October 4, 2014; Reuters

Clearly, the Afghanistan government and its NATO allies were upset by the surprise loss of Kunduz to the Taliban. The government of Afghanistan promised a major effort to retake the northern city after Afghan military forces did their imitation of Iraqi forces in Ramadi, cutting and running in the wake of the Taliban offensive.

It appears to all observers that it was a U.S. air strike that hit a hospital in Kunduz run by Médecins San Frontières—in English, Doctors Without Borders. The airstrike killed 22 doctors, nurses, and patients. MSF has declared the airstrike a “war crime” and called for an independent investigation as opposed to an internal investigation by the U.S. military. MSF General Director Christopher Stokes issued a statement that said, “Relying only on an internal investigation by a party to the conflict would be wholly insufficient.”

There is good reason for questioning the legitimacy of an internal investigation. The U.S. and Afghanistan governments, trying to carve out improved bilateral relations after the deterioration that occurred under President Hamid Karzai, might be loath to acknowledge that a major coalition effort to reverse the Taliban’s victory in the city turned out to be a humanitarian disaster of major proportions. The Afghan defense ministry has already charged that the Taliban was using the hospital building as a “human shield,” but that has been firmly contradicted by MSF.

The horror of the bombing is evident in this heart-rending account by an MSF nurse named Lajos Zoltan Jecs, worth quoting at length to remind readers of the devastating of war when innocents are involved:

It was absolutely terrifying.

I was sleeping in our safe room in the hospital. At around 2am, I was woken up by the sound of a big explosion nearby. At first I didn’t know what was going on. Over the past week we’d heard bombings and explosions before, but always further away. This one was different, close and loud.

At first there was confusion, and dust settling. As we were trying to work out what was happening, there was more bombing.

After 20 or 30 minutes, I heard someone calling my name. It was one of the Emergency Room nurses. He staggered in with massive trauma to his arm. He was covered in blood, with wounds all over his body.

At that point my brain just couldn’t understand what was happening. For a second I was just stood still, shocked.

He was calling for help. In the safe room, we have a limited supply of basic medical essentials, but there was no morphine to stop his pain. We did what we could.

I don’t know exactly how long, but it was maybe half an hour afterwards that they stopped bombing. I went out with the project coordinator to see what had happened.

What we saw was the hospital destroyed, burning. I don’t know what I felt, just shock again.

We went to look for survivors. A few had already made it to one of the safe rooms. One by one, people started appearing, wounded, including some of our colleagues and caretakers of patients.

We tried to take a look into one of the burning buildings. I cannot describe what was inside. There are no words for how terrible it was. In the Intensive Care Unit six patients were burning in their beds.

We looked for some staff that were supposed to be in the operating theater. It was awful. A patient there on the operating table, dead, in the middle of the destruction. We couldn’t find our staff. Thankfully we later found that they had run out from the operating theater and had found a safe place.

Just nearby, we had a look in the inpatient department. Luckily untouched by the bombing. We quickly checked that everyone was OK. And in a safe bunker next door, also everyone inside was OK.

And then back to the office. Full, patients, wounded, crying out, everywhere.

It was crazy. We had to organize a mass casualty plan in the office, seeing which doctors were alive and available to help. We did an urgent surgery for one of our doctors. Unfortunately he died there on the office table. We did our best, but it wasn’t enough.

The whole situation was very hard. We saw our colleagues dying. Our pharmacist…I was just talking to him last night and planning the stocks, and then he died there in our office…

Some of my colleagues were in too much shock, crying and crying. I tried to encourage some of the staff to help, to give them something to concentrate on, to take their minds off the horror. But some were just too shocked to do anything. Seeing adult men, your friends, crying uncontrollably—that is not easy.

I have been working here since May, and I have seen a lot of heavy medical situations. But it is a totally different story when they are your colleagues, your friends.

These are people who had been working hard for months, non-stop for the past week. They had not gone home, they had not seen their families, they had just been working in the hospital to help people…and now they are dead. These people are friends, close friends. I have no words to express this. It is unspeakable…

What is in my heart since this morning is that this is completely unacceptable. How can this happen? What is the benefit of this? Destroying a hospital and so many lives, for nothing. I cannot find words for this.

The preferred method of engagement for the American military appears to be bombing at a distance, which the public imagines as precision bombing, hitting targets with little X’s on them like in a computer game. The reality is that precision bombing is largely a myth. In recounting the history of imprecision in modern warfare, one article noted that in the 2003 U.S. invasion of Iraq, some aerial bombs missed Iraq entirely, landing in Turkey and Iran. (Compare that to the heavy bombers in World War II, which managed never to miss the country in which they intended their ordnance to land.)

MSF has since closed the hospital in Kunduz. A dozen of the casualties were MSF staff, suggesting that they were doing whatever they could to protect innocent, defenseless patients from the bombing. Another 19 staff were wounded, along with 37 civilians or patients. It wasn’t one errant bomb that hit the hospital, but a sustained hour-long attack. For that reason, even the United Nations has expressed a concern that this attack could be a war crime and merits a “full and transparent investigation,” something that U.S. and Afghani forces may be unlikely to do in fear of compromising military secrets.

President Obama expressed his condolences to the families, friends, and coworkers of the MSF staff who lost their lives in the bombing. In light of the civilians and aid workers who lost their lives in this incident, like so many who have lost their lives in bombings in Iraq and elsewhere, U.S. reliance on aerial bombing unfortunately reduces many otherwise innocent people to collateral damage. It is the horror of war; it is an immense challenge to humanitarian aid organizations like MSF who stand up against that horror, sometimes with their lives at stake.—Rick Cohen