19 killed after Afghan hospital hit in suspected U.S. airstrike

At least 19 people were killed, including 12 Doctors Without Borders staff members and seven patients, and another 37 wounded after a suspected U.S. airstrike early Saturday at the organization's hospital in Kunduz, Afghanistan.

The organization said the hospital was hit several times during "sustained bombing" starting at 2:10 a.m. Saturday and continuing in 15-minute intervals for more than an hour. Its president called it a "grave violation of international humanitarian law," and the United Nation's top human rights official said it may prove to be a war crime.

Three of the dead were children, Doctors Without Borders said. Of the 37 people wounded, 19 are staff members, and 18 are patients or caregivers.

The office of Gen. John Campbell, commander of U.S. forces in Afghanistan, said the strike was conducted against insurgents firing on U.S. service members, who have been advising and assisting Afghan security forces in their effort to clear the area of insurgents.

"While we work to thoroughly examine the incident and determine what happened, my thoughts and prayers are with those affected," Campbell said. "As always, we will take all reasonable steps to protect civilians from harm.”

Afghanistan President Mohammad Ashraf Ghani's office said earlier that Campbell "provided explanations about the incident and offered condolences." The two men agreed to launch a joint investigation.

The incident apparently occurred when an Air Force AC-130 attacked Taliban positions that were firing on U.S. Special Operations forces embedded with Afghan commandos, a senior defense official said. Another official said it was not clear if the hospital was struck inadvertently or if Taliban fighters were using it as a base. The officials spoke on condition of anonymity because they were not authorized to speak publicly.

Defense Secretary Ashton Carter would only call it a "tragic incident" in an area where U.S. forces were supporting Afghan security forces in their battle against Taliban fighters. The Taliban took control of Kunduz, Afghanistan's sixth-largest city, on Monday, and U.S. forces were helping to take it back.

"While we are still trying to determine exactly what happened, I want to extend my thoughts and prayers to everyone affected. A full investigation into the tragic incident is under way in coordination with the Afghan government," Carter said in a statement. "At this difficult moment, we will continue to work with our Afghan partners to try and end the ongoing violence in and around Kunduz."

Earlier, Army spokesman Col. Brian Tribus confirmed U.S. forces had conducted an airstrike in Kunduz "against individuals threatening the force." He said the strike "may have resulted in collateral damage to a nearby medical facility."

Those explanations didn't placate the international aid group that had continued to operate in the area even as conditions worsened.

“This attack is abhorrent and a grave violation of international humanitarian law,” said Meinie Nicolai, president of Doctors Without Borders. "We demand total transparency from coalition forces. We cannot accept that this horrific loss of life will simply be dismissed as ‘collateral damage.’”

Fighting had been ongoing in Kunduz for five days since the Taliban captured the city. Afghan forces, backed by U.S. airstrikes, retook much of the city Thursday. Doctors Without Borders said its hospital had treated 394 people during the week.

Afghan officials: Government forces retake Kunduz from Taliban

At the time of the bombing, there were 105 patients and caretakers at the hospital, as well as more than 80 international and Afghan staff, Doctors Without Borders said. "There are many patients and staff who remain unaccounted for," the group said. "The numbers may grow as a clearer picture develops of the aftermath of this horrific bombing."

A nurse at the hospital, Lajos Zoltan Jecs, described the carnage for the group's web site. "There are no words for how terrible it was," he said. "In the intensive care unit, six patients were burning in their beds.... A patient there on the operating table, dead, in the middle of the destruction.... We saw our colleagues dying."

Wahidullah Mayar, a spokesman for Afghanistan's Ministry of Public Health, tweeted that the hospital was "largely destroyed by fire" following the strike.​ Doctors Without Borders released photos showing the blaze.

U.S. and Afghan officials had been informed of the precise GPS coordinates of the hospital, and the location was re-communicated several times over the past months, including most recently on Tuesday, the organization said.

"The bombing in Kunduz continued for more than 30 minutes after American and Afghan military officials in Kabul and Washington were first informed by (Doctors Without Borders) that its hospital was struck," the organization said in a statement. Doctors Without Borders "urgently seeks clarity on exactly what took place and how this terrible event could have happened."

The bombs struck at approximately 15-minute intervals, hitting the main central hospital building that houses the intensive care unit, emergency rooms and a physiotherapy ward, the group said. Surrounding buildings were left mostly untouched.

“The bombs hit and then we heard the plane circle round,” said Heman Nagarathnam, the group's head of programs 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.”

At a news conference, Afghanistan Interior Ministry spokesman Sediq Sediqi said 10 to 15 "terrorists" were hiding in the hospital. "All of the terrorists were killed, but we also lost doctors," he said. In a statement, the Taliban denied any of its fighters were in the hospital at the time of the airstrike.

United Nations human rights chief Zeid Ra’ad Al Hussein issued a statement Saturday in which he called the airstrike “tragic, inexcusable, and possibly even criminal.”

“International and Afghan military planners have an obligation to respect and protect civilians at all times, and medical facilities and personnel are the object of a special protection,” Zeid’s statement said. “These obligations apply no matter whose air force is involved, and irrespective of the location.

"If established as deliberate in a court of law, an airstrike on a hospital may amount to a war crime,” the statement said.

The international watchdog group Human Rights Watch released a statement critical of the airstrike, even if enemy combatants were in the area. "Given the hospital's protected status and the large numbers of civilians and medical personnel in the facility, attacking the hospital would still likely have been an unlawfully disproportionate attack, causing greater harm to civilians and civilian structures than any immediate military gain," the group said.

"In addition, the laws of war require that even if military forces misuse a hospital to deploy able-bodied combatants or weapons, the attacking force must issue a warning to cease this misuse, setting a reasonable time limit for it to end, and attacking only after such a warning has gone unheeded."

The International Committee of the Red Cross strongly condemned the violence. “This is an appalling tragedy. Such attacks against health workers and facilities undermine the capacity of humanitarian organizations to assist the Afghan people at a time when they most urgently need it," Jean-Nicolas Marti, head of the ICRC delegation in Afghanistan, said in a statement.

The U.S. Embassy in Kabul said it was mourning for the victims and their families. "Doctors without Borders performs heroic work throughout the world, including in Afghanistan, and our thoughts and prayers are with their team at this difficult moment," the embassy said in a statement. "We remain deeply concerned about the ongoing violence in Kunduz and the difficult humanitarian situation faced by its residents."

President Obama also extended his "deepest condolences to the medical professionals and other civilians killed and injured in the tragic incident at a Doctors Without Borders hospital in Kunduz." "The Department of Defense 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 in a statement.

"We will continue to work closely with President Ghani, the Afghan government, and our international partners to support the Afghan National Defense and Security forces as they work to secure their country," Obama stated in the release.

The Doctors Without Borders hospital is the only such facility in northeastern Afghanistan, providing free care to all based on medical needs.

Contributing: Tom Vanden Brook and Jim Michaels