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The Doctors Without Borders hospital is seen in flames, after an explosion in the northern Afghan city of Kunduz, Saturday, Oct. 3, 2015 . Nine local staffers for Doctors Without Borders were killed and 30 were missing after the explosion that may have been caused by a U.S. airstrike. In a statement, the international charity said the "sustained bombing" took place at 2:10 a.m. (2140 GMT). Afghan forces backed by U.S. airstrikes have been fighting to dislodge Taliban insurgents who overran Kunduz on Monday.  (Médecins Sans Frontières via AP)
The Doctors Without Borders hospital is seen in flames, after an explosion in the northern Afghan city of Kunduz, Saturday, Oct. 3, 2015 . Nine local staffers for Doctors Without Borders were killed and 30 were missing after the explosion that may have been caused by a U.S. airstrike. In a statement, the international charity said the “sustained bombing” took place at 2:10 a.m. (2140 GMT). Afghan forces backed by U.S. airstrikes have been fighting to dislodge Taliban insurgents who overran Kunduz on Monday. (Médecins Sans Frontières via AP)
UPDATED:

KABUL, Afghanistan — At least 19 people were killed when a hospital run by Doctors Without Borders in the northern city of Kunduz was badly damaged early Saturday after being hit by what appears to have been a U.S. airstrike, sparking international outrage.

The U.S. military, in a statement, confirmed an airstrike at 2:15 a.m., saying that it had been targeting individuals “who were threatening the force” and that “there may have been collateral damage to a nearby medical facility.” The strike will bring renewed pressure on the United States, which has been playing an increasingly active role in Afghanistan amid a resurgence of the Taliban, particularly in Kunduz, but has long been criticized for causing civilian casualties from the air.

The airstrike set off fires that were still burning hours later, and a nurse who managed to climb out of the debris described seeing colleagues so badly burned that they had died. At least 12 hospital staff members and seven patients, including children, were killed in the strike.

“A few are still missing. They might have been buried in the rubble,” he said, declining to give his name because employees of Doctors Without Borders are not allowed to speak to reporters without authorization.

In a statement, Doctors Without Borders, the aid group that is also known by its French initials MSF, accused the U.S. military of continuing the bombing for 30 minutes after receiving phone calls telling military contacts that the hospital was being bombed.

“All parties to the conflict, including in Kabul and Washington, were clearly informed of the precise location (GPS coordinates) of the MSF facilities — hospital, guesthouse, office,” the statement said. “MSF urgently seeks clarity on exactly what took place and how this terrible event could have happened,” the aid group said.

President Ashraf Ghani’s office released a statement Saturday evening saying that Gen. John Campbell, commander of U.S. forces in Afghanistan, had apologized for the strike. However, Campbell said in a statement that he was “aware of an incident that occurred at a Doctors Without Borders hospital in Kunduz,” but stopped short of taking responsibility, saying that the airstrike “was conducted against insurgents who were directly firing upon U.S. service members advising and assisting Afghan Security Forces.” He said the military would investigate the incident, echoing an earlier statement by Defense Secretary Ash Carter.

One U.S. official said early reports indicated that the attack may have been carried out by a U.S. AC-130 gunship that was supporting Special Operations forces on the ground in Kunduz.

The gunship is the air frame of an Air Force C-130 four-propeller transport aircraft but fitted with a range of powerful weapons, including cannon and heavy automatic weapons. It routinely is assigned to support troops on the ground.

Airstrikes resulting in civilian casualties have caused tensions verging on hostility between the Afghan government and the United States for years. The former president, Hamid Karzai, was often in the uncomfortable position of explaining to his countrymen why Afghanistan’s biggest ally was killing innocent Afghans.

Ghani has been largely spared such confrontations since taking power last year. Although the U.S. military has kept up a steady stream of airstrikes, it has mostly targeted small groups and there have been far fewer mistakes.

The U.N. secretary-general, Ban Ki-moon, strongly condemned the airstrikes in a statement issued by his spokesman and called for a “thorough and impartial investigation.” The organization’s high commissioner for human rights, Zeid Ra’ad al Hussein, in a separate statement Saturday called the event “utterly tragic, inexcusable, and possibly even criminal.” Al Hussein also said, “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. These obligations apply no matter whose air force is involved and irrespective of the location.”

The strike came as the United States, for the first time since it began withdrawing most of its soldiers from Afghanistan, has begun to play an increasingly active role in the fight there. It is trying to support Afghan troops overwhelmed by the Taliban in the northern province of Kunduz.

The Taliban took control of Kunduz on Monday and despite sporadic but often intense fighting over the past three days, their white flag is still flying over the main square.

Accounts differed as to whether there had been fighting around the hospital that might have precipitated the strike. Two hospital employees, an aide who was wounded in the bombing and a nurse who emerged unscathed, said there had been no active fighting nearby and no Taliban fighters in the hospital.

But a Kunduz police spokesman, Sayed Sarwar Hussaini, insisted that Taliban fighters had entered the hospital and were using it as a firing position.

The hospital treated the wounded from all sides of the conflict, a policy that has long irked Afghan security forces.

Video posted Saturday morning of the hospital grounds showed fires still burning, blackened walls and, in one building, a collapsed ceiling. One side of one building appeared to be pockmarked by bullets or possibly shrapnel, suggesting that there could have been fighting there. But it was impossible to tell whether the marks were new.

Doctors Without Borders, which has released the casualty numbers, said 37 people were wounded of whom 19 were hospital staff and 18 were patients or their caregivers, which means mostly family members. The organization described the facility as “very badly damaged.”

A military spokeswoman in Kabul, Susan Harrington, said she could not comment while the investigation was open.

Doctors Without Borders said 105 patients and caretakers had been at the hospital, along with 80 staff members. The hospital was “partially destroyed” in the bombing, the group said, adding that it had been “hit several times.”

The Afghan army has also been using helicopters to attack targets in Kunduz, and a spokesman for the Afghan army brigade in Kunduz, Ghulam Hazrat, said Afghan helicopters were “maneuvering and targeting enemies last night.”

It was not yet clear whether its aircraft had been involved in the overnight attack.

The International Committee of the Red Cross also condemned the bombing.

“This is an appalling tragedy,” said Jean-Nicolas Marti, the head of the organization’s delegation in Afghanistan. “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.”

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