‘Are we saying that nobody in a conflict zone can get healthcare?’

Shortly before his stint as medical director at the Médecins Sans Frontières (MSF) trauma hospital in Kunduz came to an end, Declan Barry took a moment to sit down with his deputy and reflect on all they had experienced together.

Abdul Sattar (48), an Afghan who lived in the city with his wife and eight children, was a committed doctor and a good friend. The two men looked back over an eventful six months. They were proud that the hospital's mortality rate had fallen and that the medical team had managed to cope with surging demand for their services in a region where the shifting front line extended into the city.

“We worked really well together,” Barry says of Sattar. “I told him that it was very unusual to be able to achieve as much as we did and have such a laugh. He had a wicked sense of humour, and he was tremendously respected. The man didn’t know what it was to panic.”

Abdul Sattar was among 22 staff and patients who were killed when the US bombed the hospital, in northeastern Afghanistan, on October 3rd.

In an attack for which US president Barack Obama subsequently apologised, aircraft repeatedly hit the hospital's main building, where staff were working late to treat victims of intense fighting set off by the Taliban's arrival in the city earlier that week.

One eyewitness described six patients burning in their beds in the intensive care unit and another dead on the operating table.

Barry left Kunduz in mid-September, two weeks before the bombing and was in Paris for an MSF training course when he heard the news.

“I thought, that has to be wrong, that can’t be the MSF hospital,” he recalls.

The 92-bed hospital provided the only trauma service in Kunduz province, giving it a catchment of up to one million people. It opened in 2011 and quickly gained a reputation for its high standard of care.

In his six months there, Barry (38) had been aware of certain dangers, but an aerial bombardment wasn't one of them. "Never would I have thought that was something I had to be concerned about," he says, sitting in MSF's Dublin office after his return to Ireland.

Accept and protect

“There was acceptance from the community and the fact that we were an essential part of their healthcare protected us. That’s one of our ways of being secure. If people accept us, they will protect us.”

The news that so many friends and colleagues were among the dead left Barry stunned. “It was disbelief,” he says.

He thought of Teshil, the pharmacist who helped keep the emergency room stocked despite the turmoil, and of Najibullah, the tall and friendly janitor who would always greet him in the corridor and who volunteered to remain on duty during the heavy fighting in September. Both died.

The loss of 14 staff among the 22 dead has left Médecins Sans Frontières reeling and prompted it to call for an independent investigation.

Barry, originally from Co Longford, did his training in paediatrics in Dublin and fulfilled a longtime ambition by joining MSF in 2010. He has worked with the medical charity in Uganda, Liberia, Ethiopia and Libya. He was based in northern Syria two years ago, and had already served once in Afghanistan before returning in March this year to lead the medical team in Kunduz.

“If we’re not doing it, it might not get done,” he says of working in difficult environments.

Kunduz hospital dealt with accidental trauma cases such as car crashes and falls, but most of its workload was linked to the conflict between the Taliban and Afghan security forces. The heavy fighting season, beginning in March, would bring a steady flow of patients injured by blast bombs or gunshots.

“Bomb blasts cause what we call polytrauma,” Barry says, “which might be two amputations, chest injuries, head injuries, penetrating abdominal injuries. They can be quite complex.”

Full capacity

The hospital was running at capacity most of the time, but when the fighting came to the streets of Kunduz city itself in September, it expanded from 92 beds to 150 to meet demand. Staff worked round the clock in the week leading up to the bombing, often bringing their families to safety outside the city and then returning to tend to their patients.

The destruction leaves Kunduz province without a single trauma unit. It also leaves many questions unanswered.

The International Humanitarian Fact-Finding Commission, a body set up under the Geneva Conventions, has said it is ready to investigate if the US and Afghanistan agree. Washington, which says the bombing was an error, has pledged to carry out an investigation but says an international inquiry is not needed. Afghan authorities are also investigating.

For Barry, the attack has raised profound questions that go to the heart of humanitarian work in warzones.

“A hospital should be a protected space,” he says. “We are delivering healthcare to trauma victims. It’s in humanitarian law. If that’s up for grabs and is not to be respected, then that changes a lot.

“Our role is treating these people in these areas. If we can’t do that safely, what are we saying? That nobody in a conflict zone can get healthcare?”