A grim message was delivered at the 7 March Iraq Development Forum organised by exiles concerned about the consequences of conflict at London's Commonwealth Institute on 7 March. The accounts differed, but all agreed that international action to prepare for the humanitarian impact of war is too little and long overdue.

'It is amazing how late we are in preparing for the consequences,' Baroness Emma Nicholson, a Liberal Democrat member of the European assembly and World Health Organisation (WHO) envoy for the East Mediterranean, told the gathering.

Aid agencies say that leading bilateral and multilateral donors have been unwilling to mobilise resources out of fear that this would signal they had accepted war was inevitable. This reluctance encompasses the Department for International Development (DFID) headed by Clare Short, who on 9 March indicated she was prepared to resign if the UK participated in a war in Iraq without UN approval.

Lacking a clear policy from the UN Security Council, and conscious of the vulnerability of their staff on the ground (see page 5), UN bodies have also done little visibly to prepare for a war's effects on Iraqi civilians. A similar consideration has weighed on the non-government organisations (NGOs).

'It was only from the start of the year that we decided to take action to prepare for war,' says The Save the Children Fund (SCF) Middle East advocacy officer Christoph Wilcke. The SCF is the leading NGO active in the northern areas of Iraq controlled by the Kurdistan Regional Government (KRG). It has 60 officers in the field.

NGOs are now preparing for a major crisis in Iraq. They welcome the US Agency for International Development (USAID) announcement on 24 February of a post-crisis humanitarian effort, but most believe that American preparations are inadequate. They also question how it will be possible for a US government agency to get access to those in need in a war zone where the bulk of the fighting is going to be done by the US armed forces. American activities in Iraq are already hindered by the fact that US citizens, under sanctions legislation, are not permitted to visit Iraq.

Other possibilities being anticipated depend on the length of the war and whether chemical, biological and even nuclear weapons are used. The consensus is that this will be a short conflict involving several days of heavy bombing followed by a drive to the capital from Kuwait, plus airborne attacks in the north and northeast to protect the oil fields. But even in these comparatively benign circumstances, major humanitarian challenges are forecast.

One area of great concern is the impact of the displacement of people away from areas of conflict. A seminal UN report written in December 2002 said it was expected that in the event of war about 900,000 Iraqi refugees would require assistance.

'There is also the likelihood of transit camps established in Iraq adjacent to borders with a population of perhaps as many as 500,000 people,' the report said, citing a UN High Commission for Refugees (UNHCR) estimate. The new wave of refugees will compound the problems already created by the large numbers of Iraqis made refugees over the last two decades. At least 200,000 Faili (Persian-speaking) Kurds and Shia Arabs from the marshland areas of southern Iraq are living in Iran.

In addition, the UNHCR is responsible for 130,000 internal refugees who have fled from or been forced out of areas controlled by the government of Iraq. Neighbouring governments and aid bodies are gearing up for a possible flood of humanity. Iran is building camps to accommodate up to 200,000 people along its border with Iraq. The Catholic Caritas Internationalis network is building up stocks of blankets and medicines in Amman and elsewhere. Emergency plans include preparing 87 churches in Iraq as refugee centres, says its Iraq and Chechnya director Maura O'Donohue. SCF is anticipating up to 50,000 people, mainly women, children and old people, moving out of Iraq government-controlled areas into territories controlled by the KRG. Plans to provide assistance are being complicated by the fact that the KRG wants to keep such refugees away from the major population centres. Turkish diplomats tell MEED that they will close the border to civilian refugees.

More than half of Iraq's population live in towns and are dependent upon developed systems delivering power and water and removing effluent. 'Since power stations are likely to be a target in a war and electricity is needed to make the water system work, there is the potential for a water crisis in Iraq,' said Marwa el-Ansary, programme office for the Middle East and Europe for Care International. 'If the water system is knocked out, we estimate that we will need to supply at least 500,000 litres a day of bottled water to Iraq.' Care has been active since 1991 in Iraq, where it operates 47 water plants and healthcare.

Disruption of oil-for-food This is where the greatest worries lie. Under the programme agreed by the UN in 1997 to temper the effect of sanctions against the civilian population, around 16 million people receive food, medicines and other humanitarian goods. These are paid for through the sale of Iraqi crude. About $200 million worth of food is delivered monthly through a total of 66,000 ration agents. The ration is designed to last a month but is used up on average in 22 days, according to the SCF.

In the north, food is distributed by the UN World Food Programme but supplied by the government of Iraq. In southern and central areas, Baghdad controls all elements of the distribution programme. Perversely, the distribution of food, which is free, has devastated the Iraqi agricultural sector, particularly in the traditional breadbasket areas controlled by the KRG. This means there is no alternative if the food system breaks down. The programme has also failed to eliminate malnutrition, increasing the vulnerability of the young, old and weak to starvation and disease. Families frequently sell at least part of their food ration to pay for other goods and healthcare services. It is expected that an attack will lead to the collapse of the oil-for-food system, in part because government officials servicing it will fear attacks from the US and from vengeful and desperate fellow citizens.

A further concern is that all oil-for-food deliveries are made through Umm Qasr and transported to Baghdad by rail. If this link becomes militarised it could become a target, aid agencies warn. In the mountainous north, distribution depends upon a comparatively small number of road bridges that could be hit in war. And if oil production is knocked out, even temporarily, there will be no money to pay for the programme.

Baghdad has announced that two months' rations have been distributed, and aid agencies say that the April allocation has been delivered to at least a proportion of the population.

John Foran, a British GP with lengthy experience of Middle East aid programmes, flew out to Kuwait in the second week of March to make preliminary preparations for dealing with the consequences of conflict as a representative of the UK-based Iraqi Refugee Aid Council. His brief is chemical warfare.

'At present, the best advice I can give is to tell people to stay inside buildings and tents and keep some household bleach handy,' he says. 'In the absence of anything better, it can be used to neutralise certain types of chemical weapons.' Aid agency representatives at the London conference were critical of the failure to distribute gas masks to the Iraqi people.

Hundreds of thousands of mines were laid in various parts of Iraq during the Iran-Iraq war, the war for Kuwait and various Kurdish rebellions. The UN estimates that 20 per cent of the arable land in the area controlled by the KRG is unusable because of mines. There are reports that the government of Iraq is laying a minefield blanket around Baghdad, which will leave a long-term legacy of potential death and mutilation.

If this is not depressing enough, speakers at the forum highlighted human and civil rights issues. Human Rights Watch (HRW) director Hania Mufti warns that the treatment of prisoners will need to be scrutinised in the light of the US policy of flying suspects captured in the Afghanistan war to Guantanamo Bay in Cuba, so that questioning could proceed outside the terms of the Geneva Convention and other international codes. A longer-term issue is the possibility of violence when returning Kurdish refugees seek to recover property confiscated during the Arabisation of Kirkuk and other areas in the 1980s.

Aid agencies have also raised a factor of considerable long-term significance: how to deal with the hundreds of thousands of Iraqis who are members of the ruling Arab Baath Socialist Party or have collaborated with the government's programmes of deportation, arrest and execution. The issue was highlighted by one Iraqi exile at the London conference, who asked not to be named. 'My sister is in the Baath Party, but she had to join because she is a teacher. These are not the guilty people,' he said.

But the distinction may be lost in a society which may at last emerge from decades of war and sanctions. 'What the victims [of Saddam Hussein] want is proper justice,' said Baroness Nicholson, who is a rapporteur for the European Assembly about Iraq. 'If we don't help Iraq put in a justice system very quickly, then I fear there will be a civil war of some description for a long time to come.' n