Afghanistan has accused Pakistan of killing at least 400 people in an overnight airstrike on a drug rehabilitation hospital in Kabul on Monday. With a reported death toll of 400, the strike stands as the deadliest attack in the country’s history. It surpasses the 2021 Kabul airport suicide bombing during the United States withdrawal, in which at least 169 Afghan civilians and 13 US service members were killed.

The incident marks a sharp rise in hostilities between the two neighbours. The confrontation, which began late last month, has seen repeated cross-border firing and airstrikes, while appeals from the international community for a ceasefire have not yielded results.

Pakistan rejected the allegation that a hospital was targeted. Authorities in Islamabad said the strikes, including those in eastern Afghanistan, were aimed at specific locations and did not hit civilian infrastructure.

Afghanistan details strike and casualties

Afghanistan's deputy government spokesperson Hamdullah Fitrat, in a post on X, said the airstrike had hit the hospital in Kabul at about 9 p.m. local time, destroying large sections of the 2,000-bed facility. He said the death toll had “so far” reached 400 people, while about 250 people had been reported injured.

Local television stations posted footage on X showing security forces using flashlights as they carried out casualties while firefighters struggled to extinguish flames among the ruins of a building. Fitrat said rescue teams were working to control the fire and recover the bodies.

The strike came hours after Afghan officials said the two sides exchanged fire along their common border, killing four people in Afghanistan, as the deadliest fighting between the neighbors in years entered a third week.

Afghan government spokesperson Zabihullah Mujahid condemned the strike on X, accusing Pakistan of “targeting hospitals and civilian sites to perpetrate horrors.” In a post before the death toll rose into the hundreds, he said those killed and injured were patients at the hospital.

“We strongly condemn this crime and consider such an act to be against all accepted principles and a crime against humanity,” he posted.

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Pakistan rejects claims, calls strikes precise

Pakistani Prime Minister Shehbaz Sharif’s spokesperson, Mosharraf Zaidi, dismissed the allegations as baseless, saying no hospital was targeted in Kabul.

Pakistan's Information Minister Attaullah Tarar posted on X in the early hours Tuesday that the Pakistani military had “carried out precision airstrikes” targeting military installations in Kabul and the eastern province of Nangarhar. He said “technical support infrastructure and ammunition storage facilities” at two locations in Kabul were destroyed.

“All targeting has been done with precision only at those infrastructures which are being used by Afghan Taliban regime to support its multiple terror proxies,” he wrote.

Pakistan’s Ministry of Information said earlier that Mujahid’s claim was “false and misleading” and aimed at stirring sentiment and cover what it described as ”illegitimate support for cross-border terrorism.” It said Pakistan’s targeting was “precise and carefully undertaken to ensure no collateral damage is inflicted.”

Rising tensions and international concern

The strike came hours after the U.N. Security Council called on Afghanistan’s Taliban rulers to immediately step up efforts to combat terrorism. Pakistan accuses Kabul of harboring militant groups, particularly the Pakistani Taliban, which it says carry out attacks inside Pakistan.

The Security Council resolution, adopted unanimously, didn’t refer specifically to attacks carried out in Pakistan but condemns “in the strongest terms all terrorist activity including terrorist attacks.” The resolution also extends the U.N. political mission in Afghanistan, UNAMA, for three months.

Pakistan’s government accuses Afghanistan of providing safe haven to the Pakistani Taliban, which is designated as a terrorist organization by the United States, as well as to outlawed Baloch separatist groups and other militants who frequently target Pakistani security forces and civilians across the country. Kabul denies the charge.

The fighting — the most severe between the two neighbors — began in late February after Afghanistan launched cross-border attacks in response to Pakistani airstrikes inside Afghanistan that Kabul said killed civilians. The clashes disrupted a ceasefire brokered by Qatar in October after earlier fighting killed dozens of soldiers, civilians and suspected militants.

Pakistan has declared it is in “open war” with Afghanistan. The conflict has alarmed the international community, particularly as the area is one where other militant organizations, including al-Qaida and the Islamic State group, still have a presence and have been trying to resurface.

Conflicting claims over casualties

On Sunday, Tarar said the military has killed 684 Afghan Taliban forces, a claim rejected by Afghanistan, which says casualties are far lower. Afghanistan’s Defense Ministry and other officials have said Afghanistan has killed more than 100 Pakistani soldiers.

Pakistani President Asif Ali Zardari said Afghanistan’s Taliban administration crossed a “red line” by deploying drones that injured several civilians in Pakistan last week.

Responding to those attacks, Pakistan’s air force over the weekend struck equipment storage sites and “technical support infrastructure” in Afghanistan’s southern Kandahar Province, saying it was being used for attacks inside Pakistan. Kabul said Pakistan hit two locations, including an empty security site and a drug rehabilitation center that sustained minor damage.

In Kabul, Afghanistan’s administrative Deputy Prime Minister Abdul Salam Hanafi said defending sovereignty is the duty of all citizens. Speaking during a meeting with political analysts and media figures, Hanafi expressed regret over civilian casualties in recent Pakistani attacks, saying the war was imposed on Afghanistan.

(with inputs from AP)