In 1991, there were in Iraq 1,800 health care centers. A decade and a half later, that number is almost half and almost a third of these require major rehabilitation. This is paralleled by the country’s fall in the United Nations Development Programme’s (UNDP) Human Development Index from 96 to 127, one of the most dramatic declines in human welfare in recent history.

According to Jean Ziegler, the U.N. Human Rights Commission’s special expert on the right to food, the rate of malnutrition among Iraqi children has almost doubled since Saddam Hussein’s ouster in April 2003. Today, at 7.7 percent, Iraq’s child acute malnutrition rate is roughly equal to that of Burundi, an African nation ravaged by more than a decade of war. It is far higher than the rates in Ugand and Haiti, countries also devastated by unrelenting violence.

The population health problems are dramatically different than those facing young Iraqis a generation ago, when obesity was one of the main nutrition-related public health concerns. High rates of malnutrition started in the 1990s as a result of the U.N.-imposed sanctions to punish the Saddam Hussein regime for invading Kuwait in 1990.

Lack of dependable electricity and shortages of potable water throughout the country have led to the deterioration of the population’s health, resulting in outbreaks of typhoid fever, particularly in southern Iraq. The collapse of the water and sewage systems is probably the cause of outbreaks of hepatitis particularly lethal to pregnant women. According to the Iraq Living Conditions Survey of 22,000 households, a joint effort of the Iraq government and UNDP (United Nations Development Programme,) some 47% of urban households and only 3% of rural households have a sewage connection.

Presently, thousands of children born after the war have none of their required vaccinations, and routine immunization services in major areas of the country are all but disrupted. In addition, the destruction of the refrigeration sytems needed to store vaccines have rendered vaccine supplies virtually useless.

Even antibiotics of minimal cost are in short supply, increasing the population’s risk of dying from common infections. Hospitals are overcrowded and many hospitals go dark at night for lack of lighting fixtures. The Iraqi Minister of Health claims that 100 percent of the hospitals in Iraq need rehabilitation. As a result of all these public health failures, Iraq is the country that has least progressed in reducing child mortality since the 1990s.

There are increasing number of orphans, many of whom have become homeless and have had to resort to prostitution to survive. Although the Iraqi Ministry of Labor has created programs to eliminate this problem, its efforts have not been successful.

War has affected the psychilogical well-being of adults and children alike, many of whom present serious symptoms of post-traumatic stress disorder. It is estimated that less than one hundred psychiatrists remain in Iraq (approximately one for every 300,000 Iraqis) and none of them specializes in child psychiatry.

That children continue to suffer the terrible consequences of the war indicates that new ways have to be found to protect them better. An independent international medical commission should investigate children’s health status, and suggest measures for its improvement. Iraqi children should urgently be provided with basic nutrition, immunization and psychological care to alleviate the tremendous damage brought by a war that has taken a brutal toll on their health and quality of life.

Dr. César Chelala, an international public health consultant, is a co-winner of an Overseas Press Club of America award for an article on human rights.