When I first heard that a recent U.S. airstrike hit an MSF hospital, I was appalled. MSF does critical work to help those in need, regardless of who they are, in especially dangerous situations. They often provide care when nobody else will, and their neutrality is critical to their ability to do that. This work treats people based on their humanity alone. Hearing that their work suffered such a tragedy is awful news.

But I’m also not surprised. The way that the U.S. has been conducting warfare, it was bound to happen. Things like this have already happened. Jails have been bombed. Funerals, too. In the first year of coalition fighting against ISIS, they have reportedly killed more than 500 civilians in Syria and Iraq [pdf].

This is what comes from bombing everything that moves. The New York Times reported that “the joke was that when the C.I.A. sees “three guys doing jumping jacks,” the agency thinks it is a terrorist training camp, said one senior official.” And this line of thinking leads to things like classifying the dead – after killing them already – in a manner that “in effect counts all military-age males in a strike zone as combatants, according to several administration officials, unless there is explicit intelligence posthumously proving them innocent.”

This may seem like a tangent, but the inequality of lives on the ground versus American lives is one that leads to a lack of oversight or a trigger-happy order that leaves a long trail of fatalities.

Dider Fassin writes about the “inequality of lives” in the context of MSF in a very different, but enlightening, way. In an essay titled “Inequalities of Lives, Hierarchies of Humanity” in the edited collection In the Name of Humanity, Fassin highlights flaws in humanitarianism’s attempt to treat all lives as equal in light of the fact that some are more privileged than others.

Fassin’s chapter highlights the perceived differences between those who assist and those who are assisted; those who are sacred and those who are sacrificed. He also cites the death of MSF workers in Iraq – and the organization’s subsequent handling of that incident – as emblematic of this hierarchy. It’s an analysis that may very well prove relevant as more information comes out about the recent US bombing and as the media and state narratives about it continue to take shape. But for now, I think the framing of hierarchies and inequalities also applies to the bombing itself.

MSF released a statement charging that the US knew the hospital was there before and during the sustained bombing campaign:

As it does in all conflict contexts, MSF communicated the precise locations of its facilities to all parties on multiple occasions over the past months, including most recently on September 29.

The bombing in Kunduz continued for more than 30 minutes after American and Afghan military officials in Kabul and Washington were first informed by MSF that its hospital was struck.

The decision to knowingly bomb an area close to a hospital (or, even worse, bomb a hospital directly and intentionally) is a decision made on a calculation. Whose bodies are worth protecting, and whose are worth sacrificing? Time and again, civilian lives in the Middle East are not worth as much as others’. Even doctors treating patients cannot be exempt from the warfare going on around them. As Fassin writes: “under the moral economy of Western armies, the sacrifice of civilians is the undesired but necessary burden of, at best, establishing human rights or exporting democracy or at worst, of protecting private and national interests.”