Kunduz Déjà Vu

One year after the U.S. attack on the MSF hospital in Kunduz, I returned to the site of the massacre. The facility is still in ruins, and the Taliban are closing in on the city. Again.


Warning: Readers may find some of the following images disturbing.
KUNDUZ, Afghanistan — At 1 a.m. on Oct. 2, international and local staff and
Nepalese Gurkhas staying at the U.N. guesthouse in Kunduz woke to the thunderous boom of outgoing artillery. Afghan National Army (ANA) soldiers were positioned nearby and shelling Taliban areas in an outlying district west of the city. By 3 a.m. the shelling had subsided, but it was replaced by the sound of heavy machine guns and explosions coming from the city, five miles north.

By daybreak, Afghan Air Force helicopters were lifting off one after another from both the nearby airstrip and ANA base, making their way to the city to join the fighting. We could hear the shrill tearing sound of their rockets added to the growing noise. I called my friend and fixer, Waqif, who had dropped me at the guesthouse 12 hours earlier. Kunduz was under attack, he told me. The streets were deserted, the shops were closed, and residents were frantically trying to get out of the city.

The helicopters came back early that afternoon, landing to refuel, reload ammunition, and deposit the bodies of the soldiers who had been killed in action before returning to the air. I stood on the airstrip with a group of U.N. and Médecins Sans Frontières (MSF) staffers, watching them squint into the sky, looking for an emergency charter flight that was coming to evacuate them from Kunduz and bring them back to Kabul.

There was an unmistakable familiarity in the air — what was unfolding in Kunduz at that moment seemed to be a repeat of the events that had transpired at exactly this time last year.

In the early hours of Sept. 28, 2015, Taliban fighters, who had infiltrated the city over the Eid al-Adha holiday, emerged from supporters’ houses to launch a full-scale assault on Kunduz as insurgents in the surrounding districts pushed in from all sides. By midday, the Taliban had raised their flag in the central traffic intersection and taken control of the city. It was the first provincial capital to fall to the Taliban since the U.S.-led war began in 2001.

During the subsequent counteroffensive to retake Kunduz in October 2015, northern Afghanistan’s primary trauma care facility, the MSF Kunduz Trauma Center (KTC), became the most unlikely of casualties. In the early hours of Oct. 3, U.S. special operations forces, upon the request of their Afghan counterparts, had called in an aerial assault on the KTC after it was wrongly identified as a Taliban command-and-control center.

Baynazar Mohammad Nazar’s daughters, Raiana (then 10) and Zahra (then 8), stand by their father’s bicycle on Nov. 17, 2015.

Graffiti on a wall inside the MSF Kunduz Trauma Center after the attack, on Oct. 21, 2015.

I traveled to Kunduz in the days following the MSF attack last year. Another Kabul-based journalist and I had already made arrangements to embed with Afghan forces in Kunduz when news of the MSF attack broke. On the afternoon of Oct. 10, 2015, I was able to detach myself from a platoon we had accompanied to the front line on the southern edge of the city, only a couple of miles from the KTC. I slipped into the city with a local driver, and as a firefight between Taliban and Afghan forces escalated a block away, I managed to access the devastated MSF facility and photograph the charred remains of several victims still lying in the ruins. In a series for Foreign Policy, I reported on the experiences of those who had been at the hospital during the attack, as well as told the story of one particular victim, Baynazar Mohammad Nazar, a 43-year-old husband and father of four who was killed while being operated on. Over the months that followed, I would go back to Kunduz and the KTC several times.

Despite concerns among Kunduz residents that history would repeat itself, the Eid period came and went without incident this year. In the districts surrounding Kunduz, the Taliban had stepped up their activity in recent months but hadn’t yet threatened the city.

I returned to Kunduz on the eve of the anniversary of the MSF hospital attack, in part to attend a memorial at the KTC but also to visit those who had been most affected by its devastation, like Baynazar’s family, to see how they were faring a year later. But within three days of my arrival, I was on the tarmac of the civilian and military dual-use airstrip five miles south of the city center watching U.N. and MSF staff prepare to evacuate to Kabul. Kunduz was under attack; the Taliban were taking control of the city. Again.

Shaesta stands on a chair outside her father’s yogurt store in Kunduz’s central bazaar on Mar. 22.

On the morning of Oct. 1, 2015, 3-year-old Shaesta was at home playing with her older sister Asina. There was a lull in the fighting, and her father, Asmarai, had gone to the bazaar to buy flour. Her mother, Annissa, was sleeping in the next room. The children were unattended when an Afghan Air Force helicopter fired a rocket through the living room ceiling where Shaesta and her sister played, exploding on the concrete floor. Asina was unharmed, but Shaesta’s left leg took the brunt of the explosion and was blown apart, strands of torn muscle tissue left dangling from her hip. Annissa rushed Shaesta to the KTC on the back of a three-wheeled Zarang motorcycle where she underwent two operations. Miraculously, she survived.

Just after 2 a.m. on Oct. 3, Shaesta asked her mother to carry her from her bed in the KTC’s intensive care unit (ICU) to the bathroom. Three minutes later, the first of 211 shells fired from the circling AC-130 gunship hit the ICU, incinerating everything and everyone inside. Shaesta and her mother, still in the bathroom, survived their second airstrike in two days.

A year later, the KTC is closed. The main building is still in ruins. Its corrugated roofing, which was badly damaged during the 2015 attack, has since collapsed, and a layer of fine, dun-colored dust has settled over the rubble and medical detritus still strewn throughout the KTC’s grounds. For the residents of Kunduz province seeking medical attention, their next best option, now, is the nearby Kunduz Regional Hospital (KRH).

I visited the KRH twice on Oct. 1 and 2 to see a new trauma care unit funded by the World Health Organization (WHO) that opened in August to fill part of the void left when the KTC was destroyed. In its infancy, the facility’s shortcomings were plain to see. Safi, an orthopedic surgeon who was operating at the KTC on the night of the attack, is now the most senior surgeon at the trauma care unit. With the equipment available to him here, Safi says the best treatment he can offer patients seeking emergency care is basic first aid.

Dust now covers the steel bed frames in the KTC’s intensive care unit on Oct. 1, where all patients except Shaesta were killed during the 2015 attack that devastated the MSF facility.

Safi, an orthopedic surgeon, examines a patient in the trauma care unit at the Kunduz Regional Hospital on Oct. 2. The following day, with fighting at the hospital gates, personnel were forced to abandon the unit.

A patient who lost his legs in a mine explosion, lies in a hospital bed at the KRH’s trauma care unit on Oct. 2. The hospital lacks critical supplies including blood for emergency transfusions.

The Kunduz Regional Hospital on Mar. 9.

I watched as an exasperated father spoke with the overstretched surgeon, who — because of the KRH’s lack of supplies — had to send the man to the Kunduz bazaar to purchase drugs that the hospital didn’t supply. The man’s son was at serious risk of going into toxic shock after his leg was crushed in farm machinery. Another patient, who had lost his legs in a mine blast, needed a blood transfusion so he wouldn’t die from blood loss — blood that the hospital could not provide, so it was also purchased from the bazaar.

I interviewed some of the hospital staff, and they mentioned a range of items that weren’t supplied to them — from surgical shoes to general anesthetic and X-ray film. When I mentioned this dearth of supplies to the WHO’s Afghanistan country representative, the Kabul-based Richard Peeperkorn said “additional equipment” including surgical sets is “being procured at the moment” and that some items were even scheduled to arrive this week.

But as the Taliban continue to mount offensives nearby, that might prove difficult. The facility is located on one of the most heavily contested front lines in the city. Only 10 percent of the staff is now present. In recent reports, according to witnesses inside the hospital, two rockets struck the KRH’s main building on the afternoon of Oct. 5, shattering windows but not causing any injuries. The KRH is the only functioning hospital in the city.

Three-year-old Shaesta plays with her brother at the home where she lost her leg, on Mar. 21.

When I met Shaesta for the first time in March, she was back at the KTC (in an undamaged administrative office) in Kunduz with her parents; they had come to collect a document to prove to the U.S. military that she was at the KTC on the night of the attack and entitled to a condolence payment.

Immediately after the attack, Shaesta spent two months in Kabul recovering in a hospital run by the Italian medical charity Emergency. Asmarai had taken out a loan and sold Annissa’s gold to fund further treatment in Pakistan. International nonprofits in Kunduz offered the family assistance with Shaesta’s long-term recovery, but she had hated the painful, therapeutic massages and rejected a temporary prosthesis, throwing it to the ground.

On a separate trip to Kunduz later that month, I found her propped up on a chair at the entrance to her father’s yogurt store in Kunduz’s central bazaar. Local men crossed the street to tousle her hair and pinch her cheeks. She asked her mother where her leg was and when they could go to buy new sandals. At home, the ceiling still bore the marks of where the rocket had entered.

A year on and Asmarai has moved the family away from the house that held such painful memories. The $3,000 condolence payment from the U.S. military went some way to paying off the medical debt from Pakistan, but Asmarai says his meager earnings won’t cover his family’s expenses if he takes Shaesta to neighboring provinces for further treatment. For the time being at least, he seems resigned to the fate of his daughter’s disability.

Afghan National Army soldiers fight Taliban forces on the southwestern outskirts of Kunduz city on Oct. 10, 2015, nearly two weeks after the insurgents overran the provincial capital.

The tragedy in Kunduz came as a shock to the U.S. military, and the public apologies followed swiftly. Usually, American forces respond cautiously to reports of bombing raids gone wrong until an internal investigation clarifies what took place. But Kunduz was different — a hospital run by an international medical charity had been hit, and there was no doubt that an American aircraft had carried out the strike. The U.S. headquarters in Kabul issued an apology within hours, and, in a rare move, U.S. President Barack Obama himself expressed his regret a few days later in a phone call to the international president of MSF, Joanne Liu. The U.S. Defense Department also announced that month that it was making “condolence payments” to the victims’ families, even though such measures are customarily handled discreetly out of the public eye.

The bombing damaged the image of a military that often touts its extensive precautions and safeguards designed to avoid killing civilians in air raids. And after the strike on the MSF hospital, the U.S. military launched an elaborate internal investigation and introduced a series of measures designed to prevent another catastrophe.

The military’s investigation into the Kunduz strike, which was released on April 29, concluded that a confluence of technical, procedural, and human errors led to the bombing of the hospital. The crew of the AC-130 aircraft responsible for the attack was not aware that they were firing on a hospital, according to the inquiry. The plane had taken off in a rush, as the crew believed there were U.S. troops under fire, before a no-strike list could be loaded onto the gunship’s software. As a result of the investigation’s findings, 16 service members, including a general, were subjected to various disciplinary and administrative actions. Some of the punishments effectively ended the military careers for those involved.

The measures were in keeping with how the U.S. military handles errant operations that result in civilian deaths, but some human rights advocates have said the response fell far short of what was required. On Oct. 7, 2015, four days after the strike, Liu demanded an independent, international inquiry of the attack under the auspices of the Geneva Conventions. And some rights groups said those responsible should be put on trial for war crimes committed due to gross negligence.

Human remains lie inside the ruins of the MSF Kunduz Trauma Center on Oct. 10, 2015, a week after it was attacked by a U.S. aircraft. Forty-two people were killed.

The wreckage of an MSF ambulance, destroyed in the October 2015 attack, is still on the grounds of the MSF Kunduz Trauma Center on Mar. 22.

Shortly after the new commander of U.S.-NATO forces in Afghanistan, Gen. John “Mick” Nicholson, took over in March, he visited Kunduz to issue a public apology and to meet relatives and colleagues of those killed. He has since returned to Kunduz several times, and his wife has accompanied him. Condolence payments of an unspecified amount have been offered to 250 family members of the victims, and the Pentagon has set aside $5.7 million in funds to construct a new hospital in Kunduz, officials said. The Pentagon maintains that the payments are supposed to be gestures of sympathy and not designed to put a value on the lives lost or serve as compensation for victims.

“It’s still very present in our minds in everything we do,” Brig. Gen. Charles Cleveland, a spokesman for U.S. forces in Afghanistan, told FP.

As a result of the 2015 airstrike, the U.S. military has retrained its entire force in Afghanistan, more than 9,000 troops, on the rules for using force, also known as the “rules of engagement.” Every newly arrived service member in Afghanistan has to be certified on the rules. And commanders have introduced more rigorous procedures governing every stage of an air operation, with a particular emphasis on ensuring lists of “no-strike” sites are updated at each level of command, Cleveland told FP.

Even with the stricter rules now in place, senior officers acknowledge that there is an inherent risk to conducting airstrikes and that bombing will cause more civilian casualties.

Almost a year to the day of the one-year anniversary of the Kunduz attack, U.S. commanders faced allegations that a drone strike had killed at least three civilians in Nangarhar province near the Pakistani border.

“We are aware of some claims of Afghan casualties and are currently reviewing all materials related to this strike,” the U.S. military mission in Kabul said.

Baynazar's youngest son, Khalid, at home with his brother, Sami, on Oct. 1.

Like all those who lost family members, Baynazar Mohammad Nazar’s family received one condolence payment from the U.S. military in the amount of $6,000 in the months following the attack. An independent lawyer in Kabul established a fund to help support Baynazar’s family after readers of the FP story asked how they could help and raised another $12,000. (I had hoped it would enable Samiullah, Baynazar’s oldest son, to continue his studies, but there were no conditions on the donation.) Baynazar’s wife, Najibah, told me on Saturday, Oct. 1, in the small, mud-walled home that they rent in Kunduz that it had always been their ambition for “Sami to finish school and become a good doctor.”

Samiullah, or Sami as his mother calls him, was in his final year of high school when his father was killed. Now, at 20, the responsibility for the livelihood of his three young siblings and mother rests entirely on his shoulders. Still, unlike most young Afghan men, Sami has retained his boyish looks, and he hasn’t yet had much need of a razor. He smiles more than the last time I saw him six months ago.

The family used the money to purchase a plot of land with four outer walls on which they hope to build a house — if they can find the money — and to pay off family debts. Sami bought a cart from which he now prepares and sells Afghan-style burgers outside the entrance to the university he once had hopes of attending. Sometimes Samiullah’s younger brother, Khalid, helps him, and often his friends stop by to visit on their way back from their day at the university. When I ask Najibah how she feels about Sami dropping out of school, she says, “I’m unhappy, but what should we do?”

Sami packs away his burger stand on Oct. 2, the night before the Taliban would storm Kunduz.

Baynazar's family sits together in their home on Oct. 1.

Baynazar’s daughters, Raiana and Zahra, now 11 and 9, were going to take me to their school. We planned to stay for the first class and then leave together for the ceremony which was going to be held on the KTC grounds. But when morning came on Monday, Oct. 3, helicopters were launching rockets from above. And though there wasn’t fighting immediately near their house, Najibah told her children to stay home from school.

A mile away, a fierce gun battle was being fought southwest of the city, only a block from the KTC. It had been a major front line last year as well, and the rusted carcass of a bus hit in an airstrike still sits in the bus station a stone’s throw from the KTC perimeter wall.

According to Waqif, my friend and fixer, the insurgents had commandeered homes throughout the city, embedding themselves inside the community and using defenseless residents as collateral against the Afghan National Security Forces. They continued pushing toward the center of Kunduz through the afternoon.

The evening before, as Waqif drove me from the city to the U.N. compound, I noticed that a police checkpoint where we had been stopped earlier in the day had disappeared. He explained that “after dark, there are no police checkpoints” in Kunduz outside the city center.

MSF staff prepare to board a chartered emergency flight out of Kunduz and back to Kabul on Oct. 3.

As helicopters flew to join the fighting that first morning on Oct. 1, local staff who had been able to travel from their homes in the morning gathered at the U.N. compound in small groups to discuss what they knew and ask after family and friends. Others paced up and down over the pristine, concrete paths, talking on cell phones to family members still in the city where, they said, the situation was deteriorating.

More than a thousand staff and family members of those who were killed or injured in the MSF hospital attack last year had confirmed their attendance for the memorial set to take place on the morning of Oct. 3. MSF staff from across Afghanistan and from the Geneva headquarters had already arrived in Kabul, due to fly north the following morning.

That flight — and the senior MSF staff booked on it — never left the ground in Kabul though. With the battle intensifying, the U.N. Humanitarian Air Service deemed it unsafe to land in Kunduz. The ceremony, of course, was canceled as well.

By late afternoon on Oct. 3, videos surfaced online showing Taliban fighters crouched in prayer and thrusting Kalashnikov assault rifles to the sky in triumph in the city’s central intersection. Fighting came so close to the new trauma care unit on the grounds of the Kunduz Regional Hospital that the staff abandoned it, relocating to work alongside their counterparts at the larger KRH building. Local media reported that the provincial governor and police chief — who had hosted me at his compound in the center of the city two nights prior — had fled to the airstrip as government offices were overrun. Electricity had been cut at Samiullah’s house, and the Afghan feast that had been prepared for MSF’s guests went uneaten and grew cold in oversized, steel pots.

MSF and U.N. staff wait for their evacuation flight at Kunduz airstrip's terminal building on Oct.3.

MSF staff wait on the Kunduz airstrip watching for their chartered emergency flight to Kabul on Oct. 3.

U.N. vehicles at the Kunduz airstrip after transporting staff from their guesthouse for evacuation to Kabul on Oct. 3.

Unable to leave the U.N. compound, I stood among the staffers preparing to be evacuated on an emergency flight chartered by MSF. I asked a member of the Afghan staff who along with his Kunduz colleagues would stay in the city. “We’re wood for the burn,” he said with a hint of melodrama.


The Man on the Operating Table: Baynazar Mohammad Nazar was a husband and a father of four — and a patient killed during the attack on the MSF hospital in Kunduz. This is his story.

By nightfall, with an unmistakable sense of déjà vu, the Taliban were claiming control of Kunduz city, and Afghan government officials were vowing a swift and decisive counterattack. Inside the walls of the Kunduz Trauma Center, six members of the local staff remained, standing vigil over the ruined building. They passed the phone from one to the next to speak over loudspeaker with the 30-40 MSF staff who had gathered for a casual memorial in their Kabul compound, their voices coming through over the loudspeaker.

Coco Sami, who is the KTC’s head of security, spoke in hurried, broken English.

“The situation is not good, he said. “But we are safe.”

Dan De Luce, Foreign Policy’s chief national security correspondent, contributed to the reporting of this piece.