Iraq's people were poor and lacked most of the normal signs of development, even before the fall of Saddam Hussein.
By David Loyn
BBC developing world correspondent
Fewer Iraqis have access to clean water than did under Saddam
Then it was possible to blame the problems of dictatorship and international sanctions, but since the US-led invasion continuing poverty in this oil-rich state has had other causes.
A new report by Oxfam says that the continuing failure to provide even the most basic services to many Iraqis will not only cause continuing suffering, but "serve to further destabilise the country".
Oxfam are unable to work on the ground in Iraq in the way that they would elsewhere, but working with the NGO Co-ordination Committee in Iraq (NCCI), their new survey finds "eight million people in need of emergency aid".
The survey recognises that armed violence is the greatest threat facing Iraqis, but finds a population "increasingly threatened by disease and malnutrition".
Clear statistical analysis is difficult, but the Oxfam/NCCI report believes that more than two million people are now internally displaced within Iraq, as savage new lines are drawn between communities who were not at war before.
Delivering aid to them provides new challenges to a system that is coping even less well than it did in the year after the war.
Of the four million Iraqis who are registered to receive food assistance, 60% receive it. That is down from 96% in the year after the war.
Fewer people have access to clean water than did under Saddam Hussein, and 80% have no access to effective sanitation, a figure comparable to sub-Saharan Africa.
Most UN agencies have found it difficult to operate in Iraq since the devastating bomb that killed their special representative, Sergio Vieira de Mello, and many of his staff only six months after the invasion.
The invasion itself was not mandated by the UN, but the reconstruction effort has since won more international support and its backing.
Humanitarian needs neglected
The Oxfam/NCCI report finds that the immediate needs of Iraqis are being neglected by international funding, which is targeted at longer term development goals.
These goals will be hard to achieve given the major security challenges.
Oxfam says the world must increase humanitarian assistance to Iraq
The report finds that funding for these longer-term projects went up by almost 1000% in the first two years after the invasion, but, despite the need, immediate humanitarian aid fell by about a half.
The report says that the right of the people of Iraq to humanitarian support "is being neglected".
But, while reminding the international community and the UN of their moral responsibility, it recommends a number of basic steps that the government in Baghdad could take to improve the plight of the people.
Most urgently, the report demands that government assistance should be devolved to local control.
That way, locally accountable bodies could inspect the warehouses and delivery systems for aid.
This report must represent a major challenge both to the international authorities and the Iraqi government, who are both found to be failing their people.