MADRID — U.S. Defense Secretary Ash Carter is promising a full and transparent investigation into whether a U.S. aircraft providing air support for American and Afghan special operations forces in Afghanistan was responsible for the explosions that destroyed a hospital and killed 22 people.

Carter tells reporters traveling with him in Spain that the situation is “confused and complicated” right now.

U.S. officials say American special operations forces advising Afghan commandos in the vicinity of the hospital requested the air support when they came under fire in the northern city of Kunduz. The officials say the C-130 gunship responded and fired on the area, but it’s not certain yet whether that was what destroyed the hospital.

The officials were not authorized to discuss the incident publicly and spoke on condition of anonymity

Meanwhile, the International medical charity Doctors Without Borders said it had withdrawn from the northern Afghan city of Kunduz after the deadly airstrike.

The humanitarian crisis in the city, which briefly fell to the Taliban last week before the government launched a counteroffensive, has been growing increasingly dire, with shops shuttered because of ongoing fighting and roads made impassable by mines planted by insurgents.

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“All critical patients have been referred to other health facilities and no MSF staff are working in our hospital,” said Kate Stegeman, the communications manager for Doctors Without Borders, using the French acronym for the organization.

“Some of our medical staff have gone to work in two hospitals where some of the wounded have been taken,” she added.

The group blames a U.S. airstrike for the death and destruction. Afghan officials said helicopter gunships returned fire from Taliban fighters who were hiding in the facility.

Stegeman said there were no insurgents in the facility at the time of the bombing. AP video footage of the burned out compound in the east of Kunduz city shows automatic weapons, including rifles and at least one machine gun, on windowsills.

The Taliban seized Kunduz last Monday but have since withdrawn from much of the city after a government counterattack. Sporadic battles continue as troops attempt to clear remaining pockets of militants.

Habibullah, whose home is in central Kunduz, said the Afghan flag was flying over the central square – contrary to reports that it had been retaken by the insurgents. Gun battles were being fought in three districts on the outskirts of town, he said, notably Bandar-I-Khanabad, Bandar-I-Kabul and Sei Darakh.

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Acting provincial Gov. Hamidullah Daneshi said most of the insurgents had fled the city and that those still standing their ground appeared to be what he called “foreigners,” non-Afghans who have been boosting Taliban forces in the north of the country for some months. Officials have said that many of them are from Central Asian states, members of the Islamic Movement of Uzbekistan.

Daneshi said that 480 Taliban fighters had been killed as of Friday, and around 300 wounded. He put casualties among Afghan security forces at 30 to 35 killed or wounded.

The Taliban’s brief seizure of Kunduz marked the insurgent group’s biggest foray into a major urban area since the 2001 U.S.-led invasion ended their rule.

Afghan forces have been struggling to combat the Taliban since the U.S. and NATO shifted to a support and training role at the end of last year, officially ending their combat mission in the war-torn country.

Militants blocked and mined roads as soon as they entered Kunduz to prevent people from leaving and to thwart a government’s assault.

The deputy head of the Afghan National Disaster Management Authority, Aslam Sayas, said he was aware of the growing needs of people trapped inside the city. “We are waiting for the security situation to improve to give us an opportunity to reach those needy people,” he said.

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Saad Mukhar, the Kunduz provincial public health director, estimates that more than 70 people have been killed and more than 500 wounded in the city since the fighting began.

“I’m afraid that if this situation continues, we will not be able to help our patients because right now we are facing a serious, drastic shortage of medicine,” he said.

Rahmatullah Hamnawa, a reporter with Salam Watandar radio, said cooking gas prices had more than doubled.

Grocers and pharmacists who spoke with The Associated Press by telephone from inside the city said they make furtive deliveries after assessing the security situation.

Shir Aghan, who runs a general store, said shops were full of food items, but many shop keepers had fled to neighboring provinces before the Taliban sealed the city. “People call me and if it’s safe I’ll go out and sell them what they need,” he said.

Local television showed live footage of police officers handing bread to children, one of whom said he had not eaten for three days.

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