Mr Bush surprised America by admitting yesterday to growing similarities between the wars in Iraq and Vietnam. But he also emphasised that success should not be measured by the body count, but in terms of the ability of Iraqis to defend themselves, their access to healthcare and education.

“I define success or failure as whether or not the Iraqis will be able to defend themselves. I define success or failure as whether schools are being built or hospitals are being opened. I define success or failure as whether we’re seeing a democracy grow in the heart of the Middle East,” he told ABC News.

Only hours after his statement Major-General William Caldwell, spokesman for the US forces in Iraq, said that the results of a vast security operation to secure Baghdad — the key to this war — had been “disheartening”.

And there is little more heartening news from the results of the $30 billion (£16 billion) to $40 billion American reconstruction effort. Since the invasion not a single Iraqi hospital has been built, according to Amar al-Saffar, in charge of construction at the Health Ministry.

In fact, no hospital had been built since the Qaddumiya hospital opened in 1986 in Baghdad, he said. When the war started it had 20 intensive care unit beds. Now it has half that, with many patients forced to buy their own oxygen supplies on the black market.

The only significant attempt to build a hospital was a project promoted by Laura Bush, the First Lady, in Basra. She frequently praised the $50 million paediatric hospital being built in the southern city. But Mr al-Saffar said that through financial mismanagement — the bane of postwar reconstruction across the country — it had never been completed.

Another senior Health Ministry official was surprised that Mr Bush had latched on to healthcare as proof of progress in Iraq. “It is the worst situation that the Ministry of Health has been in in its entire history,” he said. Healthcare had become so dire that half of those who died of injuries from terrorist attacks might have been saved, according to Bassim al-Sheibani, of the Diwaniyah College of Medicine, writing in the British Medical Journal.

Doctors told The Times that almost everyone who was seriously wounded in the daily explosions and shootings would die for want of proper medical attention. And, according to Mr al-Saffar, the country’s medical workers were themselves in the line of fire — 120 doctors and 80 pharmacists have been murdered, and 15,000 doctors had fled abroad.

The refurbishment of schools had been seen as a more successful effort, with about 3,000 out of 18,000 renovated by American contractors and military engineers. But even there, the Education Ministry says, another 5,000 schools are needed and 80 per cent of the existing ones need repairs. Teachers and parents say that the work carried out after the war was often shoddy and superficial, sometimes no more than a paint job.

“They rebuilt my children’s primary school after the fall of the regime but it was done very badly. They only painted it,” Abu Abdullah, a father of two, said in central Baghdad, hinting that the school was defrauded by the contractors. “Me and my friends evaluated the cost of construction at about two million dinars (about £900) but the contract was for 20 million.”

Abu Abdullah has to escort his children to school every day for fear of attack or kidnapping, and he says that the quality of teaching is so poor that he and his wife give them extra classes after school.

Luna, 28, a Sunni teacher, had to leave her primary school in a Shia part of town. She is too frightened to discipline her students or hand out bad marks for fear of retribution from their families. “Our generator is always broken so we don’t have enough electricity. Students sit in hot, unlit rooms.”

COUNTING COSTS

$30-40bn spent on reconstruction

None Hospitals built since invasion

200 Doctors and pharmacists murdered

15,000 Doctors who have fled abroad

3,000 out of 18,000 schools refurbished

5,000 Extra schools needed

24,000 Pupils who have fled abroad

72 Iraqi civilian fatalities reported yesterday

US casualties

2,784 killed

71 this month

Iraqi police casualties

4,000 killed

8,000 wounded in the past two years

3,000 Iraqi policemen sacked this month

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