A US bombardment that destroyed much of a hospital compound in Kunduz, killing at least 20 doctors and other aid workers, went on for more than half an hour after the alarm was raised with US and Afghan officials.
The Medecins Sans Frontieres (MSF) hospital had treated hundreds of people either injured after Kunduz fell to a Taleban attack, or when government troops launched an assault to reclaim it. Beds and corridors were still crammed with patients and their relatives when it was hit on Saturday.
MSF said patients burned to death in their beds. "This attack constitutes a grave violation of international humanitarian law," the charity said.
The dead included eight nurses, three doctors, six security guards, two cleaners and a pharmacist, said an MSF doctor.
"MSF demands clarity on exactly what took place at our hospital in Kunduz, and how this unacceptable event could have happened," said Jonathan Whittall, the charity's head of humanitarian analysis.
US President Barack Obama offered his "deepest condolences" for what he called a "tragic incident".
"The Department of Defence has launched a full investigation, and we will await the results of that inquiry before making a definitive judgment as to the circumstances of this tragedy," he said.
The charity said that despite frantic calls to American and Afghan military officials in Kabul and Washington, the attack continued for another 30 minutes, with the main hospital building housing the intensive care unit and emergency rooms being targeted.
"The bombs hit and then we heard the plane circle round," said Heman Nagarathnam, MSF's head of programmes in northern Afghanistan. "There was a pause, and then more bombs hit. This happened again and again. When I made it out from the office, the main hospital building was engulfed in flames.
"Those people that could had moved quickly to the building's two bunkers to seek safety. But patients who were unable to escape burned to death as they lay in their beds."
The commander of US forces apologised to President Ashraf Ghani for the attack, the President's office said.
Sarwar Husaini, a spokesman for Kunduz police, claimed that Taleban fighters had entered the hospital compound on Saturday and were firing at security forces from inside. MSF said that it had "absolutely no information about that". The clinic should have been clearly marked on military maps, and its attack revived longstanding questions about whether Afghan forces and their Nato allies do enough to protect civilians.
"Why did the US blow up the whole hospital?" said Nasratullah, whose 25-year-old cousin Akbar was among the doctors killed. "We know that the Americans are very clever," he said. "If they can target a single person in a car from their planes, why did they have to blow up the whole building?"
MSF said it had recently recirculated GPS co-ordinates of the hospital to all parties fighting in the conflict, even though it had been working for years and was one of the few medical facilities in the city, so should have been well known. Human Rights Watch said it had serious concerns about whether US forces had taken sufficient precautions to avoid striking such a sensitive target. Hospitals are among areas protected from attack under international laws governing conflict. At the time 105 patients and their carers and more than 80 MSF international and national staff were in the hospital. None of the international volunteer doctors were hurt.
Details about MSF
1 Medecins Sans Frontieres, whose Kunduz hospital in Afghanistan was hit by a suspected US air strike, is one of the largest medical charities in the world.2 It has more than 36,000 volunteers working in 60 countries and last year treated more than half a million patients.
3 MSF was founded on December 21, 1971, when a team of French medics and journalists, including humanitarian icon Bernard Kouchner, denounced what they described as genocide in secessionist Biafra, in Nigeria.
4 The non-profit body provides emergency medical care in war zones, during epidemics and in the wake of natural disasters, and is a self-governed group of 24 associations worldwide, based in Switzerland.
5 In 2014, the charity oversaw 384 projects worldwide, 31 per cent of which were linked to armed conflict.
6 Operations in Sudan, the Democratic Republic of Congo, Central African Republic, Haiti, Sierra Leone, Afghanistan, Niger, Liberia, Ethiopia and Iraq take up just over half of the organisation's total spending.
7 MSF is funded overwhelmingly by a network of 5.7 million private donors, who provided 89 per cent of its US$1.44 billion budget last year.
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