NAJAF, June 19 (Reuters) - Hussein Abd-al Zahra fled the violence around Baghdad but now feels he is fighting a losing battle against the heat and dust in the Iraqi desert.
"This place is not even fit for animals. Look at my four children. They have not washed for two weeks. Look at their clothes, their bodies, they're filthy," he said.
More than 2 million Iraqis are seeking refuge among their own religious or ethnic communities after being driven from their homes by sectarian bloodshed.
The United Nations refugee agency UNHCR estimates a further 1.5 million Iraqis have crossed into neighbouring countries like Syria and Jordan where they are officially classed as refugees.
Jointly, this tide has created the largest exodus in the region since the Palestinians were uprooted when Israel was founded in 1948. However, the Iraqis who remain inside the country may be the most vulnerable.
UNHCR's Iraq Support Unit coordinator Andrew Harper said that the security risks of operating in Iraq complicated getting aid to these people and has masked the scale of their hardship.
"We don't know the real extent of the humanitarian crisis in Iraq because people or humanitarian aid workers just can't get out to Diyala or other provinces where security is so poor," said Harper, speaking from Geneva.
More than 1,000 Iraqis outside the southern city of Najaf are enduring their country's searing summer in a tented camp with no electricity or running water, where midday temperatures can easily reach 50 degrees Celsius (122 degrees Fahrenheit).
"We are dying in this camp. We are completely ignored but we have done nothing wrong. Our only fault is that we are Iraqi Shi'ites," said Ali Qasem Jafar, 35, whose daughter, Fatima, is seriously ill from poor food and dirty water.
Similar camps are scattered around the mainly Shi'ite south of Iraq, where security conditions have been markedly better than in Baghdad and the surrounding region. But most of those who have fled are staying with family or friends.
This may make them a less obvious problem than a sprawling refugee camp. But they are still very vulnerable because their hosts are not much better placed to provide work or essential services, and whatever resources they have are drying up.
"The fact that they live with a host community does not make their lives any better. They still have the same problems," said Rabih Torbay, vice president of operations for U.S.-based International Medical Corps, an aid group working in Iraq.
In addition to the immediate health concerns is the lasting damage done by a massive and possibly permanent population displacement, disrupting healthcare and education services for over a million children.
"It is already a major humanitarian crisis. These communities have managed to cope so far, but the needs are outpacing the ability to deliver," Torbay said.
The tide of refugees turned into a flood after an attack on a revered Shi'ite shrine in Samarra in February 2006 provoked a surge of violence in which tens of thousands have perished.
The shrine was targeted again last week, but prompt calls for restraint from Shi'ite leaders and clerics have so far contained reprisals to a scattering of attacks.
Many of the refugees come from Baghdad. A January survey by IMC found that about 80 percent of the Iraqis who have abandoned their homes since February 2006 were from the capital, emptying neighbourhoods and reinforcing the sectarian map of the city.
Most have gone south, say aid agencies, to the shrine cities of Kerbala and Najaf, or the region near the oil port of Basra.
Wealthy families can rent homes. But the poor have nowhere to turn but dusty camps, where health risks will just worsen as the temperatures soar.
"The most important need is water as we head into the summer season ... We think this could promote some serious issues in the future," said Hicham Hassan, the Iraq spokesman for the Swiss-based International Committee of the Red Cross.
One such camp sits on an abandoned amusement park outside Kerbala, whose withered grass and tree stumps are a forlorn reminder of happier times.
"There is no clean water to drink and there is no electricity. Our suffering here is incredible," said Ali Mohammed, a 39-year-old from Diyala province, north of Baghdad, which is now one of the most dangerous places in Iraq.
"Sometimes we are able to boil the water, and sometimes we cannot," he added. (Additional reporting by Waleed Ibrahim)
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