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Washington • Human error, violations of combat rules and untimely equipment failures led to the mistaken U.S. aerial attack on a charity-run hospital in Afghanistan last fall that killed 42 people, a senior American general said Friday. Investigators called the attack a "disproportional response to a threat that didn't exist."

Sixteen military members were given administrative punishments that could stall or end careers, but no one faces a court martial. A senior defense official said one of the disciplined was a two-star general.

The AC-130 gunship, bristling with side-firing cannons and guns, fired on the hospital in the northern city of Kunduz for 30 minutes before the mistake was realized and the attack was halted, Gen. Joseph Votel told a news conference as he released the Pentagon's final report on the incident. The intended target was an Afghan intelligence agency building about 450 yards away.

No one involved knew the targeted compound was a hospital, Votel said, but investigators concluded the U.S. ground and air commanders should have known.

Votel expressed "deepest condolences" to those injured and to the families of those killed and said the U.S. government made "gesture of sympathy" payments of $3,000 to each injured person and $6,000 to each family of the killed.

Zabihullah Neyazi, a nurse who lost his left arm, eye and a finger in the Oct. 3, 2015, attack, said administrative punishment for the American service members wasn't enough and said a "trial should be in Afghanistan, in our presence, in the presence of the victims' families, so they would be satisfied."

Pharmacist Khalid Ahmad, 24, said those responsible "are criminals, and they must be jailed." Ahmad still has shrapnel embedded in his waist and cannot move his right leg.

Doctors Without Borders, the international charity organization whose hospital was destroyed, said Friday that it still wants an "independent and impartial" investigation. It said the punishments were inadequate and "out of proportion" to the deaths, injuries and destruction caused by the mistaken attack.

"The lack of meaningful accountability sends a worrying signal to warring parties, and is unlikely to act as a deterrent against future violations of the rules of war," the organization said.

The Americans who called in and authorized the attack never laid eyes on either the intended target or the hospital, Votel said. He is commander of U.S. Central Command, which is responsible for military operations in the greater Middle East and Afghanistan. At the time of the Kunduz attack he headed U.S. Special Operations Command.

"This was an extreme situation" complicated by combat fatigue among U.S. special operations forces, Votel said. He said the ground force commander who authorized the AC-130 strike justified it on grounds of self-defense, but investigators determined that the attack was "a disproportional response to a threat that did not exist."

Investigators concluded that certain personnel failed to comply with the rules of engagement and the law of armed conflict, but Votel said those failures did not amount to a war crime.

"The label 'war crimes' is typically reserved for intentional acts — intentional targeting (of) civilians or intentionally targeting protected objects or locations," Votel said. "Again, the investigation found that the incident resulted from a combination of unintentional human errors, process errors and equipment failures, and that none of the personnel knew they were striking a hospital."

Meinie Nicolai, president of Doctors Without Borders, also known by its French initials MSF, took issue with Votel's assertion.

"The threshold that must be crossed for this deadly incident to amount to a grave breach of international humanitarian law is not whether it was intentional or not," Nicolai said, noting that with various countries fighting in the region with different rules, "armed groups cannot escape their responsibilities on the battlefield simply by ruling out the intent to attack a protected structure such as a hospital."

Votel said none of the names of the 16 will be released to protect the privacy of the individuals and, in some cases, because they are still assigned to sensitive or overseas positions.

The hospital was on a U.S. military no-strike list but the AC-130 crew didn't have access to the list because it launched its mission on short notice and did not have the data loaded into its onboard systems. The investigation report, which was released Friday with many segments redacted for security or other reasons, said the person who emailed the data to the airplane while in flight did not follow up to confirm that it was received. It was not received.

Votel said the military has sought to avoid similar mistakes in the future by requiring that such data be pre-loaded into aircraft.

Defense Secretary Ash Carter has ordered commanders to take a series of steps over the next four months to "mitigate the potential for similar incidents in the future." Among other things, Carter ordered that the Kunduz scenario be incorporated into pre-deployment training as an example of the kind of complicated situations that troops may face in Afghanistan or other war zones.

Carter's memo suggested that the Kunduz failure reflected communications problems on a wide scale across the military. He ordered the military to review its policies and rules of engagement to "clarify conflicting or confusing directives." He also cited "problematic guidance" from top commands and problems with "hierarchies of competing policies and authorities."

Votel said he was satisfied that those involved were trying to do the right thing.

"The investigation determined that all members of both the ground force and the AC-130 air crew were unaware that the aircraft was firing on a medical facility throughout the engagement," Votel said.

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Associated Press writers Deb Riechmann and Lolita C. Baldor in Washington and Rahim Faiez in Kabul contributed to this report.