Coalition forces, led by Saudi Arabia and backed by the United States, bombed a hospital in Yemen operated by Doctors Without Borders (MSF). It was the second MSF hospital in a war zone to be attacked this month.

The attack was not the first attack on a medical facility in Yemen. MSF has reported strikes on hospitals, roads, and towns, even when Houthis they are at war with have not been present. And, once again, the U.S. was implicated in the bombing of a hospital, which is a war crime.

As the New York Times reported, the hospital in Saada was hit by “at least two airstrikes around 11 pm Monday.” The group’s head of mission, Hassan Boucenine, told the newspaper the hospital “collapsed.”

Boucenine informed the Times that 12 patients and staff members had been in the hospital at the time of the bombing. Each was able to evacuate once there was a “lull between the two airstrikes. However, “one patient received burns and scratches, and another was in critical condition because of the hurried evacuation.”

MSF is one of the few international aid organizations to operate in Yemen. The hospital, which is located “in the Haydan district along the border with Saudi Arabia,” was one of the only medical facilities still functioning in Saada. The area has been under the control of Houthi rebels and “heavily bombed” by coalition forces.

Adding to fears that this is a disturbing trend, MSF was forced out of Donetsk, Ukraine, by the Humanitarian Committee of the Donetsk People’s Republic (DPR) on October 19. Its “accreditation” in the “self-proclaimed state” was withdrawn. This means thousands are left without health care

Like the U.S. air strike on the MSF hospital in Kunduz, Afghanistan, MSF provided coordinates for the hospital to coalition forces. Those coordinates were re-confirmed with the coalition each month in order to protect patients and staff from attacks.

Dr. Joanne Liu, the president of MSF International, has stated the U.S. air strike hit the the part of the medical compound “housing the intensive care unit, emergency rooms, and physiotherapy ward. Surrounding buildings in the compound were left largely untouched,” which adds to the body of evidence that this strike was a war crime under international humanitarian law.

The death toll has steadily risen in the aftermath, with a total of 30 people now confirmed dead. An additional MSF staff member recently died. Seven bodies were found in the rubble of the bombed compound but have not been identified yet.

Most recently, the Associated Press reported an officer from a U.S. Army Green Berets unit had noted MSF had personnel in the hospital. The officer believed the hospital was “under the control of insurgents.” Any “friendly forces” were reportedly to “clear the trauma center” of any “enemy forces.”

Spokesperson Tim Shenk was asked by “an official in Washington” if the MSF hospital in Kunduz had a “large group of Taliban fighters in it.” The organization told the official “this was not the case” and made it clear that “both sides” in the conflict must “respect medical structures.”

A targeted attack on a hospital violates international humanitarian law and is a war crime if it is: intentional, the result of negligence “stemming from a failure to properly verify the military or civilian nature of the target,” a “disproportionate response to the identified military threat,” or “undertaken without advance warning of an imminent attack.”

In the case of the attack on the MSF hospital in Yemen, coalition forces did not give staff and patients “advance warning” so they could evacuate. It was hit twice so it is intentional. They knew it was a hospital, as coalition forces were provided coordinates. This means coalition forces disregarded the protected status, which is supposed to be granted to a hospital.

Similarly, General John F. Campbell, the commander of U.S. forces in Afghanistan, has indicated the call for an air strike on the MSF hospital in Kunduz went through the chain of command and was subject to a “rigorous procedure” before being authorized.

The AP story further confirms rules of engagement were likely followed, and despite the information provided by MSF, the U.S. bombed the hospital because they were convinced it was under control of Taliban fighters. In fact, Afghan security forces previously raided this exact hospital in July because forces were upset with the MSF for treating all wounded, including Taliban fighters (which MSF must do to remain neutral while treating injuries in war zones).

In both attacks on MSF hospitals, the effect is to remove a hospital from an area in which civilians are desperately in need of a facility that can provide medical care.

“The destruction of MSF’s 94-bed trauma center [in Kunduz] will have a huge impact on access to surgical care for hundreds of thousands of people in the region,” MSF declared on October 23. “This hospital was the only facility of its kind in northeastern Afghanistan, with more than 400 staff able to provide extremely high quality surgical, post-operative, and rehabilitation care. Last year, more than 22,000 patients received care at the hospital and more than 5,900 surgeries were performed. Staff treated anyone who needed medical care, often for significant trauma injuries from traffic accidents, bomb blasts, or gunshot wounds.”

The same impact will be felt by civilians in Saada, who bear the brunt of the coalition’s attacks on Houthi rebels and will now have no nearby facility to treat injuries.

MSF hospitals have been transformed into targets by the U.S. and allied forces because the group upholds neutrality in war zones. It is not on the side of the Taliban or the Houthis (which have actually blocked medical aid to Taiz). The aid group merely recognizes taking sides would put the humanitarian work of doctors at risk.

“What is at stake is the ability of humanitarian organizations to continue their lifesaving work at the front lines of conflict,” declared Jason Cone of MSF in the United States.

This is precisely why the MSF has called for an independent investigation by the International Humanitarian Fact-Finding Commission, which has up to this point remained unused but has existed since 1991. It could be empowered to investigate violations of international humanitarian law that occurred in the U.S. air strike in Afghanistan. And, in the aftermath of the strike in Yemen, the body could investigate the attack by the U.S.-backed Saudi-led coalition as well.