Kathleen Thomas grimly recalls the day when a US warplane flew over in Afghanistan and bombed her intensive care unit.

A survivor of the attack - which killed 42 and wounded dozens of others in the northern city of Kunduz - Thomas recounted seeing patients trapped in their hospital beds and engulfed in flames.

"The strikes tore through the outpatients department, which had become a sleeping area for staff. Our colleagues didn't die peacefully like in the movies," Thomas said.

"They died painfully, slowly, some of them screaming out for help that never came, alone and terrified, knowing the extent of their own injuries and aware of their impending death. It was a scene of nightmarish horror that will be forever etched in my mind.

"My eyes tear up as the raw grief I feel tugs at my heart," she said. "And the patients … So many bright young lives ripped viciously from this world." 

The account is part of Thomas' public testimony released recently by Doctors Without Borders (MSF). The international medical charity operated the hospital in Kunduz that was flattened by a US air strike last October.

Seven months since the deadly attack, survivors and family members of victims have struggled for an elusive justice that may never come. Even though the US government has disciplined more than a dozen personnel, it has still skirted an independent investigation into the air strike, described by MSF as a "war crime".  


READ MORE: US - Strike in Afghanistan MSF hospital not a war crime


The US actions have sowed fears among human rights activists and advocacy groups that the entrenched pattern of bombing hospitals by "mistake" - in the words of the US government - would leave health facilities in conflict zones even more vulnerable. 

"We run the risk of getting used to these [unacceptable attacks] when actually our tolerance ratio should be zero," Roman Oyarzun Marchesi, the permanent representative of Spain to the United Nations, said at a recent policy forum on attacks on healthcare facilities in armed conflict.  

"Wars may be inevitable, but there are rules to follow," Marchesi said. "Respecting international humanitarian law is not only a matter of life and death; it is humanity itself that's at stake here." 

Entrenched pattern

At the forum, Jason Cone, MSF's executive director in the US, reiterated that his organisation was "not satisfied" with the lack of progress on addressing the consequences of the Kunduz bombing.

"Suspected perpetrators get away with self-investigating and there is no independent follow up on attacks," Cone said, without mentioning the US. "We are not seeking justice; we do seek accountability."

Last December, Doctors Without Borders delivered a petition with half-a-million signatures to the White House, urging President Barack Obama to consent to an independent investigation of the attack.

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Since October, the group has requested the International Humanitarian Fact-Finding Commission to conduct an investigation. So far the US government has kept mum on this. The commission is the only permanent international fact-finding body with a specific mandate to investigate potential violations of international humanitarian law under the Geneva Conventions, but its mandate has never been used.

Peter Van Buren, a retired 24-year veteran of the US Department of State - including service in Iraq - has turned into a vocal critic of US foreign policy. He has compiled a list of protected facilities that the US has attacked that dates back as far as the Vietnam War more than four decades ago. 

The bombarded health facilities include a major hospital in Hanoi, Vietnam's capital, during what historians call the infamous "Christmas Bombing" in 1972; a hospital in Belgrade, former Yugoslavia, in the 1990s; the Red Cross in Kabul, Afghanistan in 2001; and several other hospitals in Iraq in 2003.

"There are always investigations following such incidents," Van Buren said, "though in the history of modern American warfare none has ever deemed such devastation as intentional." 

To him, hospitals do make attractive targets. "Destroying them results in fighters dying of their wounds, and increases the burden on healthy soldiers, pulling them from the battlefield to care for their own wounded," he said. "In military terms that is known as a 'soft kill'. Accidents emerge in war, but so do patterns." 

It is in this context that human rights activists have called for the stepping up of political pressure as a way to prevent further attacks.

"The UN Security Council has a critical opportunity to take a first and an important step in reaffirming the rules of war that recognise and protect the state of healthcare workers, the sick and the wounded," said Cone.

"We ask that the council seize this moment to unambiguously recommit to uphold the norms that govern the conduct of war and maintain a space for humanity at the heart of hostility."


READ MORE: US troops disciplined over Afghan hospital bombing


Last January, MSF reported that its medical facilities in Yemen had been bombed four times in less than three months, with two hospitals, a clinic and an ambulance coming under fire.

Last Wednesday, more than 50 people died in the bombing by the Syrian government of a hospital supported by Doctors Without Borders in northern Syria.

"Increasingly, we are seeing attacks on medical facilities being minimised as 'mistakes'," said Raquel Ayora, director of operations for MSF. "This implies that mistakenly bombing a protected hospital would be tolerable. This logic is offensive and irresponsible." 

The Pentagon reiterated in an official report on Friday that the Kunduz bombing was unintentional, blaming human error and "equipment failures". According to the report, "administrative actions" have been meted out against 16 American military personnel, including a general officer; but no criminal charges have been pressed.

Doctors Without Borders bristled at the findings of the US investigation. 

"The threshold that must be crossed for this deadly incident to amount to a grave breach of international humanitarian law is not whether it was intentional or not," said Meinie Nicolai, the group's president. 

"With multinational coalitions fighting with different rules of engagement across a wide spectrum of wars today, whether in Afghanistan, Syria, or Yemen, armed groups cannot escape their responsibilities on the battlefield simply by ruling out the intent to attack a protected structure such as a hospital."

Doctors Without Borders also lamented the lack of legal avenues that would enable victims and their families to either sue the US military or to claim compensation for loss of life and livelihood.

"This has only compounded the devastation of the attack," the group said in a statement.

Seven months after the Kunduz hospital strike, the family of three-year-old Shaista, another survivor, is still reeling from its aftermath.

Shaista, whose full name was not released, was wounded when a bomb hit her house. She was then admitted to the MSF hospital, the only patient in the intensive care unit to survive the bombing two days later.

She lost a leg in the attack. Her father said in a YouTube testimony that the life of the entire family has dramatically changed.

"My wife is receiving medication for her mental health, and I also suffer mental disorder," he said while his daughter crawled around the room with an unencumbered smile. "And Shaista, when she hears shelling or sees aircraft she is scared and cries and screams."

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Source: Al Jazeera