Doctors working in Iraq admit that more than half of the civilians killed could have been saved if better medical equipment and more experienced staff and were available.
Writing in this week's BMJ, Bassim Al Sheibani and colleagues say that as the violence escalates, the reality is that they cannot treat many of the victims.
Official figures from Iraqi authorities and UN agencies suggest that more than 14,338 Iraqi civilians were killed between January and June 2006. And reports indicate that the killing of civilians is rising, with more than 5,800 deaths and over 57,000 people injured during May and June 2006.
But emergency medicine in Iraq has never developed to meet such unprecedented demand, they say. As a result, emergency departments are staffed by doctors who do not have the proper experience or skills to manage emergency cases, and this lack of expertise is aggravated by the lack of medical equipment, supplies, and drugs.
Doctors also face challenges beyond poor resources and lack of emergency staff, they add. Perceived as members of an elite, they have become the target of daily insurgent activities. Many have been killed, others have fled the country, and those who decided to stay have closed their clinics, fearing for their lives.
In Diwaniyah College of Medicine, the authors are trying to establish a specialist unit in emergency medicine to train the medical students and doctors. But they desperately need international support.
Iraqi doctors are doing their best in difficult circumstances, they say. But despite the daily violence that is crushing Iraq, the international medical community is doing little more than looking on.