In 1985, long before the 1991 Gulf war, it was a spectacle that drew doctors from across Iraq: "There was one case of malnutrition," recalls Abdul-Kareem Salal, a doctor at the children's hospital in Karbala, "and it was like a disaster. Nobody had ever seen it before."
But for Iraqis today - nearly seven years after President Saddam Hussein invaded Kuwait and the United Nations-imposed sanctions - those days are over.
For many like Dr. Salal, the increased Iraqi suffering has reached crisis point.
"Now you walk into any hospital, and there are a dozen people in each room who are malnourished," he says.
Few doubt that the lack of food in Iraq is exacting a growing toll. But few agree on the real reasons that several thousand children die each month.
Bombarded by the anti-West rhetoric of the regime, most Iraqis blame the UN sanctions, which the US - as chief proponent - wants in place until Iraq's capacity to invade its oil-exporting neighbors is eliminated.
But among UN and Western relief officials and diplomats, sanctions are only part of the problem.
They point to Iraq's refusal for years to take advantage of humanitarian exemptions and to its massive military spending in the 1980s, which wrecked the economy even before the Gulf war.
They also note its cynical manipulation of the "sanctions card" that appears to have reinforced Saddam's rule.
US officials insist that sanctions target Iraq's leadership and aren't meant as a collective punishment for the war.
But images of emaciated children, juxtaposed against a steady supply of pricey new cars on the streets of Baghdad for the ruling elite, are steadily undermining support for the embargo.
"It's clear the government is not weakened at all," says a Western relief official. "They use sanctions to strengthen their grip. It raises a lot of questions: Are these sanctions effective?"
In the children's hospital at Karbala, the impact is obvious - at times even resembling cases of famine in Africa. One two-year-old boy, Amjit, is barely 12 pounds.
"We have many, many like this," says Salal.
Accurate figures are difficult to come by, but a 1995 UNICEF report noted that 28 percent of the children under five years old were underdeveloped. Across Iraq, more than half the hospitalized children are malnourished.
"So what if the monthly death toll is 4,500 [the Iraqi figure for child deaths] or if it is 4,299 - it is all semantics," says Philippe Heffinck, the Belgian head of the UN Children's Fund in Iraq. "What is important is that there is a serious problem for children today, and it's deteriorating fast."
For a country that boasted an oil-driven per capita income of more than $8,000 in 1979, the fall has been hard. Income has dropped to less than $500 a year, and 15 percent of the population of 22 million is now at risk of malnutrition.
The UN considers the situation throughout Iraq to be "dismal," with the "majority" of the civilian population believed to be living below the poverty line. But it says sanctions aren't only to blame.
Iraq's ability to maintain a high standard of living began to slip well before the Gulf war. The long Iran-Iraq war of the 1980s hurt Iraq's oil production, saddled it with tens of billions in debt, and soaked up well over half the national budget.
Though Iraq's annual foreign exchange earnings grew 50-fold from 1970 to 1980, to $26 billion, it was squandered on a war that Iraq initiated.
"If someone told me that sanctions would cause thousands of Iraqi children to die, I wouldn't be indifferent," says a diplomatic source. "But I would ask: Who is responsible for that? Is it sanctions? Because if Iraq really wants to be rid of sanctions, it would do what the UN wants.
"But they do not care," he says.
UN Security Council resolutions since 1990 have all carried humanitarian-aid and food exemptions. And for years Iraq rejected an oil-for-food deal - closely supervised by the UN - that allows the sale of $2 billion of Iraqi oil every six months to buy food and medicine and pay war reparations. Sanctions are to be lifted when the UN certifies that all of Iraq's extensive missile and weapons of mass destruction programs - nuclear, chemical, and biological - are eliminated. Due to Iraqi obfuscation, UN officials say, that day will not come soon.
Iraq accepted the oil-for-food deal last fall, and oil started to flow in December. But food aid is only now being distributed.
Conspiracy theories still run deep among Iraqi officials, however. They accuse the US of trying to maintain its dominance in the region by permanently disabling Iraq's military and technological prowess.
"America and the UN know [all weapons of mass destruction] have been destroyed by their hands, but they use it as an excuse to keep sanctions to hurt the Iraqi people," claims Minister of Trade Mahdi Mohamed Saleh. "They've killed 1 million people. That is the crime. It is bigger than Hiroshima and Nagasaki."
"We are gaining [in self-reliance], but we are losing women and children," he says. "But this is the sacrifice for the freedom of Iraq."