On a recent day, as the cries of other sick children filled the pediatric room of Usaybah Hospital, Farhan didn’t even have the strength to join them. She lay still as her mother shoed away the flies and dabbed her forehead with a wet towel. “The weather is hot,” sighed Hamdi al-Aloosh, the hospital’s director and a pediatrician, standing a few feet away. “The water is no good. If we do not fix it soon, many more will die.”

The Iraqi city of Basra made headlines recently when a deadly wave of cholera swept the area. But it was only the first problem in a summer health-care crisis that will get worse in the coming weeks. Even before the war, water filtration plants across the nation were in a state of disrepair. Patched up with second-hand parts, they chugged along with machinery purchased in better days. The war delivered the coup de grace. Many of those that survived the bombing and the fighting–and quite a few didn’t–were crippled by looters after it. In recent days, as the heat has crept up into the low 100s, so has the reliance of locals in towns across the country on the ancient, sewage-choked waterways of the Tigres and Euphrates rivers. The impact on Iraq’s children has been devastating.

The border city of Usaybah, on the banks of the Euphrates up by Syria, is typical. “There is no water except from the river and there is nobody to help me,” said Jossa Jamel as she sat with her infant son, who was stricken with diarrhea and started vomiting five days ago. “What should we do? There is no other way.” Each day in recent weeks, Hamdi al-Aloosh’s staff at Usaybah Hospital has treated as many as 30 cases of dysentery. And almost every day, he loses a child. “Everything is destroyed and the pumps are 25 years old,” al-Aloosh explained. Lately, his doctors have begun to notice another disturbing trend: cases of typhoid, another deadly water-borne killer, may soon rise to epidemic proportions.

Aid organizations are not unaware of the problem. Last month, UNICEF called for “urgent action” and released a study showing that acute malnutrition rates in children under 5 in Baghdad alone had reached 7.7 percent, nearly doubling since a previous survey in February 2002. UNICEF blamed unsafe water from disrupted services for the problem. More than one in 10 children were found to be dehydrated. But UNICEF was unable to conduct a nationwide study because of security concerns. Similar problems have hampered the delivery of aid. “We can assume that the situation is as bad, if not much worse, in other urban centers throughout Iraq,” said Carel De Rooy, the UNICEF representative in Iraq, in a statement.

Even when those with the capacity to help do reach towns in need, the problems are not always so easy to fix. One example: in Usaybah, fixing the water initially topped the priority list of the military’s “Hearts and Minds” campaign. Maj. Paul Gass, who heads the civil-affairs projects for the area, visited the local pumping station the day after the Americans arrived in early May. He found one of two water pumps, broken and was able to find a new one and get it to the town within a week.

But by the time he arrived with the new pump, the other one was broken. Then he discovered a new wrinkle. Often, people build new houses in the area will hook up the plumbing on their own by shooting holes in the pipes and inserting hoses to draw water out. There are hundreds if not thousands of holes in the piping that spans the region. And unknown fecal matter and other contaminants are now impossible to keep out. More than a month after arriving, Gass is now trying to get enough chlorine to keep people from getting sick. “It’s frustrating sometimes,” he said. “I hate to deliver bad news. And I keep having to. But we’re doing the best we can.”

Ironically, some of those who are attempting to help may be making the problem worse. Before the war, aid agencies handed out powdered milk to help malnourished mothers and those who work during the day to feed their babies. Many of the mothers mix the milk with contaminated water.

Standing across the room, Ranar Athi Farhan’s father looks at his daughter. “It is breaking my heart,” he says putting his hand on his chest. He prays several times a day that she will recover. But the doctors say her chances are slim.