Channel 4 News spoke to three of the biggest hospitals in southern Afghanistan, which have all seen major increases in the number of civilian casualties they have treated this year.
They agreed that the increased intensity of the war is a factor.
In January, President Barack Obama sent 34,000 more troops to Afghanistan, many of which have been deployed in major strikes such as Operation Moshtarak in Helmand in February. In response, insurgent forces increased the intensity of their own operations.
Troops have suffered this year – 103 soldiers died in June 2010, the most lethal for the International Security Assistance Force (ISAF) since the war began. So far, 648 coalition soldiers have died this year, up to October, in Afghanistan.
But civilians are also being hit harder. Afghanistan Rights Monitor said this summer that more than 1,000 civilians had been killed just in the first six months of the year.
Rise in casualties in Afghanistan.
Markus Geisser, head of the sub-delegation for the International Committee of the Red Cross (ICRC) in southern Afghanistan, told Channel 4 News: "[The increase in civilian deaths] is certainly linked...we have seen an increase of fighting from all parties to the conflict. This environment here in southern Afghanistan has become - as the military would call it - 'very kinetic'."
He said poor people affected by the fighting had no other option than go to the charity-run hospitals, while richer people could go to private clinics.
Medical coordinator for the Emergency Hospital in Lashkar Gah, Matteo Dell'Aira added: "We see more patients when there are operations – Moshtarak in February and Operation Dragon Strike now."
Civilian casualties and deaths continue to increase despite ISAF's commitment to avoiding them.
Figures from the United Nations suggested ISAF is causing less "collateral damage", in army-speak, but insurgents are continuing to target civilians, leading to the increased casualty figures.
Rise in casualties
The UN's report on civilian casualties in Afghanistan, released this summer, showed civilian deaths and injuries in the country had increased by 31 per cent year on year, to 3,268.
The UN attributed 76 per cent of these incidents to insurgents – up from 53 per cent in 2009.
Deaths and injuries attributed to NATO and Afghan forces fell to 12 per cent.
The UN Special Representative in Afghanistan, Staffan de Mistura, said: "Afghan women and children are increasingly bearing the brunt of this conflict. They are being killed and injured in their communities in greater numbers than ever before."
Michiel Hoffman, Medecins Sans Frontieres Afghanistan representative, told Channel 4 News: "The warring parties have an obligation to minimise civilian casualties but at the end of the day it is a war and if you are near a convoy or motorcycle that gets blown up, you will get blown up. War is not pretty."
An ISAF spokesman told Channel 4 News: "We are firmly committed to avoiding and reducing civilian casualties to the absolute minimum. Since his arrival in July, Gen. David Petraeus has issued guidance and directives aimed at protecting civilians and operating in a manner that is respectful of Afghan culture. Earning and keeping the Afghans' faith and trust is paramount our mission.
"Preventing Afghan casualties remains our goal."
However – the fact remains that the overall number of civilians killed continues to rise.
Figures from the Joint IED Defeat Organisation show that the rise correlates with an increase in the numbers of improvised explosive device (IED) attacks in Afghanistan, from 816 incidents in January this year to 1,337 in October. Year on year, the number of incidents has risen by 38 per cent, the organisation said.
IEDs to blame?
ISAF medical advisor Colonel Christopher Castle told Channel 4 News he was aware of an increase in civilian casualties and blamed the rise on IED use.
IED victim in hospital.
"We plan our operations very carefully to minimise casualties," he said. "The insurgents use every attempt they can to indiscriminately use IEDs – it is part of their strategy to want to portray civilian deaths as the coalition's fault."
The UN said all parties had to make the effort to minimise casualties, and said two "critical developments" had led to the increased risk of civilian harm in 2010: firstly, a rise in the number of civilians executed by anti-government elements (AGEs), and secondly, an increase in the use of larger and more sophisticated IEDs.
It described "of great concern" IEDs placed in market areas, in some cases attached to bicycles, or close to parks frequented by women and children.
"As civilian casualties rose in the first half of 2010, women and children made up a greater proportion of those killed and injured than in 2009," UN spokesman Dan McNorton told Channel 4 News.
He highlighted incidents such as an explosive device attack in January in Rodat district, Nangahar province, which killed four children and injured 68 people, including 56 school children.
He said the wider impact of warfare also had serious consequences.
"Access to basic services, such as health and education, were adversely affected," he said. "Doctors and medical practitioners, including vaccinators, were killed and abducted by AGEs. These attacks affected not only the quality of services available to Afghans in need, but also affected access to medical care."
The UN's Human Rights Director in Afghanistan, Georgette Gagnon, said: "The devastating human impact of these events underscores that, nine years into the conflict, measures to protect Afghan civilians effectively and to minimize the impact of the conflict on basic human rights are more urgent than ever. All those concerned must do more to protect civilians and comply with their legal obligations not to attack civilians."
The ICRC's Markus Geisser said: "We cannot comment on who has caused these injuries as the ICRC.
"But what we clearly see when there are more warriors in a particular part of the world, the likelihood for combat is quite obvious and we have seen a similar phenomenon during Operation Moshtarak in February where we have also seen a hike in war-related injuries.
"So it is up to you whether you want to make a link."
Matteo Dell'Aira - at Lashkar Gah's Emergency Hospital - added: "To me it is a strange question – whether the injuries are ISAF-caused or Taliban – because the result is the same. These are all civilians, so what we have in this hospital is proof that the war is totally useless."