The situation in the war-torn Afghan city of Kunduz became more precarious for residents caught between government troops and Taliban militants after the withdrawal Sunday of an aid group that was one of the last providers of medical services there.
The aid organization, Doctors Without Borders, said it was leaving Kunduz, in northern Afghanistan, after a catastrophic airstrike on its hospital there on Saturday that killed 22 people, including 12 staff members, and destroyed the intensive care unit.
The Pentagon, which has said it may have inadvertently struck the hospital during a military operation, said in a statement on Sunday that a preliminary investigation of the episode would be completed in a matter of days. The Afghan government also vowed to investigate the airstrike.
A senior American military official said Sunday that there was heavy gunfire in the area around the hospital at the time of the airstrike, and that initial reports indicated that the Americans and Afghans on the ground near the hospital could not safely pull back without being dangerously exposed. American forces on the ground then called for air support, senior officials said.
The closing of the hospital will leave not only the residents of Kunduz, but also those of neighboring districts and provinces, with scant medical care. It was the only free trauma care hospital in northern Afghanistan, according to Doctors Without Borders. The group said that in 2014 more than 22,000 patients received treatment at the hospital and more than 5,900 surgical procedures were performed.
Trauma care is a much needed specialty in Kunduz, which has been plagued by intense fighting for at least the past six years. The medical staff regularly treated gunshot and shrapnel wounds and traumatic injuries caused by bombs. In 2009, the hospital treated scores of people wounded when a convoy carrying fuel to the north was hit by an airstrike called in by the German commander in the region; 142 people died in the strike.
The medical workers were overstretched in recent days, caring for nearly 400 people between Monday, when the Taliban occupied Kunduz, and the early hours of Saturday when the airstrike hit. The doctors and nurses said they cared for any wounded person, regardless of which side of the conflict.
With that hospital closed and the regional hospital bereft of staff, the wounded will have to find their way to hospitals in neighboring provinces. While there are a few clinics in Kunduz, they are not equipped to do surgery or handle the severe wounds inflicted by bombs, mortars and missiles.
Getting to the hospitals in neighboring Takhar Province or in Baghlan Province can take as long as two hours on a good day. Now, with Taliban and Afghan security checkpoints, it seems all but certain that some victims will not reach medical help in time for doctors to save them.
Despite an international outcry, the attack, which appeared to have been carried out by American aircraft, has not stirred the same public resentment here as have past civilian casualties caused by the Americans, which were quickly denounced in searing terms by Hamid Karzai, who stepped down as president last year, and many others.
Many residents of Kunduz, as well as people in Kabul, seemed willing to believe the accusations of some Afghan officials that there were Taliban fighters in the hospital shooting at American troops.
Doctors Without Borders, known internationally as Médecins Sans Frontières, issued a sharp statement Sunday saying it was "disgusted" by statements by Afghan authorities trying to justify the strike on the hospital and called for a transparent and independent investigation.
"These statements imply that Afghan and U.S. forces working together decided to raze to the ground a fully functioning hospital — with more than 180 staff and patients inside — because they claim that members of the Taliban were present," the group's general director, Christopher Stokes, said in the statement. "This amounts to an admission of a war crime."
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Still, some Afghan officials continued to suggest that the attack was justified. "I know that there were civilian casualties in the hospital, but a lot of senior Taliban were also killed," said Abdul Wadud Paiman, a member of Parliament from Kunduz.
More than half of those killed were hospital workers, and three of the patients killed were children, but that did not alter Mr. Paiman's view.
His defense of the bombing suggests a growing fear that the Taliban are back and strong enough to take over much of the country, which makes many Afghans reluctant to criticize one of the few nations still offering military support against them.
"Everyone, including the international community, is afraid of the Taliban," Mr. Paiman said.
Patricia Gossman, Human Rights Watch's senior researcher on Afghanistan, said many human rights abuses might be ignored because Afghans feel they have no choice but to support an ally.
"Kunduz falling to the Taliban, however briefly, is deeply demoralizing to many Afghans, who may therefore be reluctant to criticize anyone — Afghan security forces or the U.S. — who can hold the ground against them, even if they commit human rights abuses," Ms. Gossman said.
"There's a real fear that if the U.S. doesn't provide air support, or if militias are not deployed, or the Afghan forces not given free rein, the Taliban will keep advancing," she said.
Privately, many Afghans expressed disapproval of the carelessness involved in hitting a hospital, but neither the Afghan government nor Afghan television fanned anti-American sentiments as they might have just two years ago.
Tolo News, one of the most successful Afghan television channels, posted on Twitter footage of Afghan soldiers handing out food to civilians with the headline "Life gets back to normal in Kunduz."
However, interviews with a half-dozen people in Kunduz suggested that in much of the city the situation was anything but normal.
"The situation is very, very bad, so bad that one cannot imagine it," said Fazel Ahmad, a resident who said that there had been 25 families on his street, but that now he and one other family were the only ones left.
"There is no bread," Mr. Ahmad said. "No shop is open, so that even the man who has money in his pocket and goes to purchase something can find nothing to bring home."
"There is no drinking water and no electricity," he said, adding that as he walked around on Sunday he could tell which families still had working wells. "Any house which still has a working well," he said, "you can see a queue of people from 20 homes waiting to fetch water for themselves."
Several residents reported by phone that for several hours on Sunday, government forces managed to raise their flag in one of the main city squares, but several hours later the Taliban had retaken the territory.
Despite the promises of a quick investigation, some American officials said that military investigators' access to the hospital site was hampered by the presence of a significant number of militant fighters in the area, which was likely to slow the inquiry.
At the Doctors Without Borders hospital, the remaining staff members prepared to evacuate, and relatives came to claim the dead.
An Afghan radio journalist, Zabihullah Pashtonyar, 28, who was in the hospital when it was hit by the airstrike, died there, according to his boss, Zarghona Hassan, founder of Radio Kayhan.
The survivors included a day laborer, Abdul Kareem, 28, and a grocery store owner, Abdul Qadeer, 45. Both were being treated in the hospital after they were wounded in the cross-fire between Afghan forces and the Taliban during the earlier fighting for the city. Mr. Kareem was wounded again in the airstrike, and both men were evacuated to the hospital in Baghlan Province.
Their description of a city with firefights erupting unexpectedly made it clear why so many families were fleeing.
Mr. Kareem said he was caught in the middle of a firefight last week after the Taliban took over the city. "Everyone was just running here and there, including me, but with the first explosion I was hit with shrapnel," he said. "An airplane was maneuvering above me targeting enemies." He said six other civilians were also wounded in the same episode.
Then overnight between Friday and Saturday, the hospital was struck, and Mr. Kareem was wounded again.