December 15, 2005
Falluja is a large Iraqi town 90 kilometres west of Baghdad, the city is situated on the
western bank of Euphrates. Falluja is a densely populated city of an estimated 300- 400,000
Falluja is known as the city of mosques because of the large number of mosques in the area
and has a distinctive Arab Sunni identity. The majority of people living in the city were
traders or farmers living off their land.
Since the invasion and occupation of Iraq in 2003 the city of Falluja has been subjected to
fierce and heavy military attacks. These attacks have caused widespread devastation and
destruction causing huge damage to the infrastructure of the city. The biggest military
assaults on the city took place in April and November 2004, the attacks ate are known as the
'siege of Falluja’.
The cities water, sanitation and electricity supplies were severely disrupted as a result of
these military attacks. Health services have been devastated with medical facilities attacked
and targeted. A huge humanitarian crisis emerged as the siege developed military curfews
were imposed on the cities residents. Food and water was denied to civilians- the military
used this as a weapon during the conflict. These military attacks left the city with hundreds
and thousands of people homeless and displaced. The attacks caused thousands of civilian
casualties mainly women and children.
Doctors for Iraq had medical staff working inside the city during the April and November
2004 sieges. Members witnessed serious breaches of the Geneva Convention and human
rights. These breaches have been embedded in our minds and the minds of civilians
brutalised and traumatise by the illegal acts of aggression carried out by US/ Iraqi forces.
November 2005 marked the first anniversary of the second siege of Falluja. One year on facts
continue to emerge about the nature of the force used against the cities population and the
magnitude of the breaches of international human rights law. However the majority of facts
around the siege remain undisclosed.
Doctors for Iraq is an independent non-governmental organisation focusing on health and
human rights issues in Iraq. We were established in 2003 with the basic humanitarian
principles and guidelines determining our activities inside Iraq. We are a non-political
organisation working to strengthen the health system in Iraq for the benefit of all Iraqis.
Doctors for Iraq has produced this briefing note to outline some of the key issues that have
arisen from both the military attacks on Falluja in 2004.
Breaches of medical neutrality
The simple definition of medical neutrality according to the guiding principles of the World
medical association, the British Medical Association (BMA) is the bilateral obligation on
parties participating in a military conflict and health professionals to protect and respect the
rights of health workers and patients, the wounded and sick. Sick and wounded patients must
be given free access to healthcare at all times in the conflict.
• * Basic medication and food and water must be provided for civilians in need.
•* Health workers are obliged to treat patients regardless of age, gender, ethnic
background or religious / political persuasion.
• * Health workers are obliged to uphold medical ethics and human rights.
The following are the main breaches of medical neutrality that Doctors for Iraq has
documented during the two sieges of Falluja:
Harassment and inhumane treatment of medical personal, the sick or wounded
During the sieges of Falluja US soldiers occupied the main hospital in the city arresting
doctors and handcuffing medical personal. The military treated doctors inhumanely. Myself
and another doctor were trying to transport a patient from Falluja to Baghdad. The soldiers
stopped our ambulance even though we had informed them in advance that we would be
trying to move the patient. We were told to leave the ambulance and place our hands on our
heads and kneel down. Snipers positioned their guns towards our heads. We were forced to
remain in this position for several hours. We were denied the right to check on our patient
and ensure that he was ok.
Discriminatory practice directed against the sick or wounded, including the
withholding of healthcare or provision of only inferior standards of care.
During the first siege of Falluja one of our ambulances was trying to transport a family of
three, two women and one man near Abdul Aziz Asamari mosque near the centre of Falluja
when US soldier shot at the ambulance and injured the driver. He managed to escape from
the ambulance- but the vehicle was forced to remain in the area for three days with the
patients inside the ambulance. After four days we were able to bring the ambulance back to
the hospital- the three patients had bled to death inside the ambulance.
Punishment of medical personal for providing care consistent with medical ethics
As medical ethics dictate doctors and medical staff must treat all patients equally.
In Falluja US soldiers entered the theatre room of a hospital when two doctors were
operating on a patient. The soldiers were armed with guns and forced the doctors out of the
theatre room accusing them of treating insurgents.
Refusing doctors access to sick or wounded people
During the two sieges of Falluja the US army announced that if any ambulance were found
operating in the area they would be targeted. The US military to date has no evidence of
ambulances being misused by paramedics and medical personal. Curfews were put in place
along with checkpoints preventing doctors from moving around 1freely to treat the sick and
wounded. Patients were also prevented from reaching field clinics in these areas. An old
woman in the district of Shohada (second siege) was prevented from accessing medical care
for her son who sustained injuries when the ceiling of his house collapsed on him causing
both his legs to become crushed and huge amounts of bleeding. The old woman was unable
to take her son to seek medical attention because of the curfew- he bled to death in front of
Military attacks on medical personnel or units
During both sieges of Falluja field clinics inside the city were targeted and bombed despite
the military being given information about where the clinics had been set up and the clinics
being clearly marked. This happened in the second siege when US soldiers bombed a field
clinic in Nazal district- the main field clinic where medical aid from outside the city is stored.
The clinic is known to the US military as doctors had contacted the military to provide them
with information about the whereabouts of the field clinic. One patient was killed and many
doctors and medical staff were injured along with the medical store inside the city being
Use of medical personnel or medical units for military purposes
During both assaults on Falluja - US soldiers targeted and occupied the cities general hospital
on the east bank of Euphrates- cutting the main bridge between the hospital and the rest of
the city, isolating the city from its only hospital. US/ Iraqi soldiers have taken over the
hospital and used it as a military camp for long periods of time during the siege.
Illegal heavy weapons used inside Falluja
During both sieges of Falluja the US army used different types of weapons and ammunition
causing random widespread damage to civilians living in crowded areas. Some of the
weapons used are illegal under the conventions of warfare.
These weapons have been used in densely populated areas and districts, even with prior
knowledge that civilians remain in these areas the US army used these weapons.
The majority of victims affected by these attacks were women and children. Doctors for Iraq
documented the usage of these weapons through interview with members of the organisation
working in the city, eyewitnesses, families of victims and through photos and video footage.
Doctors for Iraq is concerned about all aspects of the attacks on Falluja. The use of illegal
weapons is just part of our concern. The entire military action and all its horrific
consequences on thousands of civilians will have a long-term impact on many generations.
All violations of international law must be investigated equally and thoroughly.
Chemical agents and Napalm
During the second siege of Falluja- US soldiers used chemical agents such as white
phosphorus and napalm inside the city. Doctors for Iraq gathered information at the 2time
from doctors working in the area and some eyewitnesses showing the aftermath of these
chemicals being used. Recent media reports show how white phosphorus was used inside
Falluja. At the time the US military denied using any chemical agents- now they admit to
using white phosphorus but deny the use of napalm.
Napalm is gel fuel bomb that explodes when it reacts with the ground producing a huge fire
with substance that sticks to exposed skin causing it to burn on impact. Napalm produces
heat as fierce as 300-350 c he napalm bomb produces smoke that irritates and damages the
repertory system – in some cases it can cause suffocation. Doctors for Iraq is trying to
establish if white phosphorus has been combined with napalm to produce a lethal bomb that
can generate e heat of up to 3000c
US soldiers prevented aid workers from entering the city- they were only allowed inside
Falluja three days after the end of the siege which raises questions as to why there was a
delay. Aid workers and doctors gathering bodies from inside residents’ homes after the siege.
Many of these bodies were of women and children who had died in their beds and in their
homes without any bullets entering them. Many of the bodies showed signs of suffocation.
Doctors for Iraq has photos and footages of bodies with significant burns to exposed skin. In
some cases only the bones remained as all the skin had melted away.
Cluster bombs are illegal and cannot be used in densely populated areas. These huge bombs
are dropped from the sky and fragment into smaller bombs that can spread over a wider
distance. These bombs are highly dangerous as each small bomb produces a massive shell
that has a devastating impact on the human body. Some of these bombs don’t explode on
impact and can be activated after they have been dropped which is why so many victims of
cluster bombs are children who come across cluster bombs. As a doctor I saw the results of
these bombs – and how they destroy the body’s vascular anatomy and how it’s almost
impossible to repair the damage to the body.
The cluster bomb was used during the first and second sieges of Falluja in areas crowded by
civilians such as Jolan quarter in the north east of Falluja and Shoda quarter in the southeast.
As a doctor I remember the third night of the siege of Falluja when the US army was facing
difficulties entering the Jolan quarter of Falluja- they used cluster bombs and I and my fellow
doctors ended up trying to treat people shattered into pieces by these bombs. The majority of
patients that I tried to treat were women and children.
Denial of food and water to civilians
During the two military attacks on Falluja the US and Iraqi army siege the city and created a
number of checkpoints in and around Falluja preventing trucks with food iteams from
entering the area outside of the city. Food aid trucks from Saglawiya, Garma - the main
agricultural areas close to Falluja were prevented from entering the city.
The military enforced a curfew preventing shops from opening and civilians from buying
food from markets. This had a massive impact on people as the siege continued for over two
During the first siege in the main hospital in Falluja doctors and nurses couldn’t access food
and I along with a team of medics ended up living on a diet of sugar and biscuits for several
During the first siege families living in Askari quarter were trapped in their homes for two
weeks unable to leave as the military attacks intensified. Doctors for Iraq tried to transport
food and water to residents in this quarter. When we placed containers with water outside
peoples homes US soldiers would shoot at the containers.
During the second siege of Falluja – eyewitnesses documented people being forced to eat
grass or uncooked wheat to survive.
US troops cut the electricity and water supply to the district of Falluja during both sieges
despite knowing that tens of thousands of people remained in the city. This happened in
Jolan, Askari and Shohida quarters of Falluja.
During the second siege of Falluja US soldiers told families o leave the city making them
pass through military checkpoints. At these checkpoints men aged between 18-35 were
randomly stopped and detained- taken to unknown detention centres. In many cases families
are still kept in the dark about why and where their loved ones are being detained and why
they are being detained.
US soldiers entered districts where they were met by fierce resistance. Whilst carrying out
raids on houses in these eyewitnesses report the mass arrest of young men with no specific
charges. These men were also detained in unknown facilities in Iraq.
ID Cards, check points and profiling
After the second siege of Falluja the US army issued special identity cards for the residents
of the city. People are being forced to carry cards with iris recognition technology, a scanned
photo of the individual and personal information imputed onto the card. US soldiers prohibit
anyone who refuses to carry this card from entering the city.
After the second siege of the city the US army formed four major checkpoints around the
city. These checkpoints have become a symbol of the humiliation of the people of Falluja.
People are often searched in an aggressive manner, verbally abused and humiliated at these
checkpoints. Doctors including myself have witnessed this kind of behaviour first hand.
These check points have become mechanisms to control the entire population of the city and
many local residents have described Falluja as being like 'one big prison’.
1. We are calling on the EU and the UN to investigate the usage of illegal weapons and
chemical substances inside the city of Falluja during the second siege.
2. We are calling on the EU and UN to undertake an international investigation into the
human rights violations that have been committed inside Falluja.
3. Doctors for Iraq is calling on the European Union and the UN to pressure the Iraqi
government and the US administration to lift the siege of Falluja. To dismantle the
humiliating checkpoints and ensure that Iraqi civilians living inside the city have a
free and safe passage in and out of the city.
For more information on Doctors for Iraq or on Falluja please contact: firstname.lastname@example.org
This briefing note was compiled by Dr Salam Ismael/ Doctors for Iraq/ December 2005.