An evening in the Yarmuk hospital in western Baghdad is like a microcosm of Iraq’s tense, no-holds-barred society; aggression, corruption, shortages and courageous efforts by a few people to improvise solutions.

It is also a window on the random violence which faces the capital’s residents from bombs, street gangs and kidnappers.

In one bed lies a young man shot in the back in a quarrel between two families. Two police officers sit on another bed. One is bleeding from the mouth, the other has gashes on his forehead. They were attacked while arresting a street gang.

Three uniformed members of Iraq’s National Guard run in with a captain bandaged above his left eye. Someone hit him on the head, apparently without provocation. The doctors redress the wound. “At least they’re getting out now and doing something,” says Dr Adham Sadoun Hamid, with no great sympathy for the guardsmen.

Doctors are still pumping mucus and blood out of the stomach of the woman who was run over. “It’s an old problem,” says Dr Aws Wael al-Shehabi, when asked why relatives have to fetch the basic supplies he needs. “The pharmacies have always wanted to keep control of drugs and other supplies. Probably they sell some of it out of the back door.”

Guards carrying Kalashnikov semi-automatic rifles regularly enter the ward. Others control the hospital entrance. They provide protection against looters and thieves, but their job is also to defend doctors from angry relatives if patients fail to recover quickly. “Family members should be told to sit in the foyer, but we can’t stop them crowding in,” says Dr Aws Wael, helplessly.

The woman’s pulse is getting weaker. Oxygen is pumped into her lungs. Two senior doctors who have been summoned from their rounds upstairs recommend she be taken to the neurosurgical hospital because of bleeding in her head.

A relative goes out and offers a fee to an ambulance driver to take her there. Relatives help the doctors lift the women on to the ambulance stretcher, leaving the oxygen supply behind. The doctors seem relieved when she is gone, hopeful that if she dies at the other hospital or on the way, they should be safe from any vengeful relatives.

Yarmuk’s chaos is not unique. Visits to two other Baghdad hospitals, each the country’s best in its field, reveal similar problems and shortages. At the central teaching hospital for children, all 24 beds in the gastroenteritis section are full and drug shortages are severe. “We have to ask parents to buy things for their children themselves,” says Dr Rasha Jawed.

Only two of the ward’s four rooms have air conditioners. The others have two fans, but they do little to reduce the 46C (115F) heat. Some parents bring their own. The surgical department’s respiratory cardiological unit closed last month because one of its two ventilators broke, and it has not been replaced.

Dirt
The floors and windows are dirty. “The hospital needs 100 cleaners, but we only have 20. They get a miserable 60,000 dinars [#22] a month. I don’t know why it’s so little,” says Dr Mohamed Idris.

The four hospitals in Baghdad’s Medical City complex used to be the pride of the Arab world. Patients came from all over the Gulf and beyond. A decade of sanctions started the slide, but little ground has been made up in the 15 months since Saddam Hussein was toppled.

At the surgical hospital, Dr Mohamed Ghiath, 28, an anaesthetist, has just finished attending an operation on a bodyguard for the minister of justice, whose convoy was attacked by a suicide bomber. The minister escaped unhurt, but the explosion killed four bodyguards and wounded several others.

“We had no triangular needles for sutures. We only had one-way cannulas, which means you can put new blood in but not suck anything out,” he says.

There have been two big changes since Saddam’s time. Doctors’ pay has gone up from $3 (#1.65) to $200 a month, and the medical fees which Saddam introduced five years ago have been scrapped. Now inpatient care is free. But drug supplies are still erratic, and the occupation authorities have spent little money to remedy the problem. Fear of corruption deters them and Britain’s aid to Iraq concentrates on primary healthcare. Iraq’s new UK-trained heath minister, Dr Ala’adin Alwan, acknowledges there is mismanagement and corruption, with drugs “leaking” out of hospitals to be sold in the street.

He says he needs to double the annual #550m budget to rebuild the health sector and tackle drug shortages after years of sanctions. “There are urgent issues that we need to address. One is the shortage we have in medicines and also in emergency supplies.”

He cites a lack of drugs for cardiovascular diseases, diabetes and cancer, as well as antibiotics and those medicines used to control communicable diseases. “There is a wide range of medicines where our stock is either zero or very, very small.”

Under Saddam, says Dr Ghiath, monitoring of corruption was stricter and punishments were fierce. But “with a salary of $3 doctors learned to steal”. The legacy of dishonesty has been compounded by the lawlessness, violence, and chaos of post-Saddam Iraq, he believes. “We’re no longer a unified country. Individuals just take whatever they can. This generation is lost. It’ll take a long time to change people’s mentality.”

Women doctors give the most pessimistic view. On top of their work problems, they have new security fears. “Patients’ relatives see there is no order, and no government, and they feel they can do anything,” says one who refused to give her name. “They swear, they smash windows, they hit doctors. We think this country has no future. We’re tired of waiting. We want to get out.”

Even if they felt safe to go home, there is nothing there to eat. Less than a third of the arable land was planted this season. Vast quantities of food will be needed for at least a year, for people both in the camps and in the villages, if they return. The food can only come from donations. Of course, it is still too dangerous for most people to leave the camps. Rape and pillage go on unabated, as horseback raiders known as Janjaweed continue their ethnic cleansing. The Sudanese government has consistently denied responsibility, claiming the militias are beyond its control.

The situation has shown some improvement since early last year, when the raids began on a large scale and the outside world slowly took note. The Sudanese government allowed the African Union to send a force of just over 2,000 troops as monitors. They are not peacekeepers and have no right to stop violations. But reports from the ground say their presence has had a restraining effect in the few places where they are deployed.

International pressure has forced the government in Khartoum to give permits for U.N. relief agencies, aid workers and journalists to work in what was previously an almost closed region. As a result, the threat of famine has been partially contained for now, as those people who have managed to get to camps inside Sudan or across the border in Chad have access to food and medicine.

The United Nations Security Council has taken some useful action. An inquiry identified 51 people thought to be behind the killing and the use of rape as a deliberate weapon of war. On a sealed list, the names have been given to the new International Criminal Court after the United States, which still refuses to work with the ICC, agreed not to veto the move. The ICC will take time to prepare the case, but by lifting the sense of impunity its intervention should help to deter new crimes.

The U.N. is also pressing the Sudanese government and Darfur’s two rebel movements to resume peace talks. They now promise to do so in the Nigerian capital, Abuja, next week. But signs of deterioration also abound. Visas for outsiders have become harder to get, and this week the government accused two staff members of Doctors Without Borders of “spying” and “falsifying information” after they published a report on rapes by militias. Top U.N. officials sprang to their aid, saying they too have evidence of mass rape. But the government has not backed down.

War creates general chaos, and reports are emerging of rape unconnected with the government’s militia. Women and girls are suffering abuse in the refugee camps in Darfur, which are supposed to be sanctuaries, as are women who have fled to Chad. Banditry is on the rise as marauders rob World Food Program lorries.

Clashes are breaking out between ethnic groups opposed to the government. “There is hardly any fighting anymore between the two main parties — the government and its armed militias on one hand and the Darfur rebels on the other. This is bad news for conflict resolution. The Abuja peace process will not be sufficient,” Dominik Stillhart, chief of the International Committee of the Red Cross in Sudan, said Thursday. “What will be required is tribal reconciliation.”

The best single measure to relieve the deepening crisis would be rapid enlargement of the African Union’s monitoring force and a new mandate for it to confront the gunmen rather than merely make reports. Other foreign troops are not needed, nor is NATO. “NATO cannot be the world’s gendarme,” as departing French Foreign Minister Michel Barnier rightly put it. But Britain, France and other countries with African experience should provide helicopters, transport and armored cars to help the A.U.

Ultimately, the main responsibility rests with the government of Sudan. The people of Darfur are its citizens. Unless Khartoum wants another 20 years of civil war and the prospect of secession — as it had in the south until last year’s peace agreement there — it must rein in the Janjaweed and work hard in Abuja to make the peace talks bear fruit.

The reasons are varied, the main one being that the Shiite political groups that control Basra are taking the long view. They form the backbone of Iraq’s new government in Baghdad and have no particular complaint with the current drift of Iraqi politics nationally. Although they are Islamists, the conservative stamp they have put on the city has not been opposed by the British.

The radical Shiites around cleric Muqtada al-Sadr, who strongly denounce the occupation and have taken up arms against it, are not as active in Basra as they are in Baghdad and the holy city of Najaf, which is closer to the capital.

So although there are special factors that explain it, the bottom line is that Iraq’s southeast has no real insurgency to speak of. Why, then, are British troops needed? What is the threat they are allegedly deterring, and that Iraqis cannot handle on their own? There is none. Forget the clichéis about “not cutting and running.” Cut the rhetoric about “the need to finish the job.” British troops could pull out immediately, and neither the people of Iraq’s southeast nor the people of Britain would regret it.

Bush would not be pleased, but the American president has had to accept that other once-staunch allies have changed their minds and withdrawn their forces. Spain, the Netherlands and Poland have seen the light, under pressure from their own electorates.

Now Blair should do the same. How can we say we are trying to bring democracy to Iraq, he should tell the White House, and then not recognize democracy at home? Ten days before the general election a poll showed that 60 percent of Britons wanted British troops out by the end of this year. Last week’s slashing of the Labor parliamentary majority reinforced that view.

By accepting that most British people want us out of Iraq, and telling Bush we cannot remain there purely out of solidarity with the Americans, Blair could go a long way toward restoring the public trust he has lost during the past two and a half years. It would not completely erase the effect of Iraq on his premiership (nothing will), but it would at least be a sign that he understands how unpopular his policies over Iraq have been.

Blair will never admit he was wrong on Iraq, let alone that he lied. But by bringing his policies into line with the majority of the British people, some of the taint of arrogance would be wiped away.

Iraq has been a kind of slow-motion Suez for Blair. Like Eden in 1956, he took Britain to war in error, but whereas Eden was forced to resign within three months of his blunder, Blair will have taken four or five years to go. For Eden it was more humiliating, since what undid him was not the unpopularity of the war. The Guardian and Observer opposed Suez, but most British people supported the invasion. It was U.S. opposition that undid Eden. When Dwight Eisenhower came out against the invasion of Egypt, Eden had no choice but to take the blame.

Blair’s circumstances are different. There was no majority for the war before it started, and apart from a few weeks while the invasion was under way, there has been no such support since.

Ultimately, it is a matter of courage. Has Blair the guts to tell Bush that he cannot stand beside him any longer on a war that is unpopular in Britain? British troops have been in occupation in Basra for more than two years. Their job is done. They should leave now.

While the horror of child soldiers is well known, the report says the focus of international concern is usually on boys. But out of roughly 300,000 children estimated to be living with armed groups, about 40 percent are girls.

Disarmament, demobilization and reintegration (DDR) programs are usually initiated after a conflict by the United Nations and the World Bank, but the report says they often ignore the special problems girls face. Their homecoming is often as depressing as their departure. They are ostracized by their family and community because of their “immoral” experiences. As a result, they are trapped between recrimination from the armed group if they leave and from the community if they return home.

A DDR program’s success is often measured by the number of weapons collected rather than the successful reintegration of former combatants. Children’s programs are “invariably underfunded.”

In Sierra Leone, more than 20,000 children were entitled to a DDR package, either money for a school uniform and three years of fees or a skills-training course. At first, it was given to children who had spent one year with an armed group. As money dried up, it went to those with two years’ experience, and finally only to children who could show they knew how to dismantle and fire a gun.

In interviews, girls told Save the Children they were put off by the military orientation of the DDR process. It highlighted the fact that they had been in an armed group and increased the danger of being stigmatized by their community.

Often the assistance packages are nothing more than food, water, oil, plastic sheeting for shelter and a lift home or somewhere on the way home. Sometimes the package consists of a one-off payment, which commanders often demand the girls give to them.

Girls returning home may be seen as violent, unruly and dirty or as promiscuous troublemakers. With no other means of supporting themselves, many are forced to turn to sex work, making them even more stigmatized and isolated.

The report says girls identified a number of ways the international community could help better: through mediation work with the community and family to explain they were coerced into joining the armed group; by creating networks to provide emotional support; and with help in starting new livelihoods.

The report describes the six-year conflict in the Democratic Republic of Congo as the deadliest war on the planet since the Second World War, and the worst in Africa. From 1998 to 2004, approximately 3.8 million people died as a result of it. All the parties involved in the conflict recruited, abducted and used child soldiers. Children made up approximately 40 percent of some armed groups in the eastern DRC in 2003, with at least 30,000 taking an active part in combat. Thousands more children, mostly girls, were attached to the armed groups to provide sexual and other services.

For most Iraqis, with the exception of the Kurds, Washington’s “liberation” never was. Wounded national pride was greater than relief at Saddam’s departure. Iraqis were angered by the failure to get power and water supplies repaired, the brutality of U.S. Army tactics, and the disappearance of their country’s precious oil revenues into inadequately supervised accounts, handed to foreigners under contracts that produced no benefits for Iraqis.

From last autumn’s disastrous attack on Fallujah to the huge increase in detention without trial, the casualties go on rising. After an amnesty last summer, the number of “security detainees” has gone up again, reaching a record 17,000.

The weekend’s vast protest shows that opposition is still growing, in spite of U.S. and British government claims to have Iraqis’ best interests at heart. It was the biggest demonstration since foreign troops invaded the country. Equally significant, the marchers were mainly Shiites, who poured in from the impoverished eastern suburb known as Sadr City. The Bush-Blair spin likes to suggest that protest is confined to Sunnis, with a nod and wink that these people are disgruntled former Saddam supporters or fundamentalists linked to al-Qaida, who therefore need not be treated as legitimate. The fact that the march was largely Shiite and against Saddam as much as Bush and Blair gives the lie to that.

Some Sunnis attended the march, urged to go by the Association of Muslim Scholars, which has contacts with the armed resistance. This too was an important sign. Occupation officials consistently talk up the danger of civil war, usually as an argument for keeping troops in Iraq. It is a risk that radicals in both communities take seriously.

Muqtada al-Sadr, the Shiite cleric who organized the latest march, recently joined forces with the National Foundation Congress, a group of Sunni and Shiite nationalists, to affirm “the legitimate right of the Iraqi resistance to defend their country and its destiny” while “rejecting terrorism aimed at innocent Iraqis, institutions, public buildings and places of worship.”

The key issue, now as it has been since 2003, is for the occupation to end quickly. Only this will reduce the resistance and give Iraqis a chance to live normally. In a new line of spin — which some commentators have taken to mean that the U.S. is preparing for a pullout — U.S. commanders claim the rate of insurgent attacks is down.

The figures are not independently monitored. Even if true, they may be temporary. What’s more, they fly in the face of evidence that suggests the U.S. occupation is actually failing. Most of western Iraq is out of U.S. control. The city of Mosul could explode at any moment. Ramadi is practically a no-go area.

In any case, the U.S. is only talking of a possible reduction of a third of its troops next year, which would still leave 100,000. It argues that a complete withdrawal has to be “conditions-related, not calendar-related.” Or, as Blair puts it, there can be no “artificial timetable.” By that, they mean Iraq’s security forces have to be strong enough to replace the Americans and British, a totally elastic marker.

That is surely the message that Donald Rumsfeld, the U.S. defense secretary, intends to give this week on his ninth trip to Baghdad since April 2003. Whenever there is an alleged transfer of power to Iraqis, this time to a “government” elected in a flawed poll, Rumsfeld comes with instructions.

His public warning is for Iraq’s leaders not to make any changes in the army and interior ministries, or postpone the writing of a constitution. Behind the scenes, he is probably telling them not to ask for a withdrawal timetable, and sounding them out on the opposite. The U.S. has indicated that it wants permanent bases in Iraq, just as it does in Afghanistan — which is why the joint Sadr-National Foundation Congress statement says the government “will have no right to ratify any agreement or treaty that might affect Iraq’s sovereignty, the unity of its territory and the preservation of its resources.”

Poland has just announced that it is pulling out of Iraq at the end of the year, as Spain did last year. Italy is considering a similar decision. If Blair wants to regain the trust he lost before the Iraq war, his best approach would be to announce the same by May 5. He would help Iraqis as well as himself.

Although he did not mention Britain’s detention of suspects without trial, the use of torture or the practices of sexual humiliation and other abuses uncovered at U.S.-run prisons for foreigners, Western governments’ treatment of terrorist suspects was unmistakably one of Annan’s targets.

Human rights law already made ample provision for strong counterterrorist action, “even in the most exceptional circumstances,” he said. Annan appealed to the world’s political, religious and civic leaders to state unequivocally that “terrorism is unacceptable under any circumstances and in any culture.” Rounding out the argument that oppressed people had a right to resist occupation, he said this could not include the right to deliberately kill or maim civilians.

He said the root cause of terrorism was the belief by certain groups that such tactics were effective and had the support of people in whose name they were used. “Our job is to show they are wrong,” he said.

Spain’s Socialist Party prime minister, José Luis Rodriguez Zapatero, speaking at the closing session, called for an international fund to give poorer countries financial help to fight terrorism. He also recommended that a second international fund be set up to compensate victims of attacks.

Since 2001 the U.N. has been under pressure to do a better job of coordinating and leading the fight against terrorism. Instead of the 12 treaties that now cover the issue, the secretary-general called for a single convention to outlaw terrorism in all its forms. Victims of terrorism should be compensated using the assets seized from terrorists, he said.

The secretary-general set out what he called the five D’s: dissuading disaffected groups from terrorism, denying terrorists the means to carry out their attacks, deterring states from supporting terrorists, developing states’ capacity to prevent terrorism, and defending human rights. Calling for a universally accepted definition of terrorism, he endorsed the wording contained in the recent report from the U.N. High-Level Panel on Threats, Challenges and Change, which he asked to develop broader thinking on the threats to security other than war. The panel defined terrorism as any action intended to cause death or serious bodily harm to civilians or noncombatants with the purpose of intimidating a population or compelling a government or an international organization to do, or abstain from, any act.

Annan drew an alarming picture of potential catastrophe in the fields of nuclear and biological terrorism. There would soon be “tens of thousands of laboratories around the world capable of producing designer bugs with awesome, lethal potential,” he said. Health systems in poor countries equipped to deal with infectious disease barely exist. Governments must do more to secure and eliminate hazardous material and set up effective export controls, Annan said. Stronger measures are also needed to uncover and stop money laundering by terrorists. Travel and financial sanctions against groups such as al-Qaida are vital.

Nuclear terrorism is still often treated as science fiction, he said. “I wish it were. But unfortunately we live in a world of excess hazardous materials and abundant technological know-how, in which some terrorists clearly state their intention to inflict catastrophic casualties.”