Fears of a humanitarian crisis in Iraq are growing as civilians are forced to flee or stay in the heavily bombarded cities of Basra and Baghdad.

The United Nations estimates as many as 450,000 people have fled their homes in central and northern Iraq, with most finding shelter with friends and family, but many more are expected to cross into neighbouring countries as fighting intensifies.

Civilian casualties have also risen sharply in Basra and Baghdad despite the allied forces stated policy of only attacking military targets, with aid agencies struggling to bring food, drinking water, essential medicines and other supplies into the war zones.

The long run-up to war has allowed aid agencies to prepare, with UNICEF vaccinating a quarter of a million children against polio but healthcare and medicines provision have been in a chronic state for over a decade.

UNICEF says the Oil for Food Programme, passed by the UN Security Council in 1996, has stopped conditions deteriorating, but that its current suspension has cut off a vital lifeline.

Meanwhile, Oxfam says Iraq basic infrastructures have been eroded by "decades of war, national mismanagement and twelve years of sanctions" and will have "devastating consequences" for the civilian population.

The UK Government refutes that its sanctions have undermined the situation in Iraq, and has pledged with the US that humanitarian aims, including the provision of medicines and essential supplies, are central to the war aims.

Preparing the US for war in his State of the Union Address in January, President George Bush said: "As we and our coalition partners are doing in Afghanistan, we will bring to the Iraqi people food and medicines and supplies and freedom."

The US and UK have set out formal humanitarian plans for war in Iraq, with the US saying it would try to minimise damage to Iraq infrastructure, as well as fund civilian relief agencies and non-governmental organisations.

Over 50% of the leading US-based NGOs are dependent on Government funding, but European agencies have expressed grave concerns about their ability to remain independent when working in the wake of armed forces.

Oxfam has now ruled out taking any money directly from the US or UK, and will instead work with other agencies, the EU and UN to pay for relief work.

Speaking shortly before the war began, Executive Director Jeremy Hobbs said: :We will not take funds that might allow a government to use a humanitarian operation as an instrument of foreign policy, thereby increasing the chances of war or prolonging it once it starts."

UK International Development Secretary Clare Short was one of the Government most vocal critics in the build up, but has taken back a pledge to quit in protest if war began.

Announcing details of a £30 million funding for UK forces to distribute aid, Ms Short said the resumption of the Oil for Food project was vital to prevent a humanitarian disaster.

Funded from the proceeds of Iraqi oil, almost all Iraqis benefit from the $10 billion fund, with 16 million people totally dependent on it for food, water, fuel and medicines.

Ms Short told the House of Commons that there was  "a sense of regret and dismay" at the UN and in the International Monetary Fund and World Bank about the international divisions that arose over Iraq and said she hoped a united effort would help minimise the people of Iraq suffering and help them rebuild the country.

pharmafocus@pharmafile.co.uk