The general director for Doctors Without Borders responded to Pentagon claims that Afghan military forces are responsible for bombs, which hit their hospital in Kunduz and killed 22 patients and staff, including three children.

“Their description of the attack keeps changing—from collateral damage, to a tragic incident, to now attempting to pass responsibility to the Afghanistan government,” declared Christopher Stokes, general director of Doctors Without Borders (MSF). “The reality is the U.S. dropped those bombs.”

“The U.S. hit a huge hospital full of wounded patients and MSF staff. The U.S. military remains responsible for the targets it hits, even though it is part of a coalition. There can be no justification for this horrible attack. With such constant discrepancies in the U.S. and Afghan accounts of what happened, the need for a full transparent independent investigation is ever more critical.”

General John F. Campbell, the commander of U.S. forces in Afghanistan, stated during a press briefing, “We have now learned that on October 3, Afghan forces advised that they were taking fire from enemy positions and asked for air support from U.S. forces. An airstrike was then called to eliminate the Taliban threat and several civilians were accidentally struck.”

“This is different from initial reports which indicated that U.S. forces were threatened and that the airstrike was called on their behalf,” according to Campbell.

Campbell’s statement is significantly contradicted by the account provided by Doctors Without Borders director of operations Bart Janssens: “What happened is that a plane arrived, and in several ways, they came four or five times over the hospital and every time extremely precisely hit with a series of impacts on the main building of the hospital.”

The hospital compound is larger than a football field. Staff at the hospital communicated GPS coordinates to “warring parties” in Afghanistan multiple times.

Executive director Jason Cone went on NPR’s “All Things Considered” and shared, “We had close to 200 staff and patients that were at the hospital at the time of the attack.”

“I want to reiterate that the main hospital building where medical personnel were caring for patients was repeatedly and very precisely hit during each aerial raid while the rest of the compound was left mostly untouched. So we see this as a targeted event,” Cone added.

Cone further explained, “We provided countless amount of information about potential loss of civilian and medical personnel to attacks on a hospital that was clearly providing impartial medical care for the past week and for years before that. This was a known structure, and for that reason, we have to presume until otherwise that this act is both a great violation of humanitarian law and can rise to the level of a war crime until we have an independent investigation that tells us otherwise.”

Both Afghan officials and US officials have made statements insinuating or outright suggesting Taliban fighters were using the hospital as some kind of a base or that they were using patients as human shields. To that, MSF said they were “disgusted.”

“These statements imply that Afghan and US 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,” MSF stated.

Cone unequivocally told NPR there was no fighting inside the hospital prior to the bombing. He informed the host MSF runs zero hospitals in the world, which allow combatants to enter and militarize them.

“That would be a red line for us,” according to Cone. “It puts both our patients and our staff at risk. We would never accept that under any circumstances. We work in countless countries; whether it’s Yemen, Syria and many other countries at war. And this is something we’ve been doing for 40-plus years.”

The commander of U.S. forces in Afghanistan contextualized his statements by saying the Taliban attacked Kunduz on September 28, days before the hospital was bombed. He suggested Taliban “decided to remain in the city and fight from within, knowingly putting civilians at significant risk or harm.” In other words, he was shifting blame to the Taliban for the bombing and deaths that occurred.

Statements like this, which aim to justify the bombing of a hospital, are very similar to statements Israeli military officials previously have made to justify attacks on hospitals or UNRWA shelters during Operation Protective Edge in 2014. They blame militants, particularly Hamas, and make unsubstantiated claims of fighters using the wounded or refugees as “human shields.”

Bombings like this have occurred in Yemen, where the U.S. fully backs a Saudi-led coalition that has been pulverizing areas in ways that have taken a great toll on civilians. Dr. Natalie Roberts of MSF said forces have bombed hospitals, roads, and towns even when Houthi fighters are not present.

Journalist Dahr Jamail reported studied [PDF] the impact of the Iraq war and military occupation on hospitals. It clearly documented the ways in which U.S. forces attacked medical facilities in violation of the Geneva Conventions.

“In November [2004, shortly after razing Nazzal Emergency Hospital to the ground,5 US forces entered Fallujah General Hospital, the city’s only healthcare facility for trauma victims, detaining employees and patients alike,” Jamail wrote. “According to medics on the scene, water and electricity were ‘cut off,’ ambulances confiscated, and surgeons, without exception, kept out of the besieged city.”

It was common for U.S. military forces to intrude upon facilities to interrogate and detain alleged fighters. Deliveries of medical supplies were sometimes obstructed by Marines. One doctor described how forces “shot out the lights in the front of our hospitals. They prevented doctors from reaching the emergency unit at the hospital, and we quickly began to run out of supplies and much needed medications.”

Such attacks had the impact of forcing the closure of some facilities. And, similarly, that is what has happened with the MSF hospital in Kunduz.

As journalist Glenn Greenwald highlighted, Afghan security forces raided this exact hospital in July. That is because Afghan security forces (and possibly U.S. forces) have been upset with MSF for treating all wounded, including Taliban fighters.

The United States has a track record of attacking medical facilities during war and justifying attacks by maintaining it is all part of fighting terrorists or enemy groups. The U.S. will even tolerate instances when allies like Israel or Saudi Arabia bomb hospitals because they are allies. Plus, there view of fighters using sites as “human shields” is no different from the view they have previously embraced in war zones in Afghanistan or Iraq.

Finally, the attack on the hospital is a reminder the war in Afghanistan is not winding down. In many ways, it is experiencing an escalation. Dr. Hakim, who has helped wounded Afghans, told “Democracy Now!” the war is “deteriorating.”

“Both the International Red Cross and the United Nations have reported an increase in civilian deaths over the past few years. So it is getting worse. It is definitely not scaling down. And I think Americans need to know that their taxpayer money is going to a war that is worsening,” Hakim added.

And now a large part of Afghanistan will be without a hospital because it was bombed by U.S. military forces.