Five years after the start of the war in Iraq, millions of Iraqis are still lacking clean water, sanitation and health care, a report from the International Committee of the Red Cross said Monday.

"The humanitarian situation in most of the country remains among the most critical in the world," said the report, "Iraq: No let-up in the humanitarian crisis," from the Geneva-based agency.

The conflict has worsened the impact of previous wars and years of international sanctions that caused severe hardship in the country, it said.

The country's 172 public hospitals — many of which are in substandard condition — provide only 30,000 of the necessary 80,000 hospital beds. Few Iraqis can afford to pay the $2 to $7 cost of private clinics.

"The Iraqi health-care system is now in worse shape than ever. Many lives have been lost because prompt and appropriate medical care is not available," it said.

Iraqi government officials estimate more than 2,200 doctors and nurses have been killed and more than 250 kidnapped since 2003. Of the 34,000 doctors registered in 1990, at least 20,000 have left the country.

Clean water is difficult for Iraqis to maintain and access because of population growth, increasing costs, lack of qualified staff and poor security conditions.

Chlorine supplies used to sterilize the water are limited because the chemical can be used to make bombs.

"The poor quality of much of the water is due to other factors, including illegal connections to the water supply, outdated networks of pipes that do not fully protect the water against contamination and frequent interruptions of the supply of the chemicals needed to treat and disinfect the water," it said.

The average Iraqi, who brings home roughly $150 US per month, spends about $50 per month for water.

Violence down, but gains fragile: general

American military officials report violence has decreased in Iraq since a massive troop surge early last year.

Gen. David Petraeus, the top U.S. commander in Iraq, says violence rates have fallen by 60 per cent, but the gains are fragile.

Beatrice Mégevand Roggo, the ICRC’s head of operations for the Middle East and North Africa, says security improvements are limited to certain areas of Iraq.

"Better security in some parts of Iraq must not distract attention from the continuing plight of millions of people who have essentially been left to their own devices," said Roggo.

"Among them are displaced and refugee families, and those who have returned to their homes, children, elderly people, disabled people, households headed by women and families of detainees."