United Nations and international relief officials are warning that the fragile humanitarian aid effort in Iraq will likely be among the first casualties of any sustained American bombing campaign.
After seven years of the most stringent sanctions ever applied by the UN, Iraq is deemed to be in a precarious humanitarian situation. If United States forces building in the Persian Gulf for "Operation Desert Thunder" strike the country to enforce cooperation with UN weapons inspectors, peripheral damage to the humanitarian relief system could cause it to collapse.
"The impact on food supplies for people could be catastrophic," says one senior UN official.
"It's obvious that [the UN mandated oil-for-food program] can only deal with one crisis at a time, and that crisis is the effect of sanctions," adds a Western relief worker here. "I'm afraid that military strikes could close it down."
The oil-for-food deal is based on UN Security Council Resolution 986, which allows Iraq to sell $2 billion worth of oil every six months. The tightly controlled proceeds pay for humanitarian supplies, compensate victims of Iraq's 1990 invasion of Kuwait, and finance the work of UN weapons inspectors.
Iraq accepted the program in December 1996. Delays have lowered the expectations of ordinary Iraqis, who welcome the food ration but have seen little improvement in health conditions.
To ease the strain of the sanctions - which the US says are aimed at the regime of President Saddam Hussein, not the Iraqi people - UN Secretary-General Kofi Annan proposed last month to more than double the program, enabling Iraq to sell $5.2 billion worth of oil every six months.
Iraq has so far rejected the deal, though UN officials say they are hopeful that an agreement will be reached. The proposed increase comes close to the amount of oil Iraq exported before the Gulf War. But Iraqi authorities charge the result would be complete UN control of Iraq's economy.
At the same time the Security Council struggles to cope with the humanitarian crisis, two of its members - the US and Britain - seek support for "substantial" attacks on Iraq for barring access of UN weapons inspectors to sensitive sites.
The impact of such tension on the flow of humanitarian supplies has been felt in Iraq before. During a standoff in November, when Iraq dismissed all American weapons inspectors, three Australian ships carrying 30,000 tons of food each were held up for several days. "In the system we run, a few days' delay is enough not to fill the food basket," says Denis Halliday, the UN humanitarian coordinator for Iraq.
Most of the problems with distributing food have been ironed out. The UN has brought four metric tons of food to Iraq - enough to fill 250,000 trucks and trailers.
But on the health side, numerous delays have made supply uncertain at best.
The US and Britain have been most active in blocking contracts in the UN sanctions committee, watching for "dual use" items that also can be used for illicit weapons programs.
Part of the reason, one official says, is that the US and Britain "do their homework." Approval for 100 ambulances was delayed for months, for example, because it was noted that they could be used to transport troops. And a relief agency trying to bring linen for sheets inexplicably was forced by the sanctions committee to slice them into sheet-size pieces outside Iraq before delivery.
"We all discovered how tortuous this process can be," says Eric Falt, the UN humanitarian spokesman in Baghdad.
Iraqis say that health conditions have become markedly worse since the start of the oil-for-food deal last year. International relief agencies apparently pulled out, expecting a surplus of fresh UN supplies.
"Oil for food has not met our most urgent needs," says Samir Kalander, director of the Saddam Central Teaching Hospital for Children in Baghdad. "It's not enough, and it's not constant."
Surgical operations recently were halted at this hospital for three months due to lack of rubber gloves. The memory of the 1991 American bombardment, when operations were carried out by candlelight, is still fresh. Hospital halls are crowded, and patients must purchase drugs outside, in the markets.
"We hope [any new bombing] is not a catastrophe like 1991," says Dr. Kalander, who worries that Iraq's health system will be overwhelmed by what US officials say would be a "substantial" American strike, if it comes. "We have some reserves, but for a real crisis it is not enough. If it happens like that, I don't know the result."
"Oil for food has only solved 1 percent of our problems," says Dr. Haidar Abdullah al-Kharajj, a pediatrician, though he says doubling the program "will help solve some of them."
Medical supplies, Mr. Halliday confirms, have "been one of the more visible and disappointing aspects of oil-for-food."
The UN's World Health Organization estimates that countries in this region should spend $32 per person per year on health care. Since the oil-for-food program began, Iraq has spent $16 for each of its 22 million people. But in the first five years after the Gulf War, it spent only $2 to $3 per person per year. To help close this gap, Secretary-General Annan's plan calls for a boost in health-related spending, from $210 million every six months to $777 million.
"We've been told to prevent a further deterioration of the humanitarian situation, but so far the allotment [$1.3 billion of the $2 billion program] is too small," says the UN's Mr. Falt. "After 10 months, we know we can't do the job."
Iraq is believed to have a strategic food reserve that could last five or six months. Critics charge that the regime is more interested in building new palaces - a huge complex is under construction in Baghdad, for example - than in feeding its people. They point to the recent arrival of 500 new police cars as further evidence.
But others argue that the Iraqi government's surprise release of 40,000 tons of Argentine wheat flour last April at the start of the oil-for-food program - from stocks that had never been acknowledged to exist - shows official goodwill.
International relief officials are also impressed with the Iraqi food-distribution system. The UN itself distributes food in northern Iraq because the region is not controlled by Baghdad. But in the central and southern regions, some 51,000 Iraqi agents hand out rations according to a fully computerized system that has its roots in the Iran-Iraq war of the 1980s.
Then, the ration included 10 kilos (22 pounds) of beef per family every month. These days, meat protein is the main element missing from the UN's food basket. Milk powder is provided for children under 1, but unsafe water supplies can make using it dangerous.
The Security Council is expected to endorse a version of Annan's plan. But some elements - particularly $137 million requested to improve electricity service - may be scrutinized by Washington. Electrical output last year was 40 percent of Iraq's prewar capacity, and this year it is expected to be less. The UN estimates that $7 billion will be needed over two years for repairs.
Relief officials explain that electricity is critical to other aspects of humanitarian work, such as purifying water and pumping it for irrigation. Rural areas especially experience frequent brownouts and electricity rationing. Annan's proposal also calls for spare parts so that Iraq can repair its oil line to increase capacity. It also aims to streamline the processes of purchasing oil, obtaining letters of credit, and shipping food and medicine.
The complexity is "mind boggling," says a UN official, because it requires daily communication between 20 capitals around the world and with UN headquarters in New York.
If this system collapses, Iraqis will not be alone in paying a high price. UN figures show that American companies have sold $200 million in humanitarian goods to Iraq under oil-for-food, and the US has bought more than $600 million worth of Iraqi oil, second only to Russia.
"The US has directly benefited from this operation as much, if not more, than the Russians and the French," a Western diplomat says.