It was the thud heard around the world.
Just hours after Iraqi journalist Muntadhar al-Zeidi tossed his footwear at U.S. President George W. Bush, who was making a farewell appearance in Baghdad, the other shoe dropped.
Thousands of Iraqis poured out their support for the angry gesture, al-Zeidi's backers plunged the parliament into bitter controversy, and Bush's insistence that his "surge" of increased U.S. troops had put the country on the road to peace and progress rang hollow.
U.S. officials point out that al-Zeidi was not summarily executed, as he would have been under Saddam Hussein. They say that security has increased for many in Baghdad, parts of the country are returning to normal, and that a democratically elected government proves Iraq is on the right course.
But the anger and frustration of Iraqis - amplified by Muslim protests around the world - reflects a far different reality on the ground.
Aid organizations and analysts say that more than five years after the invasion, conditions are grim and in many cases growing worse, as the country suffers widespread poverty, massive displacement, a crippling brain drain and a dangerous breakdown in infrastructure.
"Neighborhoods are flooded with sewage, households are without water or electricity and there's the threat of spreading disease," says Jennifer Abrahamson of the British-based charity Oxfam. "We are seeing that in the last year the situation has either stayed the same, or gotten worse."
In 2007, as the surge was taking effect, Oxfam and a coalition of Iraqi organizations found that nearly one-third of the 27 million population needed emergency relief, 70 per cent lacked adequate water supplies, 50 per cent were unemployed and 25 per cent of children were malnourished.
In addition, 80 per cent of households had no proper sanitation, and 2 million internally displaced people no means of support. Forty-three per cent of Iraqis were living in absolute poverty.
The surge was aimed at salvaging Washington's Iraq operation, allowing an end to a war with growing American opposition, by quelling insurgencies that were spiralling out of control. But in spite of an impressive drop in Iraqi casualties by more than 1,000 deaths a month, as bombing attacks and fighting diminished, the trickle-down effects have been slow to materialize.
The January 2007 plan temporarily boosted troops by 21,500 to restore order in Baghdad and allow the Iraqi government to launch a process of peace and reconciliation. It was aided by an "Awakening" movement of Sunni Muslims encouraged to join U.S. troops in driving out Al Qaeda cells and by the "freezing" of the main Shiite militia, under leader Moqtada al-Sadr.
But it also brought clashes, violent death, and the virtual partitioning of Baghdad, once a city of mainly mixed neighbourhoods.
"It was the most bitter and destructive time of ethnic cleansing for Iraq," says Michael Schwartz, author of War Without End: The Iraq War in Context. "To call it a success is a staggering claim."
The 2003 invasion set off a chain reaction of bloodshed and revenge that sent up to 4 million Iraqis fleeing from their homes, as rival Sunni and Shia groups battled for territory. By the end of the surge, four years later, some 2 million people were refugees in neighbouring countries and another 2 million displaced inside Iraq.
Many of the displaced are professionals, including engineers, teachers and doctors. The brain drain has reconfigured Iraq's population, with the poorest and least-skilled remaining, and few able to repair the ruined infrastructure, or run vital services. Even skilled workers find it hard to find paying jobs.
"The government has put money into the medical system and supplies are getting better," says Jean-Guy Vataux of Médecins Sans Frontières. "But there are not enough doctors and nurses and no evidence of a massive return."
Even after the surge, Iraq's security is still so uncertain that hundreds of civilians are killed each month and aid workers can't reach people who are most in need. Women report vicious attacks from Islamists "enforcing" morality codes.
"There's militia violence, criminality and kidnapping," says Juan Cole, who teaches modern Middle Eastern history at University of Michigan. "People who left have got threatening letters even when they were outside the country. They're frightened and they're not going back home any time soon."
As the two main troop contributors, America and Britain, prepare to draw down their forces, there are fears of renewed unrest from destitute Iraqis who have become homeless in their own country.
"There can be no safe withdrawal unless the overall displacement issue is addressed," warns Joel Charny of Refugees International.
Meanwhile, there has been little success in reconciling Iraq's divided society. Kurds, who populate a relatively peaceful autonomous region in the north, are struggling for control of the key oil town of Kirkuk. The Shiite majority are at risk from opposing militias and religious extremists in their own ranks. And Sunnis live uneasily among warring groups, many displaced from their former homes.
"There are winners and losers," says Zaki Chehab, author of Iraq Ablaze: Inside the Insurgency. "The Kurds are winners, the Sunnis are losers and the Shias can declare success because they're ruling the country."