Two days before a devastating U.S. strike on a hospital in Afghanistan, a top aide to the chairman of the Joint Chiefs of Staff asked Doctors Without Borders if Taliban militants were "holed up" there or at the charity's other facilities.
Carter Malkasian, a special advisor to Gen. Joseph Dunford, the highest ranking U.S. military officer, sent the query in an email that also inquired about the safety of the group's personnel, according to Capt. Greg Hicks, a spokesman for Dunford.
Doctors Without Borders replied that the hospital staffers were "working at full capacity" and that the facility was "full of patients, including wounded Taliban combatants," the medical aid group said in a report Thursday.
The exchange shows a focus on the hospital in the northern city of Kunduz at senior levels of the Pentagon before the deadly Oct. 3 airstrikes and raises fresh questions about whether the U.S. had an accurate picture of what was happening there.
The day before Malkasian sent the email, hospital staff became aware of the presence of two apparently high-ranking Taliban fighters. They were brought to the facility by several other fighters, who made regular inquiries about their medical condition to "accelerate their treatment for rapid discharge," the report said.
But the medical group's leaders maintain that was not a reason to bomb a fully functioning hospital with 105 patients and surgeries ongoing, the only one of its kind in northern Afghanistan.
"Wounded combatants are patients under international law, and must be free from attack and treated without discrimination," said Christopher Stokes, the group's general director. "Medical staff should never be punished or attacked for providing treatment to wounded combatants."
An internal review by Doctors Without Borders, known by its French initials, MSF, concluded that staff members were in full control of the hospital, that there were no armed combatants within the compound and no fighting in or near the trauma center before the airstrikes.
MSF's findings are preliminary, but the group said it was releasing them to counter speculation and to be transparent about what took place. They are based on interviews with MSF personnel, before and after pictures of the hospital, including satellite images, and emails and phone records.
U.S. military officials in Washington and Afghanistan said Thursday that they had received copies of MSF's findings and remained committed to establishing the facts of what transpired. The military, NATO and the Afghan government have launched investigations.
"We continue to work closely with MSF in identifying the victims, both those killed and wounded, so that we can conclude our investigations and proceed with follow-on actions to include condolence payments," said Capt. Jeff Davis, a Pentagon spokesman. "We are also committed to working with MSF to determine the full extent of the damage to the hospital, so that it can be repaired in full."
Malkasian's email exchange with MSF is being looked at as part of the U.S. military investigation into the airstrikes, Hicks said.
Asked about the Pentagon's inquiry at a news conference in the Afghan capital, Kabul, Stokes said it did not arouse concern at MSF at the time.
"This is one of our regular channels that we have. In a context of war or conflict you have contacts with both sides," he said. "It was the only contact during that week, so we answered that, and there was no follow-up afterwards."
The report said that MSF had been "very clear with both sides to the conflict about the need to respect medical structures as a condition to our ability to continue working."
It also reiterated assertions that U.S. forces had been given the precise coordinates of the hospital as recently as Sept. 29. As an additional precaution, staff members had placed two of the group's flags on the roof of the hospital.
When the attack began, MSF representatives in Washington and Kabul made frantic attempts to get the bombing stopped. At least 15 calls and text messages were exchanged with U.S., Afghan, United Nations and Red Cross officials, according to a log of the communications included in the report.
Nearly an hour into the attack, an American official in Afghanistan responded, "I'll do my best, praying for you all."
The attack destroyed the main hospital building, where medical personnel were taking advantage of the first quiet night since Taliban forces had seized control of Kunduz five days earlier to catch up on a backlog of surgeries.
Survivors described earth-shaking explosions that engulfed the building in flames.
"Patients burned in their beds, medical staff were decapitated and lost limbs, and others were shot by the circling AC-130 gunship while fleeing the burning building," MSF said.
Staffers used an office desk as a makeshift operating table to try to save the life of a patient in a wheelchair who was hit by shrapnel as he tried to escape from the inpatient department. The man died on the table, the report said.
In all, 30 people were killed, including 13 staff members, 10 patients and seven others whose bodies were burned beyond recognition and have not yet been identified.
Gen. John F. Campbell, the top U.S. commander in Afghanistan, has said the attack was a mistake. President Obama apologized to MSF and the Afghan government.
In Washington, White House Press Secretary Josh Earnest said Thursday that the president had called for a "transparent, thorough and objective accounting of the facts and the circumstances that led to this tragic incident."
Campbell has appointed several senior officers outside his command to conduct the investigation, which Earnest said "will consider a series of potential human errors, failures of process, and technical malfunctions that may have contributed to the mistaken strike."
Officials at Doctors Without Border also want the International Humanitarian Fact-Finding Commission, a body set up under the Geneva Conventions, to look into the attack. That would require the assent of the U.S. and Afghanistan, which they have not provided.
Cloud reported from Washington and Zavis from Los Angeles.