Kunduz, Afghanistan, 36°43’4.91’’N, 68°51’43.96’’

By Thomas Nierle, President of Médecins Sans Frontières (MSF) Switzerland

This opinion piece was originally published in French in Le Temps on 3 November 2015.

On 3 October, at around 2 a.m., an air raid by US Special Forces began targeting the main hospital building in Kunduz, Afghanistan. Several waves of air strikes followed, totally destroying the main building of the hospital run by Médecins Sans Frontières (MSF). The consequences of the attack, which can also be described as a massacre, were devastating: 30 people were killed – 10 patients, 13 MSF staff members and seven others whose bodies have yet to be identified. So far MSF confirms 27 staff injured and also many patients and caretakers. Following the chaos of the attack, tracing patients has been extremely difficult and a definite number of wounded may be impossible to determine. Despite repeated requests from MSF for the bombing of the hospital to cease, the air raid continued for over an hour.

MSF's hospital in Kunduz, which had been running since 2011, was one of the few functioning trauma centres in northern Afghanistan. Thousands of surgical procedures were performed there each year and essential medical assistance was provided to all patients in need of it. The hospital opened following lengthy negotiations with all parties involved in the conflict in order to secure medical care for all injured people, whether civilians or military, irrespective of their origin or political affiliation, in accordance with the Geneva Conventions. In the week leading up to this appalling attack, 394 patients received treatment after being injured in recent clashes in and around Kunduz city. When the attack occurred, there were 105 patients and 80 staff members in the hospital.

On 27 October, the hospital in Haydan, Yemen, was bombed by the Saudi-led coalition which is at war with the Houthi militants. When the first bombs fell, it was possible to evacuate the hospital, thus avoiding a loss of human life. But the population of 200,000 in Saada province have now lost the only hospital facility available to them. This is yet another example of a hospital being destroyed, in a war in which schools, markets and civil infrastructure are targeted on a daily basis, in the same way as military objectives.

As well as the intense grief we feel when we lose colleagues and patients in such devastating circumstances, we quickly find ourselves asking “why?” For this reason, in the immediate aftermath of these terrible events, MSF demanded an independent investigation to establish the circumstances surrounding the massacre in Kunduz and to seek an explanation. It is essential to understand the reasons a medical facility was attacked in order to assess the risks involved for our teams working in hostile environments in Afghanistan and elsewhere. When a hospital is destroyed, thousands of people are deprived of vital treatment – a matter of life or death for populations caught up in the midst of conflict. 

Ultimately, do the regular armies and Special Forces still consider themselves bound by their commitment to respect medical structures operating in conflict zones? In their various statements, those responsible systematically hide behind explanations such as “collateral damage” and “unfortunate errors” or, perversely, they try to put the blame on the medics treating the injured from the opposing side.

A functioning hospital should never be bombed under any circumstances!

A functioning hospital should never be bombed under any circumstances! For us, it's not just a question of respecting international law and in particular the Geneva Conventions aimed at sparing the civilian population from the devastating effects of war; or promoting the “rules of engagement” of modern armies such as banning attacks on medical structures without first issuing a warning so that the structure can be evacuated – including where active combatants are present. It's a question of common sense: you don't bomb a hospital with staff and patients inside!

A hospital is where the most vulnerable, the sick and injured, gather in times of war. It's a place of hope, and a place of humanity in the midst of often deadly chaos. For populations caught up in armed conflict, medical treatment structures offer the reassurance that, should people be unfortunate enough to be in the firing line, they can find treatment; that they can receive medical attention; and that, if their lives cannot be saved, they won't die alone. Attacking hospitals is a barbarous act comparable to the worst atrocities committed in modern times.

What would people say if their local hospital was destroyed, and all possibility of receiving medical treatment was suddenly wiped out? How can we expect the Afghans, Syrians or Yemenis to suffer something that no one, in other countries, would ever accept? Gratuitous violence has no place in a healthcare structure.

Unfortunately, the events in Kunduz and Haydan, although specific, are not isolated incidents. Unfathomably, medical structures have become an integral part of war zones. From Afghanistan to Yemen, Syria to Sudan, Iraq to Somalia. And our colleagues – doctors, paramedics and support staff – often pay the highest price. This isn't just a problem for MSF, it's a problem for all healthcare professionals working in countries in conflict, and therefore for millions of people currently living amid the modern theatre of war.

In an increasingly radicalised world, where the logic of “if you're not with us, you're against us” is gaining ground everywhere, where the range of actors and the scope for negotiation and compromise are being eroded, humanitarian aid – especially medical – is in danger of being sacrificed in the name of ever more cynical reasons. The end justifies the means irrespective of any principle or value. So, the level of despair that is driving entire populations to follow the path of exile in search of a possible future comes as no surprise. Some will say: “This is nothing new, war is a dirty business”.

We say: if there's no room for humanity in times of war, human civilisation as a whole will lose out in the long run. So, it's up to all of us to mobilise and urge politicians, governments and non-state armed groups to respect medical facilities. Together we shout loudly and clearly:

“Stop bombing hospitals!”