What Happened at the Kunduz Hospital Airstrikes? Details Are Starting to Emerge

Just days after an attack on a hospital run by Doctors Without Borders (also known by its French name, Médecins Sans Frontières, or MSF), in Kunduz, Afghanistan, Army General John F. Campbell, the senior military commander in Afghanistan, was called to testify before the Senate.

The attack killed 22 and injured 37, and MSF called it a "war crime." The organization described the airstrike as "a series of aerial bombing raids at approximately 15-minute intervals," beginning at 2:08am and lasting for more than an hour. MSF maintains that both US and Afghan authorities were made aware of the exact coordinates of the hospital as recently as September 29, four days before the bombing.

"A hospital was mistakenly struck," Campbell said during his testimony. "We would never intentionally target a protected medical facility." Nonetheless, Campbell confirmed that the decision to attack the hospital was "made within the US chain of command."

The details of the airstrike on the MSF hospital remain under investigation. However, there are a number of details about the airstrike and the process for its approval that are known.

The city of Kunduz was seized by the Taliban a month ago. The operation that included the airstrike on the MSF hospital was part of a major counteroffensive by Afghan forces, with the assistance of US Special Forces, to retake the city from Taliban militants.

Related: Taliban, Helped by Foreign Fighters, Makes Inroads in Kunduz

The airstrike on the hospital was not just a spur-of-the-moment decision; rather, it was the end product of detailed planning and coordination. Long before Afghan troops began operations on that night, with US Special Forces serving in an advisory role, there were detailed preparations to ensure that both US and Afghan forces had adequate close air support — in this case an AC-130 gunship circling thousands of feet above the battlefield.

In military-speak, an attack, or the use of a weapons system on a target, is referred to as "fires." The call for fire is a concise message prepared by the observer on the ground, in this case a member of US Special Forces, requesting fires on behalf of the ground forces, Afghan soldiers in this case. This call for fire is facilitated by a joint terminal attack controller (JTAC), usually a member of the Air Force, who has specialized training in calling for fire during close air support, which is the application of fires against hostile targets that are close to friendly forces.

This request is sent from the JTAC, who accompanies US Special Forces, to US military authorities in Afghanistan. Those authorities review the request, determine its legality, and pass this information back to the JTAC.

This review process, known as targeting, "is the selecting and prioritizing of targets and matching the appropriate response to them." The targeting process always includes a determination of the legality of the target and requires commanders to take steps to "avoid excessive incidental civilian casualties and damage to civilian property." It is fairly likely that a US military lawyer signed off on the Kunduz attack.

Early in the targeting process, a no-strike list, which contains objects or entities protected from military operations, such as hospitals, is compiled. Targets on this list may be removed if their status has changed; for example, "medical structures that functions (sic) as a weapons storage or barracks facilities may lose their protected status and may be legally attacked." In other words, it doesn't count if you paint a big red cross on the side of a fortress and call it a hospital.

Targeting for the strike on the MSF hospital would have occurred in a relatively short period of time — likely only a number of minutes — because the request was coming from Afghan forces who reported they were under fire from the hospital. Even with the compressed timeframe, however, all the same questions would still be asked: Was the MSF hospital on the no-strike list? If so, did the hospital lose its protected status because it was being used by Taliban military forces? Does targeting the hospital comply with the Law of Armed Conflict?

Watch the VICE News Documentary The Afghan Interpreters:

These are all questions the commander would have answered, with the assistance of his staff and military lawyers, before authorizing the strike on the MSF hospital. Because the strike on the hospital is under investigation, however, the information necessary to answer these questions has not yet been released to the public.

During his Congressional testimony, Campbell confirmed that the airstrike on the hospital was carried out by an AC-130 gunship. The AC-130 is a converted cargo plane, packed with advanced sensors and communications equipment, featuring multiple cannons, machine guns, and other weapons sticking out of the left side. It requires a crew of more than a dozen people to operate its bank of weapons and extensive suite of electronics, including radar, night-vision, and infrared sensors. According to an Air Force fact sheet, the AC-130 possesses numerous sensors that allow it to "identify friendly ground forces and targets anytime, anywhere" and provide "surgical firepower."

Unlike the fast-moving attack jets often used by the US military in Afghanistan, the AC-130 is able to loiter – military parlance for circling slowly — over a target for an extended period of time. This allows it to perform numerous fire missions, which is consistent with MSF's description of the attack on the hospital. A fire mission by an AC-130 also differs from strikes by attack jets in that the weapons on an AC-130 are guided by coordination between the JTAC and the gunship's crew.

Heman Nagarathnam, head of MSF programs in northern Afghanistan, said he and other staff could hear the plane circling, then firing, then circling some more.

"The bombs hit and then we heard the plane circle round. There was a pause, and then more bombs hit," he said. "This happened again and again."

This description is consistent with an attack by an AC-130 gunship, if we ascribe the explosions described as "bombs" by MSF to fire from the 105 mm cannon mounted onboard some variants of the AC-130.

Before an AC-130 arrives on scene, the crew is briefed on the situation on the ground, so even if it has not been acknowledged by US military authorities, the AC-130's crew was likely aware of the location of the MSF hospital.

Once a gunship arrives on scene, the JTAC on the ground provides the gunship's crew with a situational update, including location of friendly and enemy forces, terrain, and other pertinent information, which should have included the location of the MSF hospital.

The relatively slow airspeed of the AC-130 and its ability to circle the target for hours allows for greater direct interaction between the JTAC and the aircrew — including direct links to the AC-130's sophisticated suite of sensors — allowing the JTAC to provide real-time adjustments to the attacks delivered by the gunship.

Related: 19 Dead After Apparent US Airstrike Hits MSF Hospital in Afghanistan

It remains unclear how close the US Special Forces unit was to the Afghan forces and the hospital during the attack.

"Ideally, a JTAC would have eyes on the target, but that is not necessary with the advanced sensors and communications between the AC-130 and the JTAC on the ground," said Mike Haytack, a retired Air Force JTAC.

During the attack on the hospital, the AC-130 crew was receiving continual updates and adjustments from the JTAC. Because the various investigations into the attack are ongoing, there has been no information disclosed by the US military about the information passed from the JTAC on the ground to the aircrew during the hour-long attack on the hospital.

There are currently three separate military investigations being conducted to determine how the attack on the MSF hospital could have occurred. Both a US Army and a joint Afghan-US investigation are underway, and NATO is conducting a separate query.

Additionally, MSF continues to push for an "independent investigation led by the International Humanitarian Fact-Finding Commission to establish what happened in Kunduz, how it happened, and why it happened."

Follow James Weirick on Twitter: @JamesWWeirick