Doctors Without Borders seeks international fact-finding commission on hospital attack

The charity, known also as Medecins Sans Frontieres, said the commission would gather facts and evidence from the United States, NATO and Afghanistan.

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After that, the charity would decide whether to bring criminal chargs for loss of life and damage, it announced in Geneva.

“If we let this go, we are basically giving a blank check to any countries at war,” MSF International President Joanne Liu told a news briefing in Geneva. She said there was no commitment yet to an independent investigation.

The U.S. air attack killed 22 patients and medical staffters, including three children, in the northern Afghanistan city of Kunduz, which had been overrun by Taliban militants. Thirty-seven people were injured, including 19 staff members, the charity said.

The strike was not intended to strike a hospital run by an international aid group, a senior U.S. general said Tuesday, adding to an evolving Pentagon account of one of the deadliest American strikes on a civilian target in recent history.

Gen. John F. Campbell, who commands U.S. and allied forces in Afghanistan, said that the powerful U.S. gunship that struck the hospital run by Doctors Without Borders acted in response to a request from Afghan troops facing a Taliban attack.

Charity President Liu said in a statement that the facts and circumstances of the attack needed to be investigated independently because of “inconsistencies in the U.S. and Afghan accounts of what happened.”

“We cannot rely on only internal military investigations by the US, NATO and Afghan forces,” she said.

In the statement, Liu said the attack on the hospital was “the biggest loss of life for our organisation in an airstrike” and that “tens of thousands of people in Kunduz can no longer receive medical care now when they need it most.”

“Our patients burned in their beds,” she said. “Doctors, nurses and other staff were killed as they worked. Our colleagues had to operate on each other. One of our doctors died on an improvised operating table – an office desk – while his colleagues tried to save his life.

“Even war has rules,” the statement said.

Liu said the Geneva Conventions, which prohibit attacks on hospitals in war zones, had been attacked too, along with the hospital. She said the conventions were not just “an abstract legal framework”, but rather the difference between life and death for medical teams working in war zones.

Campbell told the Senate Armed Services Committee Tuesday that the United States bore ultimate responsibility for authorizing strikes on a civilian compound.

“A hospital was mistakenly struck,” he said. “We would never intentionally target a protected medical facility.”

Campbell said a full accounting of the weekend incident, which occurred as U.S. forces sought to help the Afghan government reclaim Kunduz, the first major Afghan city to fall to the Taliban since the war began in 2001, would be available after a Pentagon investigation. He declined to give a timeline for that probe.

But numerous questions remain about how Saturday’s strike, in which an AC-130 gunship conducted repeated bombing raids on a building housing the hospital’s emergency rooms and intensive care unit, could have happened.

Campbell described the incident as a mistake, but he did not specify whether the American pilots had tried to hit another target and missed or whether they intended to strike the hospital building but did not know it was a medical facility.

Neither have officials said whether U.S. forces violated their own rules of engagement in Afghanistan, which permit the United States to use air power in three situations: for counterterrorism operations, in self-defense or to protect Afghan forces “in extremis.”

In a statement released Tuesday, Defense Secretary Ashton B. Carter said he would hold those responsible accountable.

“The U.S. military takes the greatest care in our operations to prevent the loss of innocent life,” Carter said. “And when we make mistakes, we own up to them.”

Doctors Without Borders has described the attack as deliberate.

“This attack cannot be brushed aside as a mere mistake or an inevitable consequence of war,” Liu said in a statement. The organization said it repeatedly provided the hospital’s coordinates to U.S. and Afghan authorities.

U.S. military officials have already revised their account of what occurred overnight on Saturday. On Monday, speaking at the Pentagon, Campbell said the attack was authorized after Afghan troops, under attack by the Taliban, requested American air support. That contradicted earlier statements from Pentagon officials that the strike was ordered to protect U.S. forces on the ground who were taking direct fire from the Taliban.

According to Pentagon officials, U.S. Special Operations forces were positioned in Kunduz, advising elite Afghan troops nearby, when the strike took place. It now appears that U.S. forces were not facing direct attack from the Taliban.

The incident adds fuel to a debate about the future of the limited U.S. mission in Afghanistan as the White House considers further changes to its plan for bringing the U.S. military footprint to under 1,000 troops at the end of 2016. President Obama has linked his legacy to pulling U.S. forces from Afghanistan and ending America’s longest war.

About 9,800 U.S. troops are stationed in Afghanistan. Almost 7,000 are tasked to a

multinational mission to help Afghan forces fight the Taliban, while a smaller number are part of a U.S. effort to hunt down al-Qaida and other militants.

Under questioning by lawmakers, Campbell acknowledged that he believes the current exit plan should be changed, given security conditions on the ground.

Campbell spoke as Afghan forces struggle to fully retake Kunduz. While much of the city is now under government control, the Taliban’s ability to seize a major urban area illustrates the militants’ resilience despite years of assaults from NATO forces.

Fierce clashes were reported Tuesday.

A U.S. military official, speaking on the condition of anonymity to comment freely, said U.S. forces conducted two airstrikes in Kunduz province Monday, both of which targeted insurgents “threatening Afghan and coalition forces.” Special Operations soldiers remain embedded with Afghan troops battling the Taliban in and around Kunduz.

In Kabul, Afghan President Ashraf Ghani’s government did not deny it had requested the U.S. airstrike Saturday but said the matter was being investigated.

Sayed Zafar Hashemi, a Ghani spokesman, said it would be common for the Afghan military to solicit air support from the coalition. Hashemi said most of the airstrikes that occurred in Kunduz after the Taliban overran it last week resulted from a specific request from the Afghanistan military.

Saturday’s incident was among the deadliest U.S. strikes to result in civilian casualties in Afghanistan. In July 2002, more than 40 people were killed and more than 100 were injured when a U.S. aircraft fired on a wedding party.

Of the 12 Doctors Without Borders staffers killed, three were physicians. After the attack, the group withdrew from Kunduz; it still operates five other facilities in Afghanistan.

Officials with Doctors Without Borders have raised doubts about the U.S. military’s ability to conduct a satisfactory investigation of its own actions. NATO and the Afghan government have launched separate probes

The Afghan Ministry of Health issued a statement expressing its support for an independent probe. The ministry said the strike “threatens the health of millions of Afghans” because private charities are now reconsidering operating in the country.

“Staff no longer feel safe in any health facility anywhere in the country,” the ministry said. “And some international health organizations are questioning whether the risks of staying in the country are just too high after such an attack.”

Some Afghan leaders continue to defend the airstrike. Hamdullah Danishi, the acting governor of Kunduz province, said Taliban fighters had been using hospital grounds as a staging area from which to launch attacks on the provincial capital, Kunduz city.

Danishi said he played no role in ordering the airstrike, but he reiterated that the area around the hospital had to be cleared of militants. “We have a military decision-making council that decides such issues,” Danishi said. “I don’t know if it made the request.”

“But if it was me,” Danishi continued, “I would have ordered the airstrike.”

Afghan military leaders declined to comment.

The aircraft that carried out the Kunduz attack was an AC-130 gunship, a platform that is dedicated almost entirely to supporting Special Operations forces, such as those advising Afghan troops around Kunduz. The plane flies at a relatively low altitude and can loiter over a target. Its pilots must rely on visual targeting to strike locations on the ground.

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Craig reported from Kabul, Deane from London. Missy Ryan contributed to this report from Washington. Sayed Salahuddin in Kabul and Thomas Gibbons-Neff in Washington also contributed.