"If the Americans pull out, there is a risk that they will leave a country in civil war. At the same time it doesn't seem that the United States can help to stabilize the situation by staying there."

Blix, in comments that were seen as unusually critical for the diplomat, said the U.S. is facing a situation where neither staying to fight nor pulling its troops out of Iraq are good decisions.

Blix said Iraq would have been better off if the war had not happened.

"Saddam would still have been sitting in office. OK, that is negative and it would not have been joyful for the Iraqi people. But what we have gotten is undoubtedly worse," he was quoted as saying.

Blix was in charge of a team of UN inspectors who looked for weapons of mass destruction in Iraq before the U.S. and its allies invaded the country in 2003. He had asked for more time to allow the weapons inspectors to do their work, but was criticized by Washington for his request.

After his team left Iraq, a coalition of forces led by the U.S. invaded the country. The U.S. and British military forces found no weapons of mass destruction.

Violence in the country is escalating, meanwhile, with Iraqi civilians, government officials, police officers and often U.S. soldiers killed every day. Bodies are frequently found in Baghdad, bound and tortured. Bombings are common.

According to Iraq Body Count, a website that tracks reported deaths of Iraqi civilians, more than 44,000 Iraqis have died in the war.

In the first 14 months after the 2003 invasion almost $20bn (£11bn) was spent on reconstruction by the British and American funds, including hundreds of millions on rebuilding and re-equipping the country's network of 180 hospitals and clinics.

But billions went missing because of a combination of criminal activity, corruption, and incompetence, leaving Iraqis without even the essentials for basic medical care.

The violence for which the Allied forces failed to plan has meant a $200m reconstruction project for building 142 primary care centres ran out of cash earlier this year with just 20 on course to be completed, an outcome the World Health Organisation described as "shocking".

In March, the campaign group Medact said 18,000 physicians had left the country since 2003, an estimated 250 of those that remained had been kidnapped and, in 2005 alone, 65 killed.

Medact also said "easily treatable conditions such as diarrhoea and respiratory illness caused 70 per cent of all child deaths", and that " of the 180 health clinics the US hoped to build by the end of 2005, only four have been completed and none opened".

Writing in the British Medical Journal today, Dr Basssim Al Sheibani and two colleagues from the Diwaniyah College of Medicine in Iraq says that, as the violence escalates, "the reality is we cannot provide any treatment for many of the victims."

"Emergency departments are staffed by doctors who do not have the proper experience or skills to manage emergency cases. Medical staff ... admit that more than half of those killed could have been saved if trained and experienced staff were available."

They say equipment, supplies and drugs are in many cases unobtainable. " Many emergency departments are no more than halls with beds, fluid suckers and oxygen bottles."

They add: "Our experience has taught us that poor emergency medicine services are more disastrous than the disaster itself. But despite the daily violence that is crushing Iraq, the international medical community is doing little more than looking on"

The shortages were graphically highlighted in a Channel 4 Dispatches documentary made by GuardianFilms, and broadcast in February. It revealed that children with diarrhoeal disease were dying of dehydration because hospitals lacked the right sized needles to inject them with fluids.

In Diwaniyah children's hospital, doctors were shown struggling to give drugs by ventilation to a two-day old girl, Zehara, who was born with underdeveloped lungs, because they had the wrong sized plastic mask. Masks costs pennies but, like all other equipment, are in short supply.

Zehara's father was dispatched on to the streets to try to buy Vitamin K on the black market, urgently needed for an injection. But it was too late - by the time he returned, she was dead and her twin brother also passed away shortly afterwards.

In a separate report yesterday, Peter Kandela, an Iraqi doctor who has practised as a GP in Surrey for 30 years, travelled through Jordan and Syria interviewing Iraqi medical staff who had escaped the violence.

"The current Iraqi brain drain is the worst the country has seen in its modern history," he writes

"In the new Iraq there is a price tag linked to your position and status. Those doctors who have stayed in the country know what they are worth in kidnapping terms and ensure their relatives have easy access to the necessary funds to secure their speedy release if they are taken."

He describes a kidney surgeon seized by a group of armed men, despite the presence of security guards who he had hired to protect himself, whose first act was to go through his contacts book for other potential victims. " They had the audacity to suggest that in return for receiving better treatment inn captivity I should recommend others for kidnapping", the surgeon said.

He was released unharmed after a ransom of $250,000 was paid by his wife.

In Baghdad where no one can escape violence, hospitals provided the last refuge. But they are now unsafe and Iraqis are avoiding them. Public hospitals in the city are controlled by Shiia - who have come under suspicion for allowing death squads to enter them to kill Sunnis.

Abu Nasr, the cousin of a man injured in a car bomb who was dragged from his hospital bed and riddled with bullets, told the Washington Post: "We would prefer now to die instead of going to the hospitals. I will never go back to one, never. The hospitals have become killing fields."

Medical notes

34,000 The number of Iraqi physicians registered before the 2003 war.

18,000 The estimated number of Iraqi physicians who have left since the 2003 invasion.

2,000 The estimated number of Iraqi physicians murdered since 2003.

250 The number of Iraqi physicians kidnapped.

34 The number of reconstructive surgeons in Iraq before the 2003 invasion.

20 The number who have either been murdered of fled. 72 per cent of Iraqis needing reconstructive surgery are suffering from gunshot or blast wounds.

164 The number of nurses murdered - 77 wounded.

$243,000,000 The amount of money set aside by US administration to build 142 private health clinics in post-invastion Iraq.

20 The number of such clinics built by April 2006.

$0 The amount of money left over.

$1bn The amount of money the US administration has spent on Iraq's healthcare system.

$8bn The amount of money needed over the next 4 years to fund the health care system

70 the percentage of deaths among children caused by "easily treatable conditions" such as diarrhoea and respiratory illnesses.

270,000 The number of children born after 2003 who have had no immunisations.

HEALTH INDICATORS:

68 per cent of Iraqis with no access to safe drinking water.

19 per cent of Iraqis with sewerage access.

It is one of the largest long-term population movements in the Middle East since Israel expelled Palestinians in the 1940s. Few of the Iraqis taking flight now show any desire to return to their homes. The numbers compelled to take to the roads have risen dramatically this year with 365,000 new refugees since the bombing of the Shia shrine in Samara in February.

Rich and poor, both are vulnerable. "I'll need more than five bodyguards if I am to live in Baghdad," said one political leader who has left Iraq. "The police came to my antiques shop and drove me around Baghdad," said an antique dealer from the formerly well-off district of Mansur. "They wanted money or they'd charge me with illegal traffic in antiques. I gave them $5,000 [£2,650] in cash, closed my shop and went with my brother to Jordan the same night. I haven't been back."

One well-established consultant doctor escaped his kidnappers in Baghdad and fled to the Kurdish capital of Arbil where he reopened his surgery. Bakers, often Shias, have been frequently targeted. Some now make bread with a Kalashnikov rifle propped against the wall beside them. Many have left Sunni districts in some of which it has become difficult to buy bread.

Former pilots who are Sunni and served in the air force believed they were being singled out by Shia death squads because they might once have bombed Iran; many have fled to Jordan. Jordanian immigration authorities are more welcoming to Sunni than Shia Iraqis. The latter find it easier to go to Syria. Every day heavily laden buses leave Baghdad for Damascus.

All sorts of Iraqis are on the run. But the Christian minorities from Karada and Doura in Baghdad are also fast disappearing. Most of their churches are closed. Many leave the country while the better off try to rent expensive houses in Ain Kawa, a Christian neighbourhood in Arbil.

Nobody feels safe. Some 70,000 Kurds have taken flight from the largely Sunni Arab city of Mosul. Among their cruellest persecutors are Arabs, settled in Kurdish areas by Saddam Hussein over the past 30 years, who were in turn expelled by returning Kurds after the US invasion in 2003. In Basra, the great Shia city of the south, Sunni are getting out after a rash of assassinations.

Baghdad is breaking up into a dozen different cities, each under the control of its own militia. In Shia areas this usually means the Mehdi Army of Muqtada al-Sadr. In Sunni districts it means that the insurgents, who are also at war with the Americans, are taking over. The Sunnis control the south and south-west; the Shias the north and east.

The worst slaughter is happening in the towns on the outskirts of Baghdad where Sunnis and Shias live side by side. Shias are fleeing from Mahmoudiyah, 20 miles south of Baghdad, to Suwaira and Kut. The Iraqi army does little to help, and Shias complain that the US is more intent on attacking the Mehdi Army than rescuing villagers. According to one report from the Mahmoudiyah area: after two days of fighting a platoon of Iraqi soldiers "was dispatched from the Suwaira base to break the siege. They turned up for two hours and evacuated some of the women and children to the safe zone of Suwaira, but had to turn back as they were not fully equipped to handle the situation without [US] air support."

The Shias also accuse the US of attacking their own defensive lines. In Mahmoudiyah yesterday, 19 people were killed in a bombing and mortar assault blamed by the main Sunni bloc on the Mehdi Army.

Shias do have relatively safe areas to flee to (so far as any part of Iraq is safe) in east Baghdad or the Shia south of Iraq. But Sunni areas are beset so they may move only a few streets to a house they deem more secure. Otherwise they must leave the country.

Flight often brings a host of difficulties with it. Much of the Iraqi population is unemployed and depends on state-funded rations bought from a single, local grocery shop. A refugee in Baghdad cannot go to another shop even if he has taken up residence elsewhere. The lumbering state bureaucracy only shows flexibility on receipt of a bribe. Sometimes a man may move out of a district but still have his job there which he dare not give up (60 per cent of Iraqis are unemployed); 10 days ago, 14 Shia workers from the Shia town of Balad north of Baghdad were found with their throats cut in the nearby Sunni town of Dhuluiya where they had been working. In retaliation the Shias of Balad hunted down and killed 38 Sunnis.

An e-mail from a Sunni friend in Baghdad that I received in April is worth quoting in full. It reads in shaky English: "Yesterday the cousin of my step brother (as you know my father married two) killed by Badr [Shia militia] troops after three days of arresting and his body found thrown in the trash of al-Shula district. He is one of three people who were killed after heavy torture. They did nothing but they are Sunni people among the huge number of Shia people in the General Factory for Cotton in al-Qadamiyah district ... His family couldn't recognise his face but by the big wart on his left arm."

There is the total breakdown of law and order. Kidnappings are rife. Businessmen pay for the assassination of their rivals. Sunni militants kill women wearing trousers and men wearing shorts.

Rival Shia militias fight pitched battles for control of oilfields. American soldiers often shoot at anything. No wonder so many Iraqis have left their homes or fled their country.

The refugees' stories

MOHAMMED, SUNNI TRADER

Mohammed was living in the al-Jihad neighbourhood of west Baghdad. A self-confident, energetic man who was a small trader in motor parts and a driver, he does not frighten easily. But, two months ago, he decided he had no choice but to leave his pleasant home and is now living with his wife and three daughters in a single cramped room in the house of a friend.

Earlier this year, as sectarian killings increased after the destruction of the al-Askari mosque in February, he and his family fled to Syria for safety. Al-Jihad has four districts, only one of which is Sunni, and Mohammed was living in a Shia district which was increasingly dangerous for him.

Damascus was safe but too expensive. Mohammed went back to Baghdad. But when he got to his house there was bad news. His neighbours said that while he was away the Mehdi Army, the Shia militia, had come to his home. They had asked if he was Sunni or Shia. They were told he was a Sunni. They left a message saying Mohammed must go or he would be killed. He immediately took his family to the solidly Sunni al-Khadra quarter also in west Baghdad where he now lives.

LEILA MOHAMMED, SHIA MOTHER OF THREE

"Be gone by evening prayers or we will kill you," warned one of the four men who called at the house of Leila Mohammed, the mother of three children in the city of Baquba in strife-torn Diyala province north east of Baghdad. She and her family are Shia by religion and Kurdish by ethnic origin.

The men who threatened her were Sunni. One of them offered her children chocolate to find out the names of the men of the family.

Leila fled to Khanaqin, a Kurdish enclave also in Diyala. Her husband, Ahmed, who traded in fruit in the local market, said: "They threatened the Kurds and the Shia and told them to get out. Later, I went back to get our furniture but there was too much shooting and I was trapped in our house. I came away with nothing." He and his wife now live with nine other relatives in a three-room hovel in Khanaqin with no way of making a living.

MOHAMMED AL-MAWLA, REFUGEE IN SYRIA

Mohammed al-Mawla is adjusting to life in his new home as an Iraqi refugee living in Syria. He operates an internet café outside Damascus and sends his two children to Syrian schools. But al-Mawla, 42, fears the comfort he has found in Syria after escaping the violence in Iraq could quickly disappear if the money he has saved runs out, forcing him to leave his new home in search of work.

U.S. District Judge Alvin K. Hellerstein ordered the release of certain pictures in a 50-page decision that said terrorists in Iraq and Afghanistan have proven they "do not need pretexts for their barbarism."

The ACLU has sought the release of 87 photographs and four videotapes taken at the prison as part of an October 2003 lawsuit demanding information on the treatment of detainees in U.S. custody and the transfer of prisoners to countries known to use torture.

Gen. John Abizaid, commander of U.S. Central Command, said Thursday that releasing the photos would hinder his work against terrorism. "When we continue to pick at the wound and show the pictures over and over again it just creates the image--a false image--like this is the sort of stuff that is happening anew, and it's not," Abizaid said.

The judge said, however, that "the freedoms that we champion are as important to our success in Iraq and Afghanistan as the guns and missiles with which our troops are armed."

An ACLU release this afternoon said it was getting 70 photos and three video tapes. It also said that the government is being given 20 days to appeal.

What is shown on the photographs and videos from Abu Ghraib prison that the Pentagon has blocked from release? One clue: Defense Secretary Donald Rumsfeld told Congress last year, after viewing a large cache of unreleased images, "I mean, I looked at them last night, and they're hard to believe." They show acts "that can only be described as blatantly sadistic, cruel and inhumane," he added.

A Republican Senator suggested the same day they contained scenes of "rape and murder." Rumsfeld then commented, "If these are released to the public, obviously it's going to make matters worse."

The photos were among thousands turned over by the key "whistleblower" in the scandal, Specialist Joseph M. Darby. Just a few that were released to the press sparked the Abu Ghraib abuse scandal last year, and the video images are said to be even more shocking.

"Today's historic ruling is a step toward ensuring that our government's leaders are held accountable for the abuse and torture that happened on their watch," said ACLU Executive Director Anthony D. Romero. "The American public has a right to know what happened in American detention centers, and how our leaders let it occur."

One Pentagon lawyer has argued that they should not be released because they would only add to the humiliation of the prisoners. But the ACLU has said the faces of the victims can easily be "redacted."

To get a sense of what may be shown in these images, one has to go back to press reports from when the Abu Ghraib abuse scandal was still front page news.

This is how CNN reported it on May 8, 2004, in a typical account that day:

"U.S. Defense Secretary Donald Rumsfeld revealed Friday that videos and 'a lot more pictures' exist of the abuse of Iraqis held at Abu Ghraib prison.

"'If these are released to the public, obviously it's going to make matters worse,' Rumsfeld told the Senate Armed Services Committee. 'I mean, I looked at them last night, and they're hard to believe.'

"The embattled defense secretary fielded sharp and skeptical questions from lawmakers as he testified about the growing prisoner abuse scandal. A military report about that abuse describes detainees being threatened, sodomized with a chemical light and forced into sexually humiliating poses.

"Charges have been brought against seven service members, and investigations into events at the prison continue.

"Military investigators have looked into -- or are continuing to investigate -- 35 cases of alleged abuse or deaths of prisoners in detention facilities in the Central Command theater, according to Army Secretary Les Brownlee. Two of those cases were deemed homicides, he said.

"'The American public needs to understand we're talking about rape and murder here. We're not just talking about giving people a humiliating experience,' Republican Sen. Lindsey Graham of South Carolina told reporters after Rumsfeld testified before the Senate Armed Services Committee. 'We're talking about rape and murder -- and some very serious charges.'

"A report by Maj. Gen. Antonio Taguba on the abuse at the prison outside Baghdad says videotapes and photographs show naked detainees, and that groups of men were forced to masturbate while being photographed and videotaped. Taguba also found evidence of a 'male MP guard having sex with a female detainee.'

"Rumsfeld told Congress the unrevealed photos and videos contain acts 'that can only be described as blatantly sadistic, cruel and inhuman.'"

The military later screened some of the images for lawmakers, who said they showed, among other things, attack dogs snarling at cowed prisoners, Iraqi women forced to expose their breasts, and naked prisoners forced to have sex with each other.

In the same period, reporter Seymour Hersh, who helped uncover the scandal, said in a speech before an ACLU convention: "Some of the worse that happened that you don't know about, ok? Videos, there are women there. Some of you may have read they were passing letters, communications out to their men ... . The women were passing messages saying 'Please come and kill me, because of what's happened.'

"Basically what happened is that those women who were arrested with young boys/children in cases that have been recorded. The boys were sodomized with the cameras rolling. The worst about all of them is the soundtrack of the boys shrieking that your government has. They are in total terror it's going to come out."

Judge Hellerstein said today that publication of the photographs will help to answer questions not only about the unlawful conduct of American soldiers, but about "the command structure that failed to exercise discipline over the troops, and the persons in that command structure whose failures in exercising supervision may make them culpable along with the soldiers who were court-martialed for perpetrating the wrongs."

The parents of Pat Tillman, who died by "friendly fire" in Afghanistan in April 2004, already have accused US authorities of initially trying to cover up the circumstances of their son's death.

But Tillman's brother, Kevin, who also served in Iraq and Afghanistan along with his brother, spoke out for the first time with an angry condemnation of the rationale for the Iraq war and Bush's leadership.

"Somehow the more soldiers that die, the more legitimate the illegal invasion becomes," Kevin Tillman wrote in an essay published on a website. "Somehow torture is tolerated. Somehow lying is tolerated.

Somehow reason is being discarded for faith, dogma and nonsense. Somehow American leadership managed to create a more dangerous world," wrote Tillman, who gave up his own fledgling career in professional baseball to join the army.

Entitling his essay "After Pat's Birthday," Tillman notes that legislative elections will be held on November 7, a day after his late brother's birthday, and calls for voters to hold Bush's Republican party accountable.