As that fighting grew closer to the hospital, stray bullets pierced the ceiling of the intensive care unit and MSF staff were instructed to sleep inside the hospital compound. If any of them left, it was feared, they might be unable to safely return to work the next day.
And there was plenty of work to be done. One hundred wounded patients arrived on Monday -- 36 of them in critical condition. The staff added 18 extra beds. Over the next four days, another 250 patients cycled through the emergency room alone. The building was so overcapacity that staff members put mattresses and pillows in corridors and administrative offices.
Fighter jets could be heard roaring overhead as the U.S. began launching airstrikes in support of the Afghan army's haphazard efforts to retake the city. Most of the hospital's staff refrained from even stepping outside.
By Friday, however, the fighting began to recede from the area around the hospital, and staff members felt safer climbing to the roof to spread out the flags in order to ensure that the facility would be identifiable from the air. The organization had also sent the hospital's GPS coordinates to the U.S. Department of Defense, the Afghan Ministries of Interior and Defense, and the U.S. Army in Kabul four days earlier. The markers were just considered one more level of protection.
The hospital itself couldn't be missed. Its lights blazed throughout Friday night and into the early hours of Saturday morning as doctors tried to tackle a "backlog of pending surgeries." Outside the compound's walls, the rest of the city, home to 270,000 inhabitants, was mostly dark. After a week of fighting, the hospital was one of the few buildings in the area that still had running generators and so the power to light itself. It was a relatively calm night, slightly overcast and unseasonably warm for early October. The sound of gunfire had receded, and some staff members even dared to step outside for the first time in days.
"The Single Deadliest Aircraft"
The explosions began just as staff members were putting patients under anesthesia in the operating room.
At 2:19 a.m., a representative of MSF in Kabul called the American-led NATO mission to Afghanistan to say that the hospital was being bombed. A minute later, an MSF representative called the Red Cross, then the United Nations. From New York, a member of MSF called the Pentagon.
We don't know what was happening inside the Pentagon that night. We do know that, back in Kunduz, a U.S. AC-130 gunship was circling above the hospital's main building.
The low-flying AC-130 is equipped with cannons and a 105-mm howitzer. It can fly at speeds of up to 300 miles per hour, but it's designed, above all, to circle close to the ground while firing at targets below. As an article in the Washington Post explained, "The AC-130 essentially loiters over a target at around 7,000 feet, flying in a circle and firing from weapons ports mounted on the aircraft's left side."
The gunship is specially designed for night missions. The plane is equipped with infrared sensors, while its crew of 12 (or so) sport night-vision goggles. Manufactured by Lockheed Martin and Boeing, the older version of the plane, the AC-130H Spectre, cost $110 million apiece, while the newer AC-130U Spooky version goes for $210 million. One Special Operations Air Force captain described the gunship as "the single deadliest aircraft and flying squadron in the war on terrorism." In 2002, this same type of gunship fired on a wedding party in Afghanistan's Helmand province, killing more than 40 people.
Versions of the gunship have been in use by the U.S. military since the Vietnam War. An older model, which flew in Operation Desert Storm, the first Gulf War, is now on display at the National Museum of the United States Air Force at Wright-Patterson Air Force Base in Ohio. It was dubbed Azrael, which in both Hebrew and Arabic means the Angel of Death.
At 2:47 a.m., a representative from MSF in Kabul texted the American-led mission to Afghanistan that one of the Kunduz hospital's staff members had just died, that many were missing, and that the trauma center was still under repeated fire.
Five minutes later, someone from the mission texted back: "I'm sorry to hear that. I still do not know what happened."
At this point, the U.S. gunship above had been firing on the hospital's main building on and off for more than 45 minutes. The strikes were, according to MSF Director of Operations Bart Janssens, very precise. "[The gunship] came four or five times over the hospital, and every time extremely precisely hit with a series of impacts on the main building of the hospital," he told Reuters.
Surviving staff members recall that the first room to be attacked was the intensive care unit, which then held a number of patients, including two children. The strikes next hit the lab, the emergency room, the X-ray room, the mental health center, and the operating theaters, where two patients were lying on the operating tables. Both were killed.
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