In trenchant criticism, the pair say the Department of Defense alienated aid workers, misjudged the scale of looting that wrecked Iraq's health service and sent out bureaucrats who only served to complicate matters.

The traditional American response to humanitarian emergencies and natural disasters abroad is carried out by the State Department's US Agency for International Development (USAID) and Office of Foreign Disaster Assistance (OFDA).

In the months leading up to the war, these agencies trained up an 80-person team specially for Iraq, many of them with long expertise in emergencies, says the commentary, published by Frederick Burkle and Eric Noji in Saturday's Lancet.

But that initiative was hamstrung by the Pentagon which, breaking with tradition, decided to set up its own humanitarian planning team, say the authors.

That move sowed doubt and suspicion among non-governmental organisations (NGOs) in relief work, they allege.

Many of these agencies distanced themselves, fearful that their reputation for neutrality would be compromised on the ground if they had to work with occupying troops, say Burkle and Noji.

"The situation was further complicated by the fact that the [Pentagon] humanitarian planning team, citing secrecy, refused to disclose crucial information needed for planning not only to international relief organisations but also to other US military, government and civilian agencies working on humanitarian relief," they add.

As confusion mounted between the rival State Department and Pentagon relief initiatives, the US government decided to give overall administrative control to the Department of Defense's team -- by now named the Office of Reconstruction and Humanitarian Assistance (ORHA).

The big problem, though, was that Pentagon planners had not taken into account the risk of looting after the fall of Saddam Hussein.

The pillaging wrecked clinics, hospitals, emptied pharmaceutical stores and destroyed laboratories, "causing the collapse of the already tottering health system," the commentary says.

That crisis was worsened by chronic insecurity, hours-long power cuts and lack of sanitation.

Meanwhile, the ORHA team that was rushed to Baghdad was mainly staffed by policy wonks, it says.

They had little field experience in relief operations, many were ignorant of functions, charter and capabilities of UN agencies, Red Cross organisations or NGOs, and they simply created another unnecessary level of bureaucracy.

These staff, "comfortable with a top-down military-style command structure," grappled to cope with the flexible, lateral approach needed to tackle parallel problems such as providing water, sanitation, food, fuel and medicine.

"Judging from the experience in Iraq, the armed forces should be prevented form dominating humanitarian assistance as much as possible, and should leave this task to agencies that have traditionally handled humanitarian crises," the commentary adds.

Burkle and Noji work at the Center for International Emergency, Disaster and Refugee Studies at Johns Hopkins University Medical Institutions in Baltimore.

Burkle, a doctor by training, was the major health planner at USAID for Iraq and served as senior medical officer for the OFDA's disaster assistance response team.

He was the first senior health diplomat to enter Baghdad and southern Iraq after the collapse of the health system.

Noji was Burkle's deputy on the OFDA team, being deployed in Iraq from March to May 2003, during the immediate relief phase.

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