(Baghdad) – The Iraqi government is exacerbating a humanitarian crisis in Anbar Province by hindering residents from leaving areas where fighting is taking place and impeding aid from getting in. The government should immediately facilitate safe passage for residents who want to flee the fighting and halt restrictions on the delivery of humanitarian aid.

Eight residents of Fallujah or Ramadi, Anbar’s two main cities, told Human Rights Watch that, between January and April 2014, they saw government forces shoot residents who were trying to leave or return to Anbar, killing some of them. It is unclear whether armed opposition forces were in those areas at the time of these attacks but witnesses gave consistent accounts of what they said was, at the very least, indiscriminate government fire.

“The government should be helping people trapped by the fighting, not keeping them in harm’s way and denying them aid,” said Joe Stork, deputy Middle East and North Africa director. “Anbar residents are caught in a nightmare and the government is only making it worse.”

Fighting in Anbar between government forces and various Sunni armed groups, including the Islamic State of Iraq and the Sham (ISIS), has been ongoing since January 2014. According to the United Nations, the fighting has displaced more than 400,000 of the province’s estimated 750,000 people, many of them still trapped in conflict areas. From the 72,910 families registered as displaced, at least 51,000 are still in in Anbar.

The fighting in Anbar posed major obstacles to the voting there during national elections on April 30, Human Rights Watch said. Voter turnout in Anbar was reportedly under 30 percent.

Human Rights Watch has repeatedly condemned ISIS for its deliberate attacks on civilians across Iraq, which likely amount to crimes against humanity. The armed group has claimed responsibility for attacks targeting civilians, including an April 25 attack on an election campaign rally in Baghdad that killed more than 30 people and at least eight attacks on polling centers on April 28, when army and other security officers voted.

On election day, violence reportedly prevented many people from voting, particularly in Sunni and mixed Sunni-Shia areas. A suicide bomb in Tikrit killed five people and a bomb in Kirkuk killed two women. Explosives destroyed two polling stations in Beiji and shells were fired at polling stations in Diyala, local media reported. Polling stations in several majority Sunni areas in Baghdad province, including Adhamiyya, Abu Ghraib, Latifiyya, and Yousifiyya, remained closed throughout the day, according to local politicians and to residents’ reports to Human Rights Watch.

In March, the UN mission chief in Iraq reported that armed groups in Ramadi had placed booby-traps in residential buildings and along roads, preventing displaced families from returning to their homes.

Human Rights Watch interviewed 42 Anbar residents, 35 of whom had been forced to flee their homes and 7 of whom had remained in Ramadi and Fallujah, as well as 4 government officials and representatives from 6 international humanitarian organizations working in Iraq. Human Rights Watch could not visit Anbar province due to the ongoing hostilities.

Human Rights Watch was unable to establish accurate casualty figures from the four months of fighting. On April 25, the director of Fallujah General Hospital told the media that the hospital had recorded the killing or wounding of 1,418 people since the start of the fighting, mostly from shelling of Fallujah’s residential neighborhoods. An employee of the hospital told Human Rights Watch on April 27 that the hospital had recorded 262 deaths since January, “most of them civilians.” Between 40 and 50 percent of those recorded by the hospital as having been killed were women and children, he said.

On March 27, the UN reported that the medical directorate for Anbar province had tallied the killings of 336 civilians and wounding of 1,562 civilians since the conflict began, and on May 1 announced that the Anbar Health Directorate reported 135 killed and 525 injured in Anbar in April, with 57 killed and 265 injured in Ramadi and 78 killed and 260 injured in Fallujah.

Anbar residents, medical professionals, and aid workers told Human Rights Watch that casualty figures are likely to be much higher because many people cannot reach hospitalsdue to the fighting. Some do not go to the hospitals because they fear harassment by government forces or government attacks on the hospitals, they said.

The UN has reported that “on at least one occasion” government shelling hit Fallujah General Hospital. The Fallujah hospital employee Human Rights Watch interviewed said government mortars and tank shells had hit the hospital a number of times since January, including the emergency room, intensive care unit, radiology department, and central air conditioning unit. He said that no one was killed in the attacks but that four Bangladeshi hospital staff, three Iraqi doctors, and some patients had been wounded. Human Rights Watch could not confirm the employee’s account but reviewed five photographs of what appeared to be a mortar lodged in the destroyed air conditioning unit.

The hospital employee said armed men he did not know guard the hospital compound and other institutions in Fallujah, but he had never seen them enter the hospital or use the grounds as a base. A doctor from the hospital interviewed in March, as well as Fallujah residents who have been in the hospital periodically over the past four months, also said they had not seen armed men inside the hospital.

Since early March, the army has closed all roads leading into Fallujah, except for a narrow footbridge from Saqlawiyya, a town to the northwest. One Fallujah resident said the government was also allowing foot traffic across a bridge to the south of Amiriyat al-Fallujah, but only for about one hour at a time.

The government should stop preventing people from fleeing the fighting in Anbar, and provide shelter, food, medical supplies, and other necessities to displaced people inside the province, Human Rights Watch said.

“Armed groups should be held accountable for what amount to crimes against humanity, but their crimes in no way excuse government forces punishing civilians in Sunni areas,” Stork said.

Shooting at Fleeing Residents
Human Rights Watch interviewed eight residents of Fallujah and Ramadi who said that in January and February 2014 they had witnessed government attacks in which residents trying to leave or return to Anbar were injured or killed. It is not clear whether armed opposition forces were in those areas when the attacks took place, but witnesses gave consistent accounts of what they said was, in the very least, indiscriminate government fire, and may have amounted to deliberate attacks on the fleeing residents.

In one case, 33-year-old Said (whose name, as with others interviewed, has been changed for his protection) said government soldiers for no apparent reason shot at his car and about 10 other cars, all with residents fleeing the city, as they tried to leave Fallujah through the al-Muadhafeen checkpoint east of the city at about 3 p.m. on January 30. Human Rights Watch interviewed Said at a hospital in Erbil, where he was being treated for a bullet lodged near his spine. He said:

Out of nowhere, the shooting started. It sounded like it was coming from everywhere. There were helicopters flying overhead firing on the cars and on Hay al-Askari and al-Dhubat al-Thaltha [two eastern Fallujah neighborhoods]. Eight APCs [armored personnel carriers] along the highway were shooting at the cars, and mortars were coming from the al-Mazraa base [an Iraqi army base that is part of the Mazraa/Tariq military compound east of Fallujah], which is about 3 kilometers from the highway. They all started shooting at once.

It all happened so quickly, without warning, and it only lasted five or six minutes. People in three or four other cars were also injured, I saw one person shot in the hand and one in the head. He was a child. But I don’t know what happened to them.

Said said he saw no anti-government fighters in the area at the time and did not know why the government attacked.

Another Fallujah resident, Abdulwahhab, said that in mid-February he witnessed army troops kill the mother and father of two children as they were trying to leave Fallujah for the town of Sicher, about 5 kilometers to the north, also with no sign of opposition forces in the area:

They were waiting in their car – a mother, father, and their two young children – at the checkpoint that leads north to Sicher when the army began shooting. The mother and father were shot dead, but the kids survived. They waited for the firing to stop and then they walked to Sicher. My friend, who lives close by, told me the bodies of the husband and wife stayed there in their car for two days before residents finally came and buried them.

Abdulwahhab said that in late January he saw soldiers shoot and kill a truck driver for no apparent reason as the driver was trying to leave Fallujah for Saqlawiyya, north of the city. “The army claimed they thought he was ISIS,” Abdulwahhab said. “When they say that they can do whatever they want.”

Abu Mohamed, from Hay al-Askari in Fallujah, told Human Rights Watch over Skype that he decided to leave Fallujah with his family in early January after a mortar hit their home. The main roads were closed, he said, so he used dirt roads into the desert until he encountered two damaged cars from which people were pulling dead bodies. Abu Mohamed said the people told him that a government helicopter had shot at the cars:

I stopped and I helped them get the bodies out. I counted six dead, three of them children – two very small, and one 12- or 13-year-old girl, and two women and a man who looked to be about 22 years old. There were also wounded people, some of them severe and some not.

Abu Mohammed said he drove on and, about 20 minutes later, he saw two government helicopters flying overhead. “We were terrified,” he said. “We thought they would shoot us like they did those other two cars.” After the helicopters landed, the troops inside threatened Abu Mohamed’s family with arrest but then let them go, he said.

The employee of Fallujah General Hospital told Human Rights Watch that on two occasions in mid-January he saw security forces shoot at cars with men, women, and children as they were trying to leave Fallujah on the eastern highway. He said that since the beginning of the conflict, the hospital has treated members of at least 12 families who were shot by government forces at checkpoints.

Blocking Humanitarian Aid
Human Rights Watch spoke with representatives of six international humanitarian organizations. Each talked about government restrictions on aid deliveries into Anbar, including convoys blocked at checkpoints.

On April 3, UNICEF delivered hygiene kits (packages that include soap, toothpaste, and other necessities) to Fallujah, which the UN called “the first successful distribution by a UN agency within the city limits.” On March 7, UNICEF reported that a first aid convoy had managed to reach Amiriyat al-Fallujah, south of Fallujah, the previous day. The April 3 delivery is the only humanitarian delivery, as far as Human Rights Watch has been able to determine, that has reached Fallujah since fighting began in January.

According to the UN, on January 30 army personnel stopped convoys from the International Organization for Migration (IOM) and the World Health Organization (WHO) at a checkpoint, detained an unidentified IOM employee for 24 hours and an unidentified WHO employee for over a month, and confiscated their goods, even though the organizations had army clearance to enter the area.

Five Anbar residents separately told Human Rights Watch that in January and February they saw government soldiers at checkpoints prevent trucks carrying aid from entering Anbar. The employee at Fallujah General Hospital said that he had seen security forces turn away both humanitarian agencies’ deliveries and individual residents attempting to bring in food and other supplies.

“We’ve received next to nothing from international organizations,” the hospital employee said. “And when we try to bring in goods ourselves we’re harassed and turned away.”

The hospital employee said he tried to bring two containers of vegetable oil into Fallujah in January but soldiers sent him back to Baghdad and accused him of “bringing the oil for terrorists.”

Humanitarian Needs
The four months of fighting in Anbar has created severe humanitarian needs, aid agencies and the UN said. Preliminary findings of a World Food Programme assessment released on April 20 indicated that 79 percent of displaced people in Anbar lack sufficient food. A detailed assessment of displaced people’s needs in Anbar released by IOM on April 9 found that 40 percent of internally displaced people are under 15 years old. Over one-fifth of the more than 400,000 registered internally displaced people in Anbar are sleeping in schools, abandoned buildings, or public spaces, and lack money for food, the assessment said.

All of the seven displaced people still in Anbar interviewed by Human Rights Watch said they had not received any form of Iraqi government aid, and that aid from humanitarian organizations was negligible.

On March 27, the head of the UN mission in Iraq, Nikolai Mladenov, reported that many of the families displaced by the crisis remain trapped in areas of active conflict. Access by the UN and other organizations to those affected has been significantly constrained, he said.

In addition to the logistical problems of getting aid to those in need, Mladenov said that donor funding for the UN and nongovernmental organizations in Iraq is running out. As a result, he said, the UN will “very soon be unable to continue its humanitarian assistance to those fleeing the fighting in Anbar.” On April 17, the UN reported that “Most UN agencies have run out of cash and supplies required to aid the IDP families” because of lack of sufficient donor response, including from the Iraqi government, to the UN’s request for US$103.7 million for its Anbar Strategic Response Plan launched in mid-March.

The influx of displaced people in various parts of Anbar province has stretched resources such as shelter, food, and medicine, and led to inflated prices, people in Anbar told Human Rights Watch. A teacher in Heet, a city in western Anbar, told Human Rights Watch on February 16 that Heet was experiencing shortages of food, medical supplies, kerosene, and benzene. The number of displaced people in Heet has more than doubled since then, according to IOM figures, with at least 11,655 displaced families in Heet as of April 2.

Ramadi residents and an employee in Ramadi’s general hospital told Human Rights Watch that they have access to only about 20 percent of the usual medical supplies, leading to inflated prices and limited options for treatment.

Fighting in Anbar
Fighting in Iraq’s western Anbar province began on December 30, 2013, when Iraqi government forces surrounded a protest camp in a central square in Ramadi. Sunni protesters had been demonstrating for over a year against what they alleged were ongoing abuses by security forces. The government raid on the protest camp prompted fighting between security forces and local Sunni armed men.

Fighting quickly spread throughout the cities of Fallujah and Ramadi. A journalist who travels regularly to Ramadi told Human Rights Watch that many neighborhoods there have been badly damaged by fighting between SWAT, Special Forces, and the Iraqi army on one side and local armed groups with some fighters from ISIS on the other.

The Ramadi neighborhoods of Hay al-Dhubat, Hay al-Adel, Hay al-Bakr, Hay al-Malaab, Sharia 60, Hay al-Hajji al-Fakra, and Albu Jabbar have been partially destroyed and are deserted, he said. Human Rights Watch viewed photographs from the Hay al-Bakr, Hay al-Dhubat, and Hay al-Malaab areas that showed nearly all the buildings leveled and streets covered in rubble.

In March 2014, Mladenov, the UN mission chief, reported to the UN Security Council that armed groups in Ramadi had placed booby-traps in residential buildings and along roads, preventing families from returning to their homes. Armed groups, including ISIS, remain based on the outskirts of the city and heavy fighting has contributed to shortages of food and medical supplies.

Armed opposition groups, apparently including ISIS, remain in and around Fallujah. Since January, government forces have fired mortars on the city from the eastern al-Mazraa/al-Tariq military base, about 5 kilometers from Fallujah’s city center, shot from APCs stationed along the city’s eastern highway, about 2 kilometers from the center, and used helicopters to shoot missiles, concentrating on the northern and eastern areas of Fallujah, according to Fallujah residents and information provided to Human Rights Watch by a government official. An April 17 UN humanitarian report on Anbar said that “[r]enewed artillery bombardment on several districts in Fallujah continue with reports indicating that shelling targeted most of the central, south and eastern parts of the city.”

The conflict in Anbar province has spread to other areas of the country, with intermittent fighting in Diyala, Mosul, Salah al-Din, and Abu Ghraib in February, March, and April.

Legal Standards
The actions by government security forces to prevent people from leaving areas of fighting and the government’s failure to assist or facilitate assistance for displaced people in Anbar violate Iraq’s international legal obligations.

Iraq has ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) and International Covenant on Civil and Political Rights (ICCPR), international human rights treaties that protect the right to life, the right to access to adequate shelter and medical care, the right to food, and the right to health. Failure to facilitate humanitarian access to people fleeing the fighting in Anbar may violate or contravene these provisions. Security force attacks on people seeking to flee Anbar and other forms of government harassment also violate Iraq’s international obligations, which require authorities to ensure freedom of movement.

The government’s facilitation of access to aid and accountability for security forces attacks on displaced people was a litmus test for the government’s commitment to its international obligations in the period leading up to the elections. The accounts of residents, displaced people, aid workers, and officials to Human Rights Watch make it clear that Iraqi authorities failed that test.The fighting shows no sign of abating, and nor does the hardship for families the violence has trapped and displaced.