We are deeply saddened by the deaths of our friends, colleagues and patients.
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.
— MSF UK (@MSF_uk) October 6, 2015
"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."
Who were the staff who have been killed or injured?
Fourteen staff members have been killed and 19 members wounded in the attack.
All killed and injured staff were Afghan. All international staff have been evacuated following the attack.
Is the hospital still running?
The MSF hospital in Kunduz is currently not operating, following the bombing . All international MSF staff members have been evacuated to Kabul.
All critical patients were referred to other health facilities. The MSF Afghan staff who were not killed are either being treated in health facilities in the region or have left the hospital.
No medical activities are possible now in the MSF hospital in Kunduz, at a time when the medical needs are immense.
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 on Saturday, 3 October.
Do you think this was a deliberate attack on your hospital?
There is no way for us to know that. This is why we are demanding a full and transparent investigation by an independent international body into these tragic events.
The results of this investigation should be made public and we will demand access to the full report, not just the conclusions.
Does this constitute a war crime?
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.
Relying only on an internal investigation by a party to the conflict would be wholly insufficient.
Have you received any apology from the Afghan or US governments?
US President Barak Obama released a statement on 3 October.
Video taken a few months ago inside Kunduz hospital.
Claims that the Taliban were using the hospital as a base, justifying attack
It’s simply absurd and untrue. The hospital was full of MSF staff, patients and their caretakers. It is 12 MSF staff members and 10 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.
Will MSF continue its activities in Kunduz?
Since intense fighting broke out in Kunduz at the start of the week, MSF had had to expand the usually-92-bed facility up to 150 beds to cope with the influx of wounded. Some 394 wounded people had been treated that week.
Staff had been working round the clock to respond to the huge medical needs. This is exactly why MSF was there, to treat anyone who needed treatment, with total impartiality and respecting the principles of medical ethics.
Beyond the tragedy of the loss of life in the horrific bombing, it is appalling that the people of Kunduz are now deprived of MSF's trauma medical services at a time when they are more needed than ever.
It is painful for MSF to withdraw at a time when the medical needs are so acute, but in the aftermath of being bombed, it is too early to know if it would be safe to continue running medical activities.
MSF works hard in conflict areas, as had been the case in Kunduz, to ensure all fighting parties respect the sanctity of the medical space.
At the moment, MSF has not received any explanations or assurances that give us the confidence to be able to return.
This is why the organisation is demanding a full and transparent investigation by an independent international body of what happened, and why. Without that information, there are too many unknowns to allow a return in the immediate future.
MSF feels very committed to the people in Kunduz and will explore, as soon as key questions are answered, options to return with medical services in the Kunduz region.
In the week leading up to the attack our Kunduz hospital was overwhelmed treating patients affected by conflict in the town.
- Kunduz: What was lost - a doctor's story
- Afghanistan bombing: "Even war has rules"
- Afghanistan: MSF denounces blatant breach of International Humanitarian Law in Kunduz
Interactive: Hover over the image below to find out more about the current state of healthcare in Afghanistan
After more than a decade of international aid and investment, access to basic and emergency medical care in Afghanistan remains severely limited and ill-adapted to meet the growing needs created by the ongoing conflict.
MSF in Afghanistan 2014
In February 2014, Médecins Sans Frontières/Doctors Without Borders (MSF) published a report entitled ‘Between Rhetoric and Reality: The Ongoing Struggle to Access Healthcare in Afghanistan’, which revealed the serious and often deadly risks that people are forced to take to access medical care.
It found that the majority of the 800 patients interviewed could not reach critical medical assistance due to insecurity, distance and cost.
Of those who reached MSF hospitals, 40 percent told us they had faced fighting, landmines, checkpoints or harassment on their journey.
Their testimonies exposed a wide gap between what exists on paper in terms of healthcare and what is actually available.
The following is a list of services MSF provided in Afghanistan in 2014.
In Dasht-e-Barchi hospital, MSF opened a 46 bed maternity department in in a bid to reduce maternal and neonatal mortality in an area with over one million inhabitants but only one public hospital. Just over a month after opening, the department was already functioning at maximum capacity, and there had been 627 deliveries by the end of December, including 33 caesarean sections.
In Ahmad Sha Baba hospital, MSF is upgrading the hospital, increasing bed capacity and training staff. The hospital is now the most important maternal health facility in Bagrami and surrounding districts, with operating theatres and surgeons available at all times. In 2014, the team assisted 14,968 deliveries, performed 949 surgical procedures and carried out 10,094 antenatal consultations.
In Kunduz, the MSF trauma centre provides free surgical care to those with conflict-related injuries, as well as those who have experience general trauma. The intensive care unit was expanded and the total bed capacity increased to 70. Staff treated a total of 22,193 people and performed 5,962 surgical procedures. About 54 percent of the patients admitted for more prolonged treatment had conflict related injuries.
In Khost maternity hospital, the only specialised maternity hospital in the area, MSF focuses on assisting with complicated deliveries and reducing the high number of maternal deaths in the province. Staff assisted in the delivery of 15,204 babies; approximately one in three children born in Khost province.
In Gulan refugee camp, MSF teams provided assistance to the tens of thousands of people fleeing a military offensive in the Pakistani region of North Waziristan with medical care and water and sanitation. More than 2,900 children aged six months to 15 years were vaccinated against measles. A clinic was also set up in the camp, where a medical team treated on average 100 patients per day. MSF handed over the medical and sanitation activities to other humanitarian organisations who could provide longer-term support to the refugees.
MSF supports Boost hospital with surgery, internal medicine, emergency services, maternal, paediatric and intensive care. The 285-bed facility admitted around 2,480 patients and performed 300 surgical procedures each month. The maternity ward’s capacity was expanded from 40 to 60 beds and 9,207 babies were delivered in 2014. The hospital’s therapeutic feeding centre treated 2,200 severely malnourished children this year.
Find out more in our 2014 International Activity Report.
At the end of 2014, MSF had 1,738 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.”