Dispatch

MSF Hospital Survivors Recount a Night of Horror

With the roar of a plane overhead, doctors and patients huddled in the basement as the hospital went up in flames.

Photographs and story by Andrew Quilty

Large caliber bullet holes mark the wall of a partially destroyed room at the rear of the hospital.

 

KABUL — On the night of Saturday, Oct. 3, a local mullah and teacher at a private university in Kunduz was sitting by his brother’s bedside in the intensive care unit at the Médecins Sans Frontières Trauma Center in Kunduz. He remembers hearing the scuttle of fighting — what to his ears sounded mostly like small-arms fire. It was close, possibly within a half-mile of the hospital. The sound of fighting continued throughout the night in an on-again, off-again pattern, intensifying then ceasing for 30 or so minutes before resuming.

Earlier in the week, on Monday, Sept. 28, the mullah’s brother, Enayetullah, a 38-year-old high-school teacher, had been outside his house, where he lived with his wife and their three children, talking to neighbors on his way to attend a relative’s funeral. While standing in the street, he was shot just below the shoulder, the bullet piercing his lung. According to his brother, the mullah — who asked that his name be withheld because he is well-known in his community — it couldn’t be determined where the bullet had come from or who had fired it. It was assumed to have strayed from fighting associated with the Taliban push on Kunduz, which had flared not far from Enayetullah’s home in the village of Rashid Abad in Khanabad District. His family and neighbors rushed to Enayetullah’s aid and transported him to the MSF hospital, the mullah said in an interview with Foreign Policy on Oct. 16.

That Saturday night, in the MSF hospital’s ICU, the mullah sat by his brother’s bed, reciting the Quran. After about an hour, he noticed that Enayetullah had fallen asleep.

“I felt tired also,” he remembers. He asked the family member of another patient in the ICU to keep watch over Enayetullah. “When I got out of the ICU, I saw nurses sitting on the chairs,” he said. “They said not to worry, that they were there to look after my brother. I went to other rooms to look for somewhere to sleep, but there was no room so I went to the basement.”

The mullah made his way down the stairs to the hospital’s basement, where some staff and other family members of patients had lain down for the night on padded toshaks, colorful blankets or shawls. He had barely drifted off to sleep when he heard an explosion.

A guard's office inside the front gate to the hospital.

“The first thing I heard was a very heavy and hard sound.” The mullah thought it was just coming from the fighting in the city that had been going on for a week. But it seemed closer than the other gunshots and explosions he’d heard that night. He soon realized that the hospital itself was under attack. People in the basement were terrified, he said. “Some lay on the floor or hid in the corners of the room saying, ‘We’re going to die.’”

Another man present, who agreed to speak to FP on the condition of anonymity, was in the center of the hospital’s main building and said he was in the X-ray room when the attack began.

When he heard the first explosion, he thought that it was coming from outside the hospital, he remembers, just like the many others he’d heard over the past week. But then came another, and another. Bullets rained down on the hospital in bursts. “I ran out the door to the nearest exit. Two doctors and a patient were behind me in the X-ray room. People were walking with bleeding wounds or lying on the ground.”

“I could hear the sound of a plane above,” he said in an interview on Oct. 15.

The man ran out into the grounds of the hospital compound and away from the building, trying to keep up with another man who was a few yards ahead, and then watched as bullets cut down the man in front of him. He heard a voice in his head saying, “Don’t run or they’ll shoot you!” For a few minutes, he hid at the base of a tree until the sound of the plane faded. He then made a dash for the hospital basement. He hurried past another body on the ground. Minutes later, amid the chaos of the attack, the two doctors he’d been with in the X-ray room when the attack began limped down the stairs into the basement. They’d both been injured.

According to multiple accounts, the hospital’s basement had grown crowded. Some of the staff who had finished their shifts for the day had elected to sleep in the basement rather than return to their guesthouse nearby. More than one staffer told FP that they figured because it was a hospital, and presumably off-limits from the fighting, it was the safest place in Kunduz. Others in the basement were relatives of patients, like the mullah, who had opted to spend the night rather than risking the dangerous roads home.

The mullah recalled: “Some people [in the basement with him] were saying to call the foreigners to tell them that there were no Taliban [fighters] in the building and to stop the attack.” Later, MSF issued a statement saying that during the attack its staff had informed U.S. and Afghan military officials of the location of the Kunduz hospital. By the time it was over, 12 MSF staff members and 10 patients were killed during the hourlong bombardment from a U.S.-operated AC-130 gunship.

The mullah said that strangers approached him to ask what verses of the Quran they should recite, while others instinctively recited the Kalima — an Islamic prayer performed when Muslims feel they’re close to death. “We were trying to get out of the basement but couldn’t because of the flames outside the basement door. We just stayed in the basement and had no hope for survival.”

Once the sound of the plane that had carried out the attack had disappeared into the night, the mullah said he peered out from the door of the basement. “It was around 6 a.m. that we left the basement and walked around.” The hospital was in flames.

He never saw his brother again.

Left: Part of the eastern wing at the front of the hospital. Right: The remains of an MSF four-wheel-drive vehicle.

Earlier that week, in Kunduz, the Taliban had mounted its most serious attack on a major Afghan city since 2001. Some Taliban fighters had infiltrated the city during the Eid al-Adha holiday, while others streamed in from surrounding districts in the early hours of Monday, Sept. 28. By nightfall, the city of 300,000 was theirs. On Sept. 28, the white Taliban flag could be seen flying over several public areas. By catching Afghan government forces by surprise, the insurgents had dictated the battle, forcing government troops to retreat to an airstrip on the edge of the city and cutting off critical supply routes from neighboring provinces.

Zalmai Farooqi, a district governor who had retreated to the airport, estimated that the government may have had as many as 7,000 troops in the area at the time of the takeover. “The problem wasn’t lack of security forces,” Farooqi told the New York Times, “but there was no good leadership to command these men.”

With the assistance of NATO special operations forces and U.S. airstrikes, Afghan troops launched multiple counteroffensive attacks against the Taliban in Kunduz. On Sept. 29, President Ashraf Ghani spoke at a news conference, stating that while the Afghan military was making gains, the problem was “that the treacherous enemy is using civilians as human shields.” He continued, “The government of Afghanistan is an accountable government and cannot bombard inside the cities, and it will not.”

On Oct. 1, according to an eyewitness familiar with the area and who was in the hospital, government soldiers were fighting insurgents who had positioned themselves in the home of a prominent local elder near the governor’s office, some 500 yards from the hospital. The eyewitness recalled that the position was leveled by an airstrike that night. By the night of Oct. 2, fighting in the city was flaring intermittently.


The attack on the MSF hospital began at roughly 2 a.m. in the early morning of Oct. 3. Within hours, MSF had posted news of the attack on Twitter. In its initial account of the incident, the U.S. military said an airstrike had been carried out at the request of American special operations forces who had come under fire and that officers were investigating reports of possible civilian casualties. But two days after the attack, the top commander of U.S. forces in Afghanistan, Gen. John Campbell, told a hastily arranged Pentagon press briefing that on Oct. 3 “Afghan forces advised that they were taking fire from enemy positions and asked for air support from U.S. forces. An airstrike was then called to eliminate the Taliban threat, and several innocent civilians were accidentally struck.”

The next day, on Tuesday, Oct. 6, Campbell was more direct, saying a hospital had been “mistakenly struck” and said “the decision to provide aerial flyers was a U.S. decision made within the U.S. chain of command."

Campbell named U.S. Army Brig. Gen. Richard Kim, a one-star general, to conduct the military’s investigation into the strike. Kim has since visited the hospital’s site and begun interviewing American and Afghan troops about what transpired that night, Pentagon officials told FP. A key element of the inquiry will be audio and video recordings taken from the aircraft.

The plane that carried out the attack, an AC-130 gunship, is a cargo plane outfitted with powerful cannons; it is largely devoted to supporting special operations forces. Unlike fast-flying jets, the lumbering AC-130 circles a target at a relatively low altitude, firing its heavy guns repeatedly, and often relies on spotting a target visually instead of with GPS coordinates.

U.S. President Barack Obama has issued an apology for what the military has called a tragic mistake and has conveyed his condolences to the charity organization in a phone call to its president, Joanne Liu. On Oct. 10, the Pentagon announced that it would be paying “condolence payments” to families who lost loved ones in the attack.

MSF’s leadership has accused the U.S. military of a war crime and has demanded an independent, international investigation into the attack. The medical charity has said it informed the U.S. military of the hospital’s coordinates as recently as Sept. 29.

An NBC News report on Oct. 15 claimed that cockpit audio recordings from the gunship that carried out the attack show that the crew questioned whether the airstrike was legal and that a Pentagon official has acknowledged that the raid may amount to a war crime. Legal experts say the strike could meet the definition of a war crime if evidence showed that the officers involved did not take sufficient precautions to identify what was being targeted and to determine if civilians could be endangered by the attack.

Left: The emergency waiting room in the center of the main hospital building. Right: Chests of drawers and gas tanks litter the floor at the emergency entrance in the center of the building, its view looking out toward the hospital's front gate.

Earlier this week, in another report for FP, I described the state of the hospital as I saw it exactly one week after the attack on Oct. 10. Though nearly two weeks have passed since Oct. 3, exactly what took place the night of the U.S. attack is still unclear.

Ten people who were present at the hospital in Kunduz the night of the attack were contacted for this report — eight MSF employees, one patient, and the family member of a patient (the mullah). The majority declined to recount their experiences — citing that they had received explicit instructions from MSF not to speak with the press. But the mullah, along with two individuals who wished to remain anonymous, gave statements in interviews conducted with FP that contradict reports from the U.S. and Afghan governments.

Both individuals said that on the night of Oct. 2, and in the early morning hours of Oct. 3, fighting could be heard, but it was not “close” to the hospital. Rather, according to each individual’s estimate, the fighting appeared to be somewhere between 200 yards and half a mile away from the MSF compound. These two individuals stated that there were several patients from both the government and Taliban sides in the MSF hospital on the night of the airstrike; the mullah and one patient interviewed by FP concurred with this recollection. However, all parties said that there were no active fighters from either side present nor, as per MSF policy, had they seen any indications of weapons in the hospital. Another person familiar with MSF procedures, who wished to remain anonymous because of the sensitivity of the issue, stated adamantly in a phone interview on Oct. 15: “Our hospital is for everyone. The rule is that no one can enter with a gun.”

The mullah said that the Taliban took MSF’s policy seriously. On one occasion, he had seen some Taliban fighters try to enter the hospital with weapons, when other members of the insurgent group — and family members of patients — had confronted the fighters themselves to keep them from violating the MSF mandate.


Back in the basement, the survivors weathered the attack. It wasn’t until morning light began to color the sky that the mullah said he felt it was safe enough to leave the basement. He made his way back to the ICU where he’d left his brother, Enayetullah, a few hours earlier. In places around the hospital, the fire still burned, clinging to debris on the ground. “When I went to the ICU, the ceiling had fallen in; there were no doors or windows; all the beds were destroyed,” he said. “The bodies that were there were all unidentifiable.”

The mullah saw some relatives of a Taliban fighter who’d shared the ICU with Enayetullah before the man had been taken into the operating theater for surgery. His family told the mullah that the man hadn’t survived. Others who’d emerged from the basement were screaming into the smoldering building for their loved ones.

For the next couple of hours, doctors and medical staff worked frantically to save their colleagues and patients. In a statement released by MSF on Oct. 3, Lajos Zoltan Jecs, a nurse in the hospital during the time of the attack, described what he saw upon emerging after the airstrike had ended.

“We went to look for survivors. A few had already made it to one of the safe rooms. One by one, people started appearing, wounded, including some of our colleagues and caretakers of patients.

We tried to take a look into one of the burning buildings. I cannot describe what was inside. There are no words for how terrible it was. In the intensive care unit six, patients were burning in their beds.

We looked for some staff that were supposed to be in the operating theater. It was awful. A patient there on the operating table, dead, in the middle of the destruction. We couldn't find our staff. Thankfully, we later found that they had run out from the operating theater and had found a safe place.”

From what the mullah remembers, some 10 minutes after he had emerged from the basement, just moments after discovering the catastrophic scenes in the ICU, “firing began close by … so we all went back to the basement.” They stayed there through two other rounds of nearby fighting. When the gunfire had quieted, they emerged to find soldiers and police entering the grounds of the hospital on foot and in armored personnel carriers.

The mullah told FP that the soldiers instructed everyone in the compound who was physically capable to evacuate, while soldiers and ambulance drivers assisted the injured into vehicles. According to various reports, patients from the Kunduz hospital were admitted to hospitals in Baghlan and Kabul later that day. The mullah said he then saw a couple of vehicles arrive to collect foreign staff and ferry them to the airport.

The mullah left the hospital grounds by car, alone.

“I called my brother and father to tell them what had happened — that I was fine but that Enayetullah had been killed. But I couldn’t call his wife.”

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