A U.S. airstrike in the Afghan city of Kunduz hit a hospital run by Doctors Without Borders (MSF) on Saturday, killing at least 19 people at the medical center, the medical charity said.
In a statement, MSF said the "sustained bombing" took place at 2:10 a.m. local time and continued for 30 minutes after staff raised the alarm to U.S. and Afghan military officials. Three children are believed to be among the dead.
U.S. Defense Secretary Ash Carter said the United States still was trying to determine how the airstrike hit the hospital. "A full investigation into the tragic incident is under way in coordination with the Afghan government," Carter said in a statement.
He said the area around the hospital had been the scene of intense fighting in recent days with U.S. forces supporting Afghan Security Forces against Taliban fighters. The incident could renew concerns over the use of its air power in the conflict.
The head of U.S.-led forces in the country later phoned Afghan President Ashraf Ghani to apologize, according to a statement from Ghani's office.
UN rights chief Zeid Ra'ad Al Hussein said that the incident was "inexcusable" and possibly criminal. Zeid called for a full and transparent investigation, noting that, "if established as deliberate in a court of law, an air strike on a hospital may amount to a war crime."
Afghan forces backed by U.S. airstrikes have been fighting to dislodge Taliban insurgents who overran Kunduz earlier this week. Tribus said Saturday’s deadly raid was the 12th U.S. airstrike "in the Kunduz vicinity" since Tuesday.
Doctors Without Borders said its trauma center "was hit several times” during the attack and that the hospital was “very badly damaged."
One of the hospital’s walls collapsed as a result of the raid, scattering fragments of glass and wooden door frames, and three rooms were ablaze, said Saad Mukhtar, director of public health in Kunduz.
"Thick black smoke could be seen rising from some of the rooms," Mukhtar said after a visit to the hospital. "The fighting is still going on, so we had to leave."
MSF said all of its international staffers were alive and accounted for.
But many patients and staff remain missing after the attack which happened when almost 200 patients and employees were in the hospital, the only one in the region that can deal with major injuries.
"We are deeply shocked by the attack, the killing of our staff and patients and the heavy toll it has inflicted on healthcare in Kunduz," the aid group's operations director, Bart Janssens, said in a statement.
MSF said it gave the location of the hospital to both Afghan and U.S. sides several times in the past few months, as well as this week, to avoid being caught in crossfire.
Taliban spokesman Zabihullah Mujahid said there were no militant fighters being treated at the hospital.
MSF said it had treated almost 400 patients in the 150-bed hospital since fighting broke out, most for gunshot wounds. So many patients have flooded in that the hospital had to put them in offices and on mattresses on the floor. The U.S. embassy in Kabul said in a statement it "mourns for the individuals and families affected by the tragic incident."
The hospital was on the frontline in the fighting. On Friday, Taliban fighters hiding behind the walls of the hospital were firing at government forces, said Khodaidad, a Kunduz resident who lives near the hospital.
"I could hear sounds of heavy gunfire, explosions and airplanes throughout the night," said Khodaidad, who has only one name. "There were several huge explosions and it sounded like the roof was falling on me."
Afghan Interior Ministry spokesman Sediq Sediqqi said 10 to 15 "terrorists" had been hiding in the hospital at the time of the strike. "All of the terrorists were killed but we also lost doctors," he said in a press conference.
EU Commissioner for Crisis Management Christos Stylianides said he was shocked by the news of the bombing.
"I call on all parties to the conflict to respect international humanitarian law and ensure that health care facilities and humanitarian workers are protected," he said in a statement.
France has called for an investigation.
The International Committee of the Red Cross said it was "deeply shocked" by the incident.
"This is an appalling tragedy," said Jean-Nicolas Marti, head of the ICRC in Afghanistan. "Such attacks undermine the capacity of humanitarian organizations to assist the Afghan people at a time when they most urgently need it."
The clinic in Kunduz is a sprawling facility with numerous buildings situated in the east of the city, in a residential area close to the local office of the NDS intelligence service.
Electricity and water have been cut off since the Taliban's Monday assault and seizure of the city, officials and residents said. Food and medical supplies cannot get through because the Afghan military is still working to clear mines planted by the Taliban. Sporadic gunfights are continuing in various pockets of the city as troops advance.
Most of the Taliban appear to have fled the city after the troops moved in on Thursday, taking looted vehicles, weapons and ammunition with them.
Officials have reported that they have moved east, into Takhar and Badakhshan provinces, where a number of districts fell to the Taliban on Friday. The Defense Ministry said troops had retaken the Baharak district after retreating under fire Friday.
The U.S. Embassy in Kabul issued an emergency notice to Americans in Badakhshan, saying they should "consider departing the area immediately."
Al Jazeera and wire services