder. Faizullah could feel his own hot blood gushing down his back. The power went out, and the darkness was rent with flashes of lights.

Faizullah crawled up to Satar and held him. "I lost my right arm, please help me," his colleague cried. "I know," Faizullah replied. "I'll get you out, if we're alive. I'm not going to leave you."

As they cowered, reciting the Islamic profession of faith, more shrapnel struck them. Three times, Faizullah tried to stand them up, struggling with the bulky Satar, whose legs seemed to be paralyzed, before another explosion would send them sprawling. The sound of the blasts was the hardest thing to bear.

By the time the gunship's fire moved on to another part of the hospital, the air had filled with acrid smoke, and Faizullah could hear the sound of flames licking the building. He got to his feet and pulled at Satar's arm. He was limp and silent. He's dead, Faizullah thought, and I'll die if I stay here.

In the darkness, he heard a voice. "Please forgive me for whatever happened, because I'm going to die. Take care of my children." Making his way forward, Faizullah saw that it was the young emergency-room doctor, Amin, sitting in a doorway, talking on his cellphone. His right leg was missing at the knee, and blood was spurting and pooling underneath him.

"It's going to catch fire!" Amin shouted, seeing Faizullah. "We have to get out." Amin heaved himself onto his remaining leg and hopped through the smoke-filled emergency room, and Faizullah followed him out, through the entrance into the covered driveway, where Amin clutched the row of pillars that lined it. "I can't move," he gasped, and so Faizullah slung him over his back and staggered out onto the front lawn of the hospital, where they collapsed in the grass.

As they looked back at the hospital, another round of shells struck the driveway where they had just been standing, partly collapsing its roof. The hospital was on fire now, its flames leaping up and setting tall pine trees alight. The lawn was lit with its dancing orange flame. From inside, Faizullah could hear the screams of people burning alive.

Sixteen service members have been disciplined for their role in the airstrike, but the military has declined to pursue criminal charges. The military has argued that while both the Special Forces and the AC-130 crew made serious errors, and in doing so violated the Geneva Conventions, they were not guilty of crimes because they had not known they were targeting a hospital.

"The label 'war crimes' is typically reserved for intentional acts -- intentional targeting of civilians or intentionally targeting protected objects or locations," Gen. Joseph Votel said. Hutchinson was relieved of command and reprimanded, but he was recently assigned as his battalion's executive officer, according to Representative Hunter's office.

It is true, as the report states, that there was a pileup of mistakes and technical problems, without any one of which the strike might have been averted. An antenna that would have allowed the gunship to send video of its target to the Special Forces, and to receive an email sent by its headquarters with the MSF hospital's coordinates, stopped working shortly after takeoff.

Later, the Special Forces headquarters at Bagram sent a Predator drone to observe the wrong NDS location on the other side of the city, and as a result wasn't watching the strike when it started.

Most important, because the strike was carried out under the special self-defense-of-others designation given to the Afghan commandos, it didn't have to be approved by anyone besides Hutchinson and the aircraft commander. Hutchinson, who was inside the police compound, claimed that he thought he saw the K.K.A. convoy nearby and then heard them come under machine-gun fire.

In fact, the report states, the convoy was still five and a half miles away from the target and had not yet been attacked. The investigators concluded that Hutchinson violated the rules of engagement and stated that his "version of events surrounding his decision to authorize the strike is internally inconsistent, implausible and contradicted by other available sources of credible information."

But Hutchinson was arguably only doing what he was asked to do by his higher-ups: fight with Afghan forces to retake the city of Kunduz as quickly as possible. "If someone must be held accountable, let it not be the man who was ordered to sky-dive without being given a parachute," a Green Beret officer in Kunduz -- his name is redacted -- said, complaining of "moral cowardice" and an "abject failure of leadership."

As a result of the self-defense justification, an airstrike against a building -- which would normally have gone all the way to General Campbell for approval -- could be approved on the spot.

These safeguards around airstrikes (which succeeded in reducing civilian casualties from airstrikes, to 204 in 2012 from 353 in 2011, according to United Nations figures) were intended not only to prevent simple errors or collateral damage but also to avoid acting on bad intelligence provided by Afghan sources, who had in the past been careless in passing on unverified rumor as fact, or even seeking to maliciously use American air power to target their rivals.

This, in turn, raises the question of what targeting information was provided by the Afghan forces. The military has focused on the NDS headquarters' coordinates, which the gunship's targeting system mistakenly indicated as an open field. But those grids were passed to the Special ­Forces at 6 p.m., when the Afghans informed them of their plan of attack for that night.

When Hutchinson asked them, seven hours later, after the confusion with the gunship's targeting system, about the compound to strike, they gave a description of a "long T-shaped building" with a north-facing gate, which he in turn passed to the gunship.

Maj. Gen. William Hickman, who led the military's investigation, described this as "an ambiguous physical description" that "appeared to match the MSF trauma center." But it's actually a rather specific description that corresponds to MSF's distinctive layout. It does not at all resemble the NDS headquarters, which is a trapezoidal compound with a south-facing gate and two main rectangular buildings facing each other across a cramped courtyard.

Indeed, according to the report, when the AC-130 returned to a normal altitude, the sensor operator, worried that the navigation system had failed earlier, tried punching in the original grid coordinates, and this time it aimed his sensor at the NDS headquarters.

The crew members then did a "side-by-side comparison" of the NDS and MSF sites using both of their sensors, but based on Hutchinson's description, they decided that they were 100 percent confident that the T-shaped building was their target.

Hutchinson and the other Special Forces on the ground later told investigators that the Afghans had a second target that night, in addition to the NDS headquarters. They all claimed not to know or recall what exactly it was. "There was actually two targets they said they were going to hit, but they didn't even have a location for the other one, so we didn't concern ourselves much with it," Hutchinson said.

Another Green Beret said the Afghans had provided two sets of coordinates, one for the NDS headquarters and the second for what was described as an insurgent command-and-control location, but he didn't know precisely what the other grid referred to. "I don't recall and don't want to speculate," said a third, who claimed to have passed both grids to the aircraft. A member of the gunship crew also said they received "multiple grids" that night.

Could the second target have been the hospital? Did Afghan forces, influenced by their longstanding animosity for MSF, believe that it had become a Taliban headquarters and needed to be taken out? Unless their findings have been redacted, the military's investigators seemed not to have probed these questions.

When I interviewed them in November, none of the Afghan forces would claim responsibility for passing on the description to the Special Forces. Yaftali, the K.K.A. commander, said that the decision to strike the hospital was made by the United States and that it was unfortunate but justified. "They were firing R.P.G.s at us from the direction of the hospital," he said.

"The Americans were aware that they were firing from there," said Captain Munib, an Afghan commando who was partnered with American forces in Kunduz. The K.K.A. "had reported to them that the Taliban were there, and then they hit it." (Independent investigations have revealed no evidence to suggest that armed Taliban fighters were inside the hospital or firing from nearby.)

In fairness, much like their American partners, the Afghan special forces sent up from Kabul were reliant on information from local sources, who had longstanding views about MSF's role in Kunduz. "That hospital is in the service of the Taliban," Gard said when I visited him in Kunduz. "I swear to God, if they make it a hundred times, we'll destroy it a hundred times."

Is there still a place in today's wars for a hospital to treat all sides? On May 3, denouncing a pattern of attacks against medical facilities in conflict zones, the United Nations Security Council adopted Resolution 2286, which called for an end to impunity for those responsible. Oddly, some of the individuals seated around the Security Council's horseshoe-shaped table represented countries involved in these strikes.

In Yemen, for example, the military coalition led by Saudi Arabia and supported with American and British intelligence and weaponry has repeatedly struck medical facilities; it bombed an MSF clinic on Oct. 26, despite having been provided with its coordinates.

In Syria, MSF does not provide coordinates of the medical facilities it supports to the Assad regime or the Russian forces backing it, out of fear that the information will be used to target them.

Aid and human rights groups have accused both governments of deliberately attacking medical facilities, including an MSF-supported hospital in northern Syria on Feb. 15, an accusation they have denied.

"Can we provide treatment to whoever you consider to be your enemy?" said Jonathan Whittall, MSF's head of humanitarian analysis. "When you look at the track record of the last few months, when four out of the five permanent members of the Security Council have been involved in bombing MSF facilities, it's a question that we urgently need to have answered."

In Afghanistan, health facilities remain under threat, both by the Taliban -- who frequently commit war crimes like indiscriminately attacking civilians -- and by the Afghan government.

According to the United Nations, on Feb. 18, Afghan police commandos stormed into a clinic run by the Swedish Committee for Afghanistan and executed two patients and a teenage caretaker who were suspected of being insurgents.

Jorgen Holmstrom, the SCA's country director, told me that the commandos belonged to the 333 Battalion -- the same unit that raided the MSF hospital last July and participated in the battle for Kunduz -- and were accompanied by British troops. (A spokesman for Resolute Support stated that its investigation found "absolutely no evidence to support that allegation" of executions and declined to comment on which units were present.)

In Kunduz, the hospital remains in ruins, and its staff has struggled to make sense of what happened. Faizullah, the archivist, survived, but his young friend Amin did not. "Whenever I went to sleep for two minutes, I was just seeing the bombing and the killing and the dead bodies," Faizullah said.

Once the airstrike ended, Esmat tried to suture Amin's severed femoral artery on a makeshift operating table, but to no avail. Madina, the little girl, lived through Esmat's operation but not the bombing. Her family found her two days afterward and buried her with her big sister. "We tried to save her, but she died," Esmat said, picking his way through the rubble. "She died, and she burned."

The walls around us still stood, but the roof was open to the gray winter sky.

Editor's note:The United States military initially declined to comment and referred questions to the Afghan government, which also declined to comment. After this article went to press, Peter Cook, the Pentagon's spokesman, said in a statement:
"The comprehensive investigation that followed the Kunduz tragedy determined that all members of both the ground force and the AC-130 aircrew were unaware that the aircraft was firing on a medical facility throughout the engagement. The investigation ultimately concluded that this tragic incident was caused by a combination of human errors, compounded by process and equipment failures."

Matthieu Aikins is a Schell fellow at the Nation Institute and has been reporting from Afghanistan since 2008. He has twice been a finalist for the National Magazine Award and won a 2013 George Polk Award.

Posted in accordance with Title 17, Section 107, US Code, for noncommercial, educational purposes.

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