In a country with an already fragile health infrastructure, after a decade of economic sanctions, the war was always going to cause problems for health care. But the looting and violence that followed were even more damaging. This chaos seems to have been wholly unanticipated by the coalition forces, although not by aid agencies.

The recent war in Iraq has raised many questions of legality, not least over the right of the US-led coalition to wage the war, and the alleged illegal holding of weapons of mass destruction by Iraq. There are also a complex set of humanitarian laws that govern war and its aftermath.

The Hague declaration and conventions of 1899-1973, the Geneva Conventions of 1949, and their additional protocols list in some detail what the obligations of a warring party or an occupying power are, with the aim of averting the irreparable breakdown of societies in conflict.

The strangeness of such laws at times of chaos is summed up by Francoise Bouchet-Saulnier (of MSF) in her book The Practical Guide to Humanitarian Law, where she says that "the laws of war are at the crossroads between realpolitik and metaphysics".

Both the coalition and Iraq have used these laws as propaganda in this war, particularly the third Geneva Convention which covers the treatment of prisoners of war. But now the war is over the coalition has been urged by, among others, the UN Secretary-General, Kofi Annan, to give top priority to fulfilling its obligations under the various conventions that relate to civilians.

Of particular relevance are article 43 of the 1907 Hague regulations, which states that an occupying power "shall take all the measures in his power to restore and ensure, as far as possible, public order and safety", and Articles 55-63 of the fourth Geneva Convention, which detail the requirement of occupying powers to provide for the hygiene and public health of the civilian population as well as for the provision of relief.

In a country with an already fragile health infrastructure, after a decade of economic sanctions, the war was always going to cause problems for health care. But the looting and violence that followed were even more damaging.

This chaos seems to have been wholly unanticipated by the coalition forces, although not by aid agencies. A briefing note prepared by Oxfam in April, 2003, as the war was continuing noted that "there will be grave threats to human security after the war. As in previous conflicts ethnic tensions, political retribution, and sexual violence could spiral. A 'protection gap' in the transition period must be avoided".

Before the 1991 Gulf War the Iraqi health system was among the best in the world. The occupying forces must fulfil their obligations under humanitarian law and move rapidly to restore law and order so that humanitarian agencies, led by the UN, can begin to repair the damage of the past 12 years.

It is not clear why the coalition forces have been unable or unwilling to protect the civilian population, or its infrastructure and heritage, but the consequences of this inaction are apparent in the daily news from Iraq. There is a shortage of water, electricity, medicines, and trained staff in the hospitals that are not too damaged to open. There has been a sharp rise in the number of children with diarrhoeal disease. In Baghdad the two water-treatment plants are only working at a fraction of their (barely adequate) pre-war level. There has been virtually no garbage collection in Baghdad since the war ended.

The coalition forces have made searching for Iraq's elusive arsenal of weapons of mass destruction a priority, but they may have already unleashed something just as deadly on the Iraqi people.

In the past week in the e-mail discussion group of the World Association of Medical Editors (WAME), Ian Roberts, Professor of Public Health at the London School of Hygiene and Tropical Medicine, has argued that by concentrating on what the coalition forces consider as bioterrorism (ie, the introduction of a new organism to a healthy people) medical journals have paid insufficient attention to the effects that economic sanctions, deliberate destruction of water and sanitation systems, and interventions that reduce access to essential medicines have had on the health of the Iraqi people.

Further, he suggests that such actions are a form of bioterrorism, in which people are rendered more susceptible to infections in their environment.

Not all editors who participated in the discussion believed it was an appropriate topic for medical editors, and the moderator of the discussion attemped to stop the debate.

To argue that these aspects of public health are not a legitimate concern for doctors ignores the responsibility and the unique position that the medical profession has to raise debate over the consequences of the coalition's actions.

Before the 1991 Gulf War the Iraqi health system was among the best in the world. The occupying forces must fulfil their obligations under humanitarian law and move rapidly to restore law and order so that humanitarian agencies, led by the UN, can begin to repair the damage of the past 12 years.

The Lancet