U.S. airmen monitor the engine starts of an AC-130H Spectre gunship on Nov. 27, 2013, at an undisclosed location in Afghanistan. In a report released Thursday, Nov. 5, 2015, Doctors Without Borders said the charity was in communications with coalition forces even as gunfire from an AC-130 gunship rained down on its hospital in northern Afghanistan last month.

U.S. airmen monitor the engine starts of an AC-130H Spectre gunship on Nov. 27, 2013, at an undisclosed location in Afghanistan. In a report released Thursday, Nov. 5, 2015, Doctors Without Borders said the charity was in communications with coalition forces even as gunfire from an AC-130 gunship rained down on its hospital in northern Afghanistan last month. (Jason Robertson/U.S. Air Force)

Coalition officials in Kabul and Washington sent reassuring messages to Doctors Without Borders, even as gunfire from a U.S. aircraft rained down on its hospital in northern Afghanistan last month, the medical charity said in a preliminary report released on Thursday.

As an American AC-130 gunship fired on the hospital, staff made a series of desperate calls and sent text messages to military officials. In reply, an unidentified official with the U.S.-led Resolute Support mission sent text messages saying, “I’m sorry to hear that, I still do not know what happened,” and “I’ll do my best, praying for you all.”

Separate investigations by the Pentagon and the NATO coalition are ongoing, and the Defense Department said on Thursday that the military was working closely with the medical group to determine the facts.

Pentagon spokesman Capt. Jeff Davis said in a statement that Gen. John Campbell, commander of U.S. and NATO forces in Afghanistan, had met with the group’s representatives on Wednesday.

The Oct. 3 attack sparked international outrage and calls for an independent probe into the incident, in which 30 medical staff and patients were killed and dozens more wounded. Doctors Without Borders, which goes by the French initials MSF, has called it a war crime.

Senior Afghan officials have claimed that the hospital compound was being used by Taliban fighters to fire on government forces trying to retake the area. NATO officers have said Afghan forces requested the strike to take out Taliban firing positions.

But MSF asserts in Thursday’s report that the hospital was not being used as a base by insurgents and that there was no heavy fighting in the area at the time.

“The view from inside the hospital is that this attack was conducted with a purpose to kill and destroy,” said Christopher Stokes, MSF’s general director, told reporters at a press conference in Kabul on Thursday. “A mistake is quite hard to understand and believe at this time.”

Based on interviews with staff and witnesses, the report does not include information from the American or Afghan militaries, which have yet to release detailed information on the attack.

MSF lays out in the report a chronology of the days leading to the deadly airstrike, which came amid heavy fighting in the city of Kunduz, the first major population center to be captured by the Taliban since it was ousted from power in 2001.

On Sept. 28, the day the Taliban captured the city, Afghan military officials pulled all but their most seriously wounded soldiers from the hospital. After that point, MSF says, it is unaware of any more security forces being brought to the hospital, as most new patients were either Taliban fighters or civilians.

On Sept. 29, MSF once again relayed the exact coordinates of the hospital to the U.S. Defense Department in Washington, to the Afghan Defense Ministry and to American military officials in Kabul.

“Confirmation of receipt was received from both U.S. Department of Defense and U.S. Army representatives, both of whom assured us that the coordinates had been passed on to the appropriate parties,” the report said.

By Wednesday, Sept. 30, roughly half of the 130 patients at the hospital were Taliban, including two whom MSF staff believed to be of “higher rank.”

The next day, Oct. 1, an American military official in Washington contacted MSF to ask if any of the organization’s facilities had a large number of Taliban “holed up,” and inquired about the safety of the medical staff.

MSF officials replied that “staff were working at full capacity in Kunduz and that the hospital was full of patients, including wounded Taliban combatants,” according to the report.

In the day before the airstrikes, staff placed MSF flags on the roof, and employees were instructed to sleep in safe rooms in the basement to reduce a reported threat of kidnapping.

“Throughout the night before the airstrikes began, all MSF staff confirm that it was very calm in the hospital and its close surroundings,” the report said. “No fighting was taking place around the hospital, no planes were heard overhead, no gunshots were reported, nor explosions in the vicinity of the hospital.”

An MSF staff member conducted a routine survey of the compound between 12:20 a.m. and 1:10 a.m. on Oct. 3.

“The coordinator reported that the (Kunduz Trauma Center) was calm, with no armed combatants present, nor any fighting on the hospital grounds or within the audible vicinity. From all MSF accounts, there was no shooting from or around the Trauma Centre and the compound was in full MSF control with our rules and procedures fully respected.”

Just after 2 a.m. a “series of multiple, precise and sustained airstrikes” began. Inside the hospital were 105 patients, including an estimated three or four government forces, 20 injured Taliban, and 149 Afghan and international staff, the report said.

Despite the pleas sent to Kabul and Washington, the strikes continued for more than an hour, MSF said. The first room to be hit was the intensive care unit, where several immobile patients, including children, were being cared for, the report said.

The strikes then continued to methodically destroy the rest of the main hospital building, including the operating rooms where two patients were killed as they lay on the operating tables, the report said.

In the report, witnesses describe some victims being gunned down as they tried to flee the building, which suggests that the aircraft was tracking the running targets. The hospital caught fire, with some patients burning to death in their beds, according to witnesses.

A few hours after the attack stopped, ambulances from the city’s public hospital arrived to evacuate the wounded. At the same time, Afghan special forces soldiers arrived and started searching the vehicles for Taliban patients, the report said. Clashes began outside the compound, and one ambulance was struck in the crossfire.

MSF says it is cooperating with the various investigations, but insists that an independent assessment is needed, by a party other than the U.S. or Afghan governments. So far, however, American and Afghan officials have not agreed to an independent investigation.

On Oct. 24, coalition investigators acknowledged that civilians were killed during the attack, and President Barack Obama has apologized to MSF.

In its statement, the Pentagon said it was working with MSF to identify the victims and determine the damage to the hospital “so that it can be repaired in full.”

Pentagon officials have indicated that their investigators are focusing on a series of communications and intelligence failures that may have caused the American forces to violate their own rules of engagement. Twitter: @joshjonsmith

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