At least 42 people were killed in sustained airstrikes on the Médecins Sans Frontières/Doctors Without Borders (MSF) hospital in Kunduz, Afghanistan, on Saturday 3 October.
As far as we know, 24 patients and 14 staff were killed, along with four caretakers.
MSF has been informed that the International Humanitarian Fact-Finding Commission (IHFFC) has been activated.
Despite receiving an apology from President Obama, we reiterate our ask that the US government consent to an independent investigation led by the IHFFC to establish what happened in Kunduz, how it happened, and why it happened.
"Our colleagues didn’t die peacefully like in the movies. They died painfully, slowly, some of them screaming out for help that never came, alone and terrified, knowing the extent of their own injuries and aware of their impending death.
"Countless other staff and patients were injured; limbs blown off, shrapnel rocketed through their bodies, burns, pressure wave injuries of the lungs, eyes and ears. Many of these injures have left permanent disability. It was a scene of nightmarish horror that will be forever etched in my mind."
Dr Kathleen Thomas is an intensive care doctor from Australia who was on her first mission in MSF's Kunduz Trauma Centre in Afghanistan from May 2015 until the US airstrikes on 3 October.
Kunduz attack investigation
The United States' government has admitted to carrying out the bombing of our hospital.
MSF General Director Christopher Stokes said: "There can be no justification for this abhorrent attack on our hospital that resulted in the deaths of MSF staff as they worked and patients as they lay in their beds.
“MSF reiterates its demand for a full transparent and independent international investigation."
On 3 October 2015, the Médecins Sans Frontières/Doctors Without Borders (MSF) Trauma Centre in Kunduz, Afghanistan, was destroyed in an aerial attack, during which 42 people were killed, including 14 MSF staff, 24 patients and four patient caretakers.
MSF in Afghanistan 2015
MSF opened the hospital in Kunduz in August 2011, in order to provide free, high-quality surgical care to victims of general trauma, such as traffic accidents, as well as patients with conflict-related injuries. It was the only facility of its kind in the whole northeastern region of Afghanistan.
Independently run by MSF, the 84-bed hospital had an emergency room, an intensive care unit, three operating theatres, outpatient and inpatient departments (with separate surgical wards for male and female patients), a physiotherapy department, a laboratory, an X-ray room and a pharmacy.
Other services included mental healthcare and health promotion. The hospital offered services not only to the residents of Kunduz province but also to patients from neighbouring provinces such as Badakhshan, Takhar, Baghlan, Balkh and Samangan. The hospital’s capacity reached 92 beds by September 2015, just before it was bombed.
Between January and August, more than 2,400 patients were admitted to the centre, most of whom (88 percent) had been injured in road or domestic accidents.
Twelve percent presented with injuries caused by explosions, gunshots or bombings. Over the same period, MSF staff carried out 18,088 outpatient consultations and 4,667 surgical interventions, including orthopaedic surgery involving internal fixation techniques to repair bones.
Emergency surgery and medical activities continue in one of the remaining parts of MSF's hospital in Kunduz in the immediate aftermath of the bombing yesterday morning. “Under the clear presumption that a war crime has been committed, MSF demands that a full and transparent investigation into the event be conducted by an independent international body," says Christopher Stokes, General Director, Médecins Sans Frontières. "Relying only on an internal investigation by a party to the conflict would be wholly insufficient. Not a single member of our staff reported any fighting inside the MSF hospital compound prior to the US airstrike on Saturday morning. The hospital was full of MSF staff, patients and their caretakers. It is 12 MSF staff members and ten patients, including three children, who were killed in the attack. We reiterate that the main hospital building, where medical personnel were caring for patients, was repeatedly and very precisely hit during each aerial raid, while the rest of the compound was left mostly untouched. We condemn this attack, which constitutes a grave violation of International Humanitarian Law.” #MSF #DoctorsWithoutBorders #Kunduz #Afghanistan
Ahmad Shah Baba hospital
At Ahmad Shah Baba hospital in eastern Kabul, MSF’s support has concentrated on upgrading the facility so it can cater effectively to the needs of the growing population in the area, and capacity has increased to 58 beds. A range of free, high-quality medical services is offered, with a particular focus on emergency and maternal care. Working with the Ministry of Health, MSF ensures treatment for malnutrition, paediatric care, family planning services, health promotion activities and vaccinations.
As the population is growing, and because MSF offers the highest-quality obstetric care in the district, the maternity department is one of the busiest in the hospital. On average, 1,400 deliveries were assisted each month and 16,654 antenatal consultations conducted over the course of the year.
MSF continued running mobile clinics in the most remote of eastern Kabul’s suburbs to increase access to free, high-quality preventive and curative healthcare for children under the age of five, and referred severely ill patients to Ahmad Shah Baba hospital. In 2015, more than 5,370 pregnant women were vaccinated, and 6,721 children under five were screened for malnutrition.
MSF continued to run a maternity department in Dasht-e-Barchi hospital dedicated to complicated deliveries, and emergency neonatal and obstetric services. Today, Dasht-e-Barchi hospital and three small satellite health centres are the only options for public healthcare in the district.
Opened in November 2014, the maternity department is open around the clock, and offers free medical care. During its first year, 10,727 deliveries were assisted, 558 caesarean sections were performed and 1,303 babies were admitted to the neonatal unit with complications such as hypoglycaemia.
By the end of the year, up to 300 women were being admitted to the maternity ward each week and 40 babies were being delivered per day.
Much of the area surrounding Lashkargah was the scene of active fighting in 2015, although MSF’s Boost hospital continued to function in the provincial capital as normal. For the past six years, MSF has been supporting Boost hospital, one of only three referral hospitals in southern Afghanistan. A new 54-bed maternity ward, a 24-bed neonatal intensive care unit and a 10-bed paediatric intensive care unit were also built. By the end of the year, 12,721 babies had been delivered in the hospital.
MSF supports the hospital with surgery, internal medicine, emergency services and intensive care. In mid-2015, the team also began supporting the diagnosis and follow-up of TB patients, addressing a major yet under-reported public health concern in Afghanistan, and 181 patients started first-line treatment. At the end of the year, an MSF surgical burns specialist provided training to improve treatment for the high number of burns patients seen at the hospital.
Malnutrition continues to be one of the main causes of child mortality in the region, and the hospital’s intensive therapeutic feeding centre treated 2,281 children this year, many of whom were suffering from severe malnutrition.
Afghanistan is considered one of the most dangerous places in the world to give birth, due to the high number of women who die during pregnancy or labour.
In 2015, approximately one out of every three babies born in Khost province was delivered in MSF’s maternity hospital and in December deliveries reached a record high of approximately 58 a day and 1,733 in one month. In addition to the maternity ward, there are two operating theatres, a neonatal unit and a dedicated women’s health clinic. MSF also offers vaccinations for newborns, family planning and health promotion activities.
In order to focus on caring for women with complicated deliveries, who are most at risk of dying, and to manage the large number of patients, MSF is working to improve the referral system to the Ministry of Health’s hospital. When the MSF maternity hospital reaches maximum capacity, patients showing no signs of complications are referred to the provincial hospital.
Find out more in our latest International Activity Report.
At the end of 2015, MSF had 2,303 staff in Afghanistan. MSF first began working in the country in 1980.
Fatima, 30-years-old, Dasht-e-Barchi
“I feel very tired but so happy. It’s my first baby. I have been pregnant four times before but never had a baby.
"I lost each of them, after three months, four months and five months. The last one after six months … When I got pregnant again, I went to a small private clinic for antenatal care.
"I never did before because we don’t have money to spend for that. But this time, we really thought it was important and I went three times …
"My husband had to work a lot to pay for the medical care. Our neighbours told us to come [to the MSF clinic] once the baby came. They said I would be taken care of.”