More than 70 people have died and a further 260 have been injured during three weeks of fighting between Islamist militants, sectarian factions and government forces in the western Iraqi province of Anbar.
The United Nations believes that as many as 70,000 people have been displaced since the violence erupted at the turn of the year, but all these numbers are “most likely an under-estimate”, warns a report on the situation published on 18 January.
According to this latest UN report, fuel shortages are growing, food prices are rising, and health care facilities are coming under increasing pressure from the hike in injuries and are short-staffed and rapidly running out of medicines.
“The capacity to adequately and rapidly respond to the increased needs has been overwhelmed by the task at hand,” the World Health Organization (WHO) representative to Iraq, Syed Jaffar Hussain, said in a statement.
“Anbar Governorate has experienced in the recent weeks a surge of violence and armed conflict that increased the health needs not only for the displaced population but also for the host communities, where the few health facilities that are still working are no longer able to provide even lifesaving interventions,” the statement said.
“There is an increasing number of patients suffering from injuries which, if not treated, will lead to irreversible damage,” Hussain added.
Heavy shelling under helicopter cover has been reported, particularly in the cities of Ramadi and Fallujah, but also in the villages in between. Police stations have been raided and prisoners freed, and government buildings have been set on fire.
Humanitarian appraisals are ongoing in order to track the exact numbers, locations and needs of the displaced families, who are have scattered throughout Anbar, Iraq’s largest province, and into neighbouring Salah ad-Din, Kerbala, Baghdad and Najaf.
Out of the 70,000 displaced people, an estimated 14,000 have crossed into the semi-autonomous Kurdish north of the country, creating a fresh headache for the Kurdistan Regional Government (KRG), which is already hosting some 200,000 refugees from Syria.
A detailed assessment is due to be submitted to the UN’s Office for Coordination of Humanitarian Affairs (OCHA) in the coming days and additional funding may be required to cover the cost of the response.
Health officials fear the fighting will disrupt a planned polio immunization campaign, a major concern given the province’s long and porous border with Syria, where the virus has recently been identified for the first time since 1999.
Fabio Forgione, head of mission in Iraq for Médecins Sans Frontières (MSF), which supports hospitals in Kirkuk and Hawija, to the north of Anbar, said they were concerned by the unfolding situation there.
“MSF presently does not have teams or medical activities in Anbar Province, however we are closely monitoring the evolutions of the situation and its potential medical consequences,” he told IRIN.
Rashid Hasan, an International Committee of the Red Cross (ICRC) delegate who took part in an aid distribution for displaced people in Tikrit, in Salah ad-Din Province, said: “People are struggling hard to cope with the cold as blankets, mattresses and food are lacking… We encountered a group of around 65 people, many of them children, who were all staying in the same four-room house.”
The violence and subsequent displacements began quickly and without much warning, and the unpredictability of the security situation has complicated the aid response, though the UN has stressed that relief items are now getting through.
Last week, WHO supplied three trauma kits - each sufficient for 100 surgical interventions - to hospitals in Fallujah and one was sent to Ramadi, and the UN Refugee Agency (UNHCR) gave families stranded in mosques and schools blankets, plastic sheets, cooking sets and mattresses.
The World Food Programme (WFP) says it has delivered 130.2 metric tons of food parcels, and the UN Children’s Fund (UNICEF) has distributed high-energy biscuits, as well as a range of sanitation items, such as buckets, hygiene sets, disinfectant and water kits.
However, while aid is starting to flow, the latest UN report on the situation notes that the “volatile and highly fluid” security situation with “rapidly changing frontlines” has continued to make access “difficult and inconsistent”.
“[The] security situation in Anbar remains volatile as the province remains an active combat zone,” it said. It referred to blocked roads and the destruction of a bridge between Fallujah and Baghdad, and it said that the area of Al Saqlawiyah had been “under siege and its safe-access corridors to humanitarian assistance either halted or severely reduced”.
Earlier this month, New York-based Human Rights Watch issued a statement accusing the government of “indiscriminately shelling civilians” and limiting flows of water, food and fuel into towns where militants were operating.
The ICRC’s delegation head in Iraq, Patrick Youssef, joined the UN in calling on those involved in fighting to “spare and protect civilians, and to allow medical personnel to carry out their lifesaving duties in safety.”
Last week, the UN Security Council issued a statement saying it “deplores in the strongest terms the recent events in the cities of Ramadi and Fallujah in Anbar Province”.
It went on: “The Security Council expresses concern about the impact of the violence on civilians, and encourages the safe passage of civilians trapped in conflict areas, as well as the safe return of internally displaced persons as conditions allow.”
This latest outbreak of violence in Anbar - which was at the heart of the 2003 insurgency in opposition to the US occupation - was triggered by the arrests of Sunni Muslim politicians and the shut-down of Sunni protest camp in Ramadi by the Shia-led government.
This has stoked sectarian tensions in the province, which is one of Iraq’s few majority-Sunni provinces. The situation has been further fanned by the involvement of Islamist militant from the al-Qaeda-affiliated Islamic State of Iraq and the Levant (ISIS), which is currently fighting across the border in the Syrian civil war.
In recent days, there have been media reports of heavily armed government units launching several assaults in a bid to reclaim control of areas that members of ISIS and other groups had claimed as their own.
Last year the UN reported that 7,818 civilians and 1,050 members of the security forces died in bomb and gun attacks, the highest such rate in five years.
According to the Iraqi Body Count, an independent UK-based research group, as many as 698 people have already died since the start of 2014.