The city suffered two devastating U.S. military attacks during 2004. Many of the buildings were destroyed, or heavily damaged. Several collapsed under the heavy bombing, and were never rebuilt. The heaps of concrete slabs and piles of rubble remain where they were.

"We wonder why we have been targeted by Americans since the first days of the occupation," Dr. Mohammad Abed from al-Anbar University told IPS. "This city sacrificed thousands of its citizens through five years of occupation just because they said 'no' to a project that threatens their country's future."

Now a less visible form of destruction is being spread, he said. "The new wave of destruction is represented by tearing the social tissue apart. The Americans are paying tremendous amounts of money to get people of Fallujah to fight each other."

The road into Fallujah from the main Amman-Baghdad highway is safer today, but nobody is allowed into Fallujah who is not from the city and can prove it by providing elaborate identity documentation. That can only be obtained by undergoing biometric identification by the U.S. military -- a process which includes retina scans, body searches and finger-printing before issuance of a bar-coded ID badge.

The city remains sealed. Many residents refer to it as a big jail.

"Being sealed for five years, Fallujah has lost all aspects of natural life," Ahmad Hamid, a former member of the city council told IPS. "A man who has lived most of his life mixing with British and American people told us in 2003 that we could not reach any agreement because they (Americans) look at Fallujah as a centre of Iraqi people's unity. He told us Iraq would be divided into regions, provinces and even tribes, but we in the council did not listen to him."

The city remains tense in the face of power struggles and turf wars between tribal chiefs and Awakening group commanders, in Fallujah and in other areas of the volatile al-Anbar province. Disputes between the Iraqi Islamic Party and Awakening groups are also creating security tensions. The Awakening forces are former resistance fighters that the U.S. pays to be now on its side.

Beyond security, the health situation in the city is particularly difficult. A study conducted by two civil society organisations and the administration of Fallujah General Hospital over a two-year period was submitted to the UN High Commissioner for Refugees on Mar. 4.

The hospital administration and the two groups, the Conservation Centre of Environment and Reserves in Fallujah and the Monitoring Net of Human Rights in Iraq, say that in 2006 they found "5,928 new illness cases that were unknown before in Fallujah," over 70 percent of which were "cancers and abnormalities" in children below 12 years of age.

"In the first six months of 2007 there were 2,447 cases, more than 50 percent of these cases were children. Simply, this means that most of the victims are children, and this will threaten the new generation in this city."

"Now we face death of all kinds," said a doctor at Fallujah General Hospital. "In addition to all known diseases, new ones are invading us. Blackwater fever for instance was an unknown disease in our area, but now it is spreading like fire in a forest. We have no medicines to give our patients, and the black market is flourishing.

"Our best doctors fled the city for fear of being detained by American and police forces just because they helped civilians during the two sieges of 2004. They are now considered terrorists or at least terrorist supporters, when they should have been decorated with medals for their heroic work in helping their people."

Medically speaking, "the siege is total," a doctor who gave his name as Dr. Kamal told the press recently, speaking of the lack of drugs, oxygen, electricity and clean water at Fallujah General hospital.

U.S. military officials say reconstruction is under way, and that aid is being provided to hospitals. People see little of that.

"The brutal destruction of Fallujah by the American army was not followed by any reconstruction, as if the city is being punished for its attitude against the occupation," said an engineer in Fallujah, Kaltan Fadhil.

Water and electricity supply, health facilities and roads were provided "in a way that only made some people who collaborated with Americans richer," he said. "It was no more than repainting some buildings to make them look nicer for a while, and then new contracts were announced to rehabilitate what was already rehabilitated."

Ali al-Fadhily, IPS correspondent in Baghdad, works in close collaboration with Dahr Jamail, our U.S.-based specialist writer on Iraq who has reported extensively from Iraq and the Middle East