This is the third time in the last 25 years - after the war with Iran from 1980 to 1988 and the Gulf War in 1991 - that Iraqi civilians, mostly children, have suffered the consequences of war. This is happening in a country where almost half of the inhabitants are younger than 18.

In 1991, there were 1,800 health-care centers in Iraq. More than a decade later, that number is almost half, and almost a third of them require major rehabilitation. On the United Nations Development Program's Human Development Index, the country has fallen from 96 to 127, one of the most dramatic declines in human welfare in recent history.

According to Jean Ziegler, the United Nations 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 malnutrition rate is now 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 Uganda and Haiti, countries also devastated by unrelenting violence.

The population health problems are dramatically different from 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, following U.N. sanctions to punish the Saddam Hussein regime for invading Kuwait in 1990. But following the 2003 invasion by the coalition forces, a constant cycle of insurgent violence and occupation forces' counterattacks have significantly damaged the basic health infrastructure in the country.

Lack of dependable electricity and shortages of potable water throughout the country compound the deterioration of the population's health, along with outbreaks of cholera and typhoid fever, particularly in southern Iraq. The collapse of the water and sewage systems has also been the probable cause of an outbreak of hepatitis, particularly lethal to pregnant women.

According to one estimate, 60 percent of rural residents and 20 percent of urban dwellers have access only to contaminated water. In the hardest hit regions, more than 70 percent of primary-school buildings lack potable water. (According to World Bank statistics, 25 percent of primary school-age children in Iraq do not go to school. Ministry of Education statistics state that 80 percent of the schools need repair and 9 percent are in need of demolition.)

Hundreds of thousands of children born since the beginning of the present war have had none of their required vaccinations, and routine immunization services in major areas of the country are all but disrupted. Destruction of refrigeration systems needed to store vaccines have rendered the vaccine supply 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.

To compound the problem, international aid organizations such as Doctors Without Borders and CARE International have closed their operations in Iraq because of the threat of violence. Both groups have traditionally had a high tolerance for risk and a remarkable record of cooperation with public-health authorities in the country.

The Center for Strategic and International studies, a Washington research group, recently assessed five sectors of Iraq's reconstruction: security, governance and participation, economic opportunity, services and social wellness. The center concluded that health care is the sector deteriorating most rapidly. As a result of all these public-health failures, Iraq is the country that has progressed least in reducing child mortality since the 1990s.

Adults play their perverse war games, and children suffer. This is a severe indictment of any war - and of those who orchestrate war without assessing its potential consequences on the most vulnerable of civilian populations.

César Chelala (Cchelala@aol.com) is an international health consultant.