Iraqis will suffer the health consequences of the second Gulf war "for years, maybe generations", says a report warning of an "information black hole" on what is truly happening in the country.
The international health charity Medact said yesterday that up to 9,565 civilians might have been killed between the start of the war in March and October 20, and more were at risk as already weakened public services collapse.
A breakdown in law and order, lack of security and damage to infrastructure threatened further casualties.
Even in 2001, Unicef, the UN's children's organization, reported that one in eight children under five died and one in four was chronically undernourished.
The Medact report, Continuing Collateral Damage, estimates that 22,000 to 55,000 people on all sides, including in the military, had died in the war and its aftermath. The figure is far lower than the 49,000 to 261,000 the UK-based charity forecast before the war, largely because military resistance collapsed quickly.
But disruption to the country's health was still considerable, says the report's author, Dr Sabya Farooq, pointing to dangers such as leftover explosives and ammunition - Unicef has said this has hurt more than 1,000 children - landmines, and risks of cancers from toxic dust from weapons with depleted uranium.
"The mental and physical health of already weakened and unhealthy people is being damaged further," the report says. "Shortages of clean water, adequate food and power leads to an increase in diseases that is likely to result in more deaths than those directly caused by the conflict."
It adds: "The absence of reliable data, the failure of occupying forces to provide full information, and the deteriorated security situation which caused most UN staff and many non-government organizations to leave have led to an information black hole of unique proportions."
The report calls for independent academic institutions or the UN to be funded to monitor the war's effects, while an assessment of chemical risks and a rapid clear-up of unexploded ordnance should be organized. A strong health sector, eventually paid for by progressive taxation, must be established quickly, it says.
Iraq's £260bn debt must be cancelled or substantially cut and not left hanging like a millstone around the new democratic government's neck.
Iraqi doctors working in Britain who attended a London seminar to launch the report warned that health professionals still in Iraq were in increasing danger of kidnap, violence and murder.
Salih Ibrahim, a histopathologist at St Peter's hospital in Chertsey, Surrey, said: "It is a living hell. Doctors are regarded as soft targets. Nurses on their way to work have to have a male relative to accompany them and wait to take them home."
© Guardian Newspapers Limited 2003