IRAQ - The Refugee & Health Problems.

Human rights groups on April 17 warned that escape routes for Iraq's refugees were closing inside the country and at its borders. The warning came at an international conference held on April 17-18 in Geneva to mobilise support for Iraqis forced from their homes - most of them since the 2003 invasion. The UN refugee agency, which organised the conference, said a continuing flood of displaced people - at 40,000-50,000 a month - was putting an intolerable strain on host communities both in Iraq and in neighbouring countries.

UN High Commissioner for Refugees Antonio Guterres urged the world to share the burden of helping 1.9m people internally displaced and 2m who fled to neighbouring countries, primarily Syria (host to 1.2m) and Jordan (750,000). He said: "In the most significant displacement in the Middle East since the dramatic events of 1948 [creation of Israel], one in eight Iraqis have been driven from their homes. Host communities are straining under this extraordinary burden, while the suffering of the displaced grows by the day". As well as financial, economic and technical support, he said, there should be expanded resettlement for the most vulnerable.

The meeting brought together ministers and officials from 60 countries as well as the UN and other international agencies. In a move welcomed by UNHCR officials, Iraqi Foreign Minister Hoshyar Zebari pledged $25m to assist neighbouring countries hosting Iraqi refugees, including provision of basic services. However, from other quarters there were warnings of rising barriers to new refugees seeking safety from sectarian violence and terrorism. Bill Frelick of the US-based Human Rights Watch (HRW) said: "Jordan and Egypt have pretty much closed their doors to Iraqi refugees, while Syria is shutting out Palestinians trying to flee Iraq".

The FT on April 18 quoted Andrew Harper, head of UNHCR's Iraq Support Unit, as saying Jordan and Syria had shown great generosity in taking refugees but that Jordan was "close to the limit of what it could absorb", especially given the scarcity of water resources. He said without international help, school and medical facilities could not cope with the sudden influx of Iraqi refugees, noting similar problems for host communities inside Iraq.

The International Organisation for Migration said half of Iraq's 15 central and southern governates were reported to be turning newly displaced people away unless they could prove they originated there. The US has offered to resettle 7,000 refugees from Iraq this year and on April 16 human rights groups urged the UK to follow suit. But Harper said UNHCR was no nearer finding a solution for about 15,000 Palestinian refugees in Iraq, once protected by Saddam's Sunni/Ba'thist dictatorship and now ostracised and persecuted.

A compendium of new statistics released on April 17 by the World Health Organisation (WHO) quantifies how desperate the situation has become for ordinary Iraqis. The WHO says there are the risks of car bombs and snipers, which kill an average of 100 people a day. But beyond that, there are more fundamental problems created by years of conflict: 80% of Iraqis lack access to sanitation, 70% lack regular access to clean water and 60% lack access to the public food distribution system. Diarrhea and respiratory infections account for two-thirds of the deaths of children under 5. According to a 2006 national survey conducted by UNICEF, 21% of Iraqi children are chronically malnourished, which puts them at risk for both stunted growth and mental development. The statistics were presented by the WHO.

Les Roberts, a principal researcher in a series of public health surveys on mortality among Iraqis, whose results have been published in the UK journal Lancet, on April 17 said: "There has been so much violence for so long that the result is inevitably this kind of complete social decay". He said some of the new data vastly under-estimated the humanitarian tragedy, adding: "The WHO has done a great job in walking a tightrope". Roberts, formerly at Johns Hopkins School of Public Health and now heading the Programme on Forced Migration and Health at Columbia University, said: "They are telling the world that the Iraqi health situation is really bad and likely to get worse, but doing it within the political constraints of respecting government numbers not offending the host country in which they operate".

Roberts said the report of 100 excess deaths a day was in his mind "a gross under-estimate", placing the probable tally at several times higher. According to the UN, the Baghdad morgue alone has been receiving about 50 bodies a day for more than a year. Roberts said the morgue received only a fraction of dead in the city and that surveys by his group and others had suggested that Baghdad was less violent than other parts of the country.

Khaled Shabib of the UN group said most of the public health figures were "better a few years ago" because "loss of electricity and displacement of people have led to a deterioration of our public services and lack of access". He said: "if the environmental situation continued to deteriorate, there will be increased diarrheal diseases, such as cholera. Also, if there continues to be so many displaced people who are crowded together, maybe living with relatives, there will be a great rise in respiratory diseases, maybe even tuberculosis". The UN has not detected such outbreaks and the childhood malnutrition rate of 21% is better than average for the region.

Hundreds of doctors and nurses are fleeing the chaos of Iraq, although there are no official numbers. As a result, clinics and hospitals are under-staffed and under-supplied. With a huge number of wounded people arriving at emergency wards, the health system is not able to cope with the burden. The government says almost 70% of critically wounded patients die in the hospital due to lack of staff, drugs and equipment. To make matters worse, wounded, ill and pregnant people in central Iraq and in Baghdad are afraid to risk the trip to the hospital for medical help for security reasons.

The problem was compounded by the Shi'ite-Sunni war, creating fear that patients would not be treated at certain clinics because of their sect. Roberts said: "This is reminiscent of what happened to the people of Sarajevo after a year's siege. But for some reason, the world does not focus on the humanitarian consequences in Iraq. They're thinking about the military violence".