Afghan troops, not Americans, requested the U.S. airstrike that destroyed part of a Doctors Without Borders clinic. And it seems possible the Afghans knew full well the compound they were asking be targeted was a hospital.

The hour-long chain of aerial attacks in the early morning of October 3 on the embattled city of Kunduz involved a four-engine AC-130 gunship, which fires guns from the left side of its fuselage while banking in a steady turn over its target. Operated by 13-person crews and packing sophisticated sensors and communications, AC-130s typically support U.S. Special Operations Forces, including those advising Afghan soldiers fighting to retake Kunduz from a resurgent Taliban.

Ten patients and 12 staff died in the clinic attack and 37 people were injured, according to Doctors Without Borders, a Paris-based humanitarian organization also known by its French acronym, MSF. Declaring the incident a “war crime,” Doctors Without Borders shut down its operations in Kunduz on October 4.

In the hours after the airstrike, the U.S. military headquarters in Afghanistan claimed it had targeted “insurgents who were directly firing upon U.S. service members advising and assisting Afghan security forces in the city of Kunduz.”

But on October 5, U.S. Army Gen. John Campbell, the top officer in the American-led military coalition in Afghanistan, admitted the initial explanation was untrue. Campbell said Afghan forces requested the strike. The Afghans “advised that they were taking fire from enemy positions and asked for air support from U.S. forces,” Campbell told reporters.

“A hospital was mistakenly struck,” Campbell added during testimony before the U.S. Senate Armed Services Committee on October 6. “We would never intentionally target a protected medical facility.”

Earlier, Hamdullah Danishi, the acting governor of Kunduz, had told The Washington Post that Taliban fighters had taken up positions in the clinic grounds.

“The hospital campus was 100 percent used by the Taliban,” Danishi said. “The hospital has a vast garden, and the Taliban were there. We tolerated their firing for some time” before ordering the airstrike.

Doctors Without Borders insisted there were no Taliban at the clinic on the morning of October 3.

In any event, Danishi’s phrasing seems to imply that Afghan troops were familiar with the clinic before they requested the aerial attack. Indeed, as recently as July, Afghan soldiers had forced their way into the facility in an attempt to arrest three men they apparently suspected of being insurgents.

“Heavily armed men from Afghan Special Forces entered the MSF hospital compound, cordoned off the facility and began shooting in the air,” Doctors Without Borders said of the July 1 incident. “The armed men physically assaulted three MSF staff members and entered the hospital with weapons. They then proceeded to arrest three patients.”

Doctors Without Borders said its staff tried to continue treating the three patients and, in the process, two soldiers pointed their weapons at the staff. “After approximately one hour, the armed men released the three patients and left the hospital compound.”

Despite their apparent familiarity with Doctors Without Borders’ activities in Kunduz, the Afghans who ordered up the October 3 airstrike seem not to have alerted the Americans that the compound they were about to target was a medical clinic. Doctors Without Borders said it relayed the GPS coordinates of the Kunduz facility to the U.S.-led coalition as recently as September 29, but it is not clear that the information disseminated all the way to the advisers and aircrew on the front lines.

The complex chain of command overseeing coalition missions in Afghanistan may have contributed to the confusion—and, by extension, to the deaths of 22 people.

Typically, when coalition troops come under fire and want air support, they must filter their request through a highly trained air controller who helps confirm the target and coordinates with incoming aircraft. These controllers may be on the ground, with or near the troops under fire. Or they might be far away from the front line, performing their coordination duties via radio.

In Kunduz on October 3, “the actual call for fire almost certainly came from a radio call from the U.S. forces on the ground to the gunship,” one former AC-130 crew member told The Daily Beast on the condition of anonymity.

The Pentagon has implied that U.S. Army Special Forces advisory teams were near Kunduz at the time of the AC-130 strike, but the military hasn’t said how near. Proximity matters, as it determines whether any Americans were able to see the clinic buildings before approving them as targets.

“The difficulties come when you have more than two geographically separated friendly forces because it becomes harder to keep track of them all,” the former AC-130 crew member said. “The question is, did the crew know it was a hospital? Hospitals over there don’t look like hospitals in the States. You would need to have it marked on a map. And if they didn’t and the Afghans did and wanted them to hit it, what does that mean? I don’t think it makes the crew completely innocent but it does change the thought process.”

The Pentagon is investigating the Kunduz killings. And top coalition commander Campbell said he is ordering “in-depth training” and a review of military rules of engagement in order to “prevent any future incidents of this nature.”

That’s not enough, said New York-based Human Rights Watch. “There’s no question deadly mistakes were made in the bombing of the MSF hospital,” Brad Adams, the advocacy group’s Asia director, said in a statement. “Now it’s the responsibility of the U.S. government to take prompt and transparent action to fully compensate the victims of the attack, ensure full accountability for what occurred and adopt measures to ensure this doesn’t happen again.”