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Doctors Without Borders investigation shows precise targeting during Kunduz hospital bombing

An emergency trolley bed lies abandoned in front of the heavily damaged entrance of the physiotherapy department. (Credit: Dan Sermand/MSF©)

A month has passed since U.S. airstrikes destroyed a Doctors Without Borders hospital in Kunduz, Afghanistan. The medical aid group immediately called for an independent international investigation, but the U.S., which admitted fault in the incident, has yet to agree to the inquiry. Increased pressure by the group has yet to yield significant gains, so it released its own preliminary investigation review yesterday. The findings refute claims that the hospital was over-run by the Taliban.

“The facts compiled in this review confirm our initial observations: the MSF trauma centre was fully functioning as a hospital with 105 patients admitted and surgeries ongoing at the time of the US airstrikes; the MSF rules in the hospital were implemented and respected, including the ‘no weapons’ policy; MSF was in full control of the hospital before and at the time of the airstrikes; there were no armed combatants within the hospital compound and there was no fighting from or in the direct vicinity of the trauma centre before the airstrikes,” says Joanne Liu, head of Doctors Without Borders, officially known as Médecins sans frontières (MSF), in the report introduction.

People at the hospital report seeing people being shot at as they fled from the hospital during the attack. MSF holds it up as evidence that the attack was not an accident, as claimed by the U.S. and NATO. A before and after photo of the hospital shows the destruction and precision of the attack.

“All the information that we’ve provided so far shows that a mistake is quite hard to understand and believe at this stage,” said Christopher Stokes, MSF general director, to the media. “From what we are seeing now, this action is illegal in the laws of war. There are still many unanswered questions, including who took the final decision, who gave the targeting instructions for the hospital.”

Some 30 people were killed, including hospital staff and children, by the attack. The U.S. says it is cooperating with MSF in its investigation of the incident. It has offered little in terms of comments about what happened. That is not good enough for some, as seen in recent comments by Mego Terzian, MSF France President.

Below is an interview with Terzian originally published in the French blog Mediapart. The office of MSF France provided us with an exclusive English translation of the conversation in which Terzian provides some rather raw commentary on the Kunduz attack and general threats to aid workers.

Three weeks after the death of our colleagues and patients in Kunduz, can you tell us about the latest developments and how you feel about them?

Last week an American delegation went to the Kunduz hospital and forced their way in: their soldiers didn’t know we were there. Members of the Belgian MSF section were there to gather information and clarify some issues. In the light of these latest developments, widely reported in the press, and after the many contradictory statements we have heard since October 3rd, I would, first of all, be inclined to credit Afghan and U.S. forces with an unparalleled and, frankly, unbelievable degree of incompetence. However, I want to avoid falling into the trap of obsessive anti-Americanism, and cannot overlook the indiscriminate bombings carried out by Bashar al-Assad, Omar al-Bashir and Vladimir Putin: on the evening of 3 October, our Syrian colleagues told us that the Lattakia hospital, where the MSF Belgian section had worked previously, had been bombed apparently by a Russian plane. We have also just learned that last night in Haydan, in the northwestern Saada province of Yemen, aircraft belonging to the Saudi-led coalition bombed and destroyed a hospital run by our teams. Only one person has been lightly injured, but the maternity unit, emergency room, outreach and hospitalization services were totally destroyed. We should remember that this coalition, led by Saudi Arabia with U.N. approval, is also backed by the U.S.A.

In a message you recently sent to your colleagues in other MSF sections you underline our reluctance to publicize regular attacks on health workers and establishments. At the same time you criticize the sort of global awareness-raising campaign that MSF could lead on this issue. Is this not a little inconsistent?

I have serious doubts about the effectiveness of global awareness-raising campaigns on the threats to aid workers and establishments as well as civilians in general. As I see it, this is not the way to change the behavior of militias, regular armies and rebels. What I’m about to say is pretty cynical and pessimistic, but sadly there will be other Kunduz’s, not because of the context, but because if wars have rules, these rules obey first the idea that ‘might is right.’ We can see this clearly with what is happening today in Haydan. So our task is not to try and improve the morality of war in general, using global awareness-raising campaigns that I feel have little effect, but rather to work within specific circumstances to ensure that the opposing armies have more to lose than to gain when they do fail to respect the safety of medical establishments and workers. I don’t want to be naive, but this is what should inform our efforts to expose and denounce the attacks on hospitals, whether in Syria, Yemen or elsewhere. Let’s take the example of South Sudan, where we have not always managed to respond to events adequately. We need to ask ourselves what signs we are sending to the parties in a conflict when we remain almost silent about the pillaging of health centers, with the wounded and staff forced to flee, taking refuge and providing aid in the forest, or patients being murdered within the very walls of the hospital. Or in Yemen, when an MSF team in Taz could not cross the front line for 48 hours to bring medicines to a besieged enclave. At the end of the week, a bomb fell right next to the house where our colleagues thought they were safe. We cannot limit ourselves to a purely symbolic press release and a telephone call to the Saudi authorities asking them to be more careful with their bombs. A few hours later, what were Saudi-led coalition forces doing? Pulverizing another hospital! We need to put our foot down and speak out publicly. The events that have just occurred in Haydan, whether they concern MSF or another body, and, more generally, the war as a whole currently being waged in Yemen, must be denounced. Because over and above the destruction of yet another health establishment, the message being sent to civilians and health workers is clearly more than just a threat: ‘Either you’re for us, and have no reason to be there, or you’re against us!’

In the particularly violent contexts where we operate today – Libya, Yemen, Syria, South Sudan and CAR – we need to react a lot faster and be more focused on taking a political stance, even where MSF teams are not directly involved. Everybody today is talking about Kunduz because of the tragedy that has occurred, and because the media are taking an interest. Over the coming hours, maybe the talk will turn to what happened last night in Haydan, and more generally to the plague of targeted or indiscriminate hospital bombings. But we should remember that the [International Committee of the Red Cross] reported 19 acts of violence against health establishments in Yemen between last March and August. And what about the bombings of markets, schools and other civilian establishments? When we are not direct witnesses to an event, when we do not deal directly with the dead or wounded from these killings, MSF is almost silent, maybe because we have an excessive distrust of the propaganda that is so widespread during times of war; this is something we need to think about. As doctors, when we are challenged, when we’re targeted and ordered to choose a side, our task is to resist every time, to show solidarity and systematically denounce and expose the gap between words and actions, even if it means brandishing the regulations of international law, which, if nothing else, at least serve as a reminder that they are constantly ignored, circumvented or instrumentalised by those acting purely out of self-interest.

So what do you think of the Kunduz case being submitted to the International Humanitarian Fact-Finding Commission?

I’m worried that we’re giving false hope to MSF members by submitting the case to the [International Humanitarian Fact-Finding Commission]: the hope that it will lead us to the truth. There is a risk that this will not be case. However, we needed to make a bold gesture, particularly for symbolic and political reasons. But beyond the symbolic value, our objectives in calling on the Commission are not always clear. The Commission can undertake investigations on its own initiative, as long as the Afghan and American governments agree. But once they have agreed, the two governments have also to agree to the conclusions being passed on to us, at the very least. There is reasonable cause to doubt that will happen, particularly if the conclusions contain sensitive military data. The next few days will be decisive, keeping in mind that we still have time to consider other options for achieving our main objective, i.e. to get to the truth.

You say that we need truth, not justice. What do you mean by that?

Our objectives need to be both clear and achievable. This means that we need to start by taking action so that the truth can be revealed: the truth will allow us to learn lessons from what happened in Kunduz. Barack Obama’s apology has taken him a few steps down the right path, because he is providing us with a measure of truth by confirming the U.S.A.’s manifest responsibility in this carnage. Naturally these apologies are not enough, but at least they demonstrate a degree of regret, as the Afghan authorities continue to deny their responsibility, despite this being equally manifest. This is far from reassuring. And let’s not forget that it was in Afghanistan that five of our colleagues were killed in Badghis province in 2004; and that the people behind the murders were swiftly released. Is there a parallel between Badghis and Kunduz? And how should we interpret it? I don’t have the answers. All I know is that an MSF team is currently working on the border with Pakistan in a region that is made perilous by fighting between Taliban and coalition forces, and that it is therefore vital that we get clarification on how the Afghan authorities perceive us. Are we targets? Was the Kunduz bombing simply incompetence? Is it something that the current government, which feels that we shouldn’t work in areas under Taliban control, finds acceptable? Answers to questions such as this will allow us to alter our activities accordingly. And we absolutely must get the same answers from the coalition forces in Yemen, although it is a matter of regret that we have had to wait for the bombing of Haydan hospital before really becoming aware of the issue.

Other than promises of compensation, does this mean you do not expect anything from the legal system?

I have no idea if we can hope for any legal redress, and recent history shows us that disappointments tend to be rife. For instance, we could cite again the example of our colleagues murdered in Badghis province, or the massacre of 17 ACF staff members in Sri Lanka by government forces in 2006. In the light of these examples, I think that what really counts for MSF during the various stages of legal proceedings, which are often complex and undermined by the passage of time, is our ability to learn lessons from the way a legal system reacts. This is one way to raise the issue of impunity as well. After the murder of our two colleagues in Mogadishu in late 2011, the authorities arrested the murderer but then released him almost immediately. They reacted to our protests by trying to put him back in prison, but failed: he had fled and been taken in by Al-Shabaab militants. Since then, the militants have done nothing about bringing him to justice. I see this as a sign not just of Al-Shabaab’s political immaturity, but also of its defiance; most importantly, it demonstrates the need to clarify our relationship with this group before we can consider returning to Somalia.


About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]