It was the only trauma hospital serving the people of Kunduz, an area in northeastern Afghanistan. On October 3 2015, the US army bombed the Kunduz Trauma Centre, killing 42 staff and patients. The hospital was destroyed. Built by Medecins Sans Frontieres (MSF) in 2011, the hospital provided essential health care to civilians and soldiers alike. Its destruction had untold consequences for the people in the area. Guilhem Molinie and Jonine Lotter, two MSF staff, were in Kunduz at the time.
“MSF works in conflict zones all around the world, having operated in Afghanistan since the late 1970s,” says Molinie, the current general director for MSF Southern Africa. Based in Johannesburg, he oversees operations in Malawi, Lesotho, Eswatini, and South Africa.
“The hospital in Kunduz provided trauma surgery to women, children, and soldiers who came to the hospital,” says Lotter. At the time of the Kunduz bombing, the centre had over 300 staff, servicing many of the people living in the mountainous region. One of the staff members was Lotter, a MSF nurse who has worked with people injured in conflict in Kunduz, South Sudan, and Mosul.
The hospital, the only active medical trauma facility in the area, treated more than 22 000 patients in 2014 alone. “The centre focused on trauma care and wounds, local and international staff treated injuries which included bomb, mortar and even road injuries, which were very common,” says Lotter.
The fully equipped hospital was able to carry out orthopedic and general surgeries. It’s bombing left a bigger impression on the area beyond the infrastructure, with a tragic human impact. People were left with nowhere to go when they got injured. “Even the opening of a clinic in 2017 didn’t make a difference,” Lotter says, as that clinic provided very basic medical care.
During the Soviet Occupation of the country in the late 1970s and 1980s, MSF worked in an unofficial capacity without government support. Molinie says: “During the late 1980s, the organisation started working in an official capacity with the permission of all conflicted parties in the country.”
Operations in Afghanistan were stopped between 2004 and 2009 due to the direct killing of four MSF staff. Projects resumed in 2009, and were mainly hospital projects. The ongoing war in Afghanistan had led to the destruction of most of the health facilities in the country, opening up a huge need for these projects.
Post-Kunduz bombing, the people have been without any major advanced medical healthcare. Over 15 000 people, including civilians and combatants, were left without medical care, and have had to seek alternative health service. Lotter says: “This health care could only be found by travelling for a day over mountainous area to Afghanistan’s capital, Kabul.”
Rebuilding the hospital has been a long process, with many concerns hindering the process. “The need to have a trauma care hospital in that area remains very high,” says Molinie. While the people of that region need the health care service provided by MSF, the security concerns of ensuring an airstrike like the one in 2015 does not happen again remains a big issue. “The rebuilding itself is not a difficulty. The difficulty is based on its destruction by the US Army, and in making sure that if this kind of thing does not happen again.” says Moline.
Ongoing negotiations have been taking place to have the hospital rebuilt. As in many other countries which are experiencing conflict, discussions need to be held with all of the warring parties. In this case, consultations were held with the Taliban, the Afghan government, and the US army. The organisation needs to be seen as impartial and neutral in order to do the work, and not be working according to any political agenda.
The worrying statements the US Army were making during the talks did not provide the necessary guarantees that the civilians rights would be respected and healthcare could be provided. This caused a delay with the overall negotiations of starting the rebuilding process taking three years, all to ensure that Kunduz would not be repeated.
“The most important thing in any war situation is that civilians need to be protected. The general conflict rule is that as long as civilians do not take part in the conflict, they cannot lose their protection from the being victims of warring parties,” Lotter said.
But as the ongoing conflicts around the world demonstrate, these rules are continuously flouted. Investigations took place in Kunduz, yet no party was charged with what happened. In the absence of meaningful sanctions against perpetrators, another Kunduz is likely to happen.
All images provided by MSF Southern Africa.