The US airstrikes that targeted a Médecins Sans Frontières (MSF) hospital in the northern Afghan city of Kunduz, killing 12 staff members, at least 10 patients and seriously wounding 37 people, brought about the single largest loss of life that the medical charity has suffered in 35 years of working in the country.
But while the Kunduz incident has drawn attention to the perilous circumstances in which MSF frequently operates, it is far from the first time it has been attacked in Afghanistan and elsewhere.
In 2004, five MSF staff members were murdered after working at a rural health clinic in northern Afghanistan. The killings prompted the charity to withdraw – the first time it had ever left a country because of security concerns. It returned in 2009.
Over recent years, it has also withdrawn and returned to Iraq, been expelled from parts of Darfur, and ended 22 years of operations in Somalia after “a long series of threats, kidnappings, extremely violent attacks on staff, and murders”.
Last year, five members of MSF were abducted in northern Syria and held captive by an armed group for months. In January this year, a hospital operated by the charity in the South Kordofan region of Sudan was bombed by the Sudanese Air Force. Although more than 150 patients and staff were in the hospital at the time, only two people were injured. The medical facility had been bombed seven months earlier, injuring six people.
South Sudan’s 22-month civil war has also seen an MSF hospital targeted. In January last year, the charity was forced to abandon its hospital in Leer, where it had worked from 25 years. Although the hospital was looted and almost razed, local staff evacuated patients to the bush where they continued to treat them as best they could. MSF returned to the hospital, but efforts to provide sustained care have been being jeopardised by ongoing fighting.
The charity has long been known for working in troublespots where few other humanitarians would venture, and for its “first in, last out” approach. And, despite its governing principals of impartiality and neutrality, it is often more outspoken than many of its peers.
“When MSF witnesses extreme acts of violence against individuals or groups, the organisation may speak out publicly,” it says. “We may seek to bring attention to extreme need and unacceptable suffering when access to lifesaving medical care is hindered, when medical facilities come under threat, when crises are neglected, or when the provision of aid is inadequate or abused.”
The charity was awarded the Nobel peace prize in 1999 “in recognition of the organisation’s pioneering humanitarian work on several continents”. Its early – and vocal – efforts to fight the recent Ebola outbreak and shake the world into action saw it awarded both the Chatham House prize and the Lasker-Bloomberg Public Service award.
Its long experience of working in warzones has seen MSF develop a set of standard protocols that govern its operations. The charity is adamant that it followed its usual practices on informing all parties to the fighting about its presence in Kunduz – and the position of its hospital.
Vickie Hawkins, MSF UK’s executive director and a former head of mission in Afghanistan, said the organisation always had “open channels of communication” with all warring parties.
“In this case we were giving frequent updates as to the hospital’s location and the most recent GPS co-ordinates had been handed over on 29 September – so only a few days before the attack itself,” she told BBC Radio 4’s Today programme on Monday.
Hawkins said the charity “absolutely” rejected suggestions that Taliban fighters were at the hospital.
“We had closed the gates of the compound when it got dark the previous evening as is our normal practice,” she said. “Inside the compound were 105 patients, their caretakers and 80 MSF staff. There was nothing untoward happening that evening inside the compound itself.”
Until the bombing raid, added Hawkins, all parties had respected the status of the hospital and it had not been attacked.
She also said that, as of Monday morning, MSF had yet to hear directly from either the US or Afghan authorities.
“We’re extremely angry and shocked: this is the single biggest loss of life in Afghanistan we’ve ever experienced and the comments from the Afghan government yesterday are only making matters worse,” she said.
“They are essentially acknowledging that this was a deliberate act and from that we can only presume that this in fact constitutes a war crime.”
