As well as the casualty numbers, the air strike has destroyed a vital medical facility in one of the most war-torn parts of the world. There can be no excuse, the hospital was well known and was not a legitimate target.
Three separate probes have been set up by the US military, Nato and Afghan officials. US President Barack Obama has apologised to MSF and the Pentagon has announced compensation to those killed and injured.
But the loss may have ramifications down the line, going much further than even the senseless destruction of a much-needed medical facility.
If America wants to be seen as the good guy, it can't act with impunity. Apologies and compensation just don't cut it with vulnerable young people looking elsewhere for a future. Such actions are just ammunition for the jihadis.