Security has become so bad in Iraq that many reconstruction, assistance and growth efforts are falling by the wayside.

As recently as Tuesday, officials said oil exports to neighboring Turkey have been suspended. Exports are lower now than when former dictator Saddam Hussein (search) was in power and sanctions were imposed on Iraq by the United Nations.

In less than one month — since April 28 — 89 car bombs have killed at least 355 people, according to Associated Press calculations released Tuesday. An additional five homicide bombings by individuals wearing explosives killed at least 107 people, the AP calculated.

The inability to conduct even the most basic business combined with the murder and kidnapping of aid workers over the last year has forced a number of relief and development organizations to bolt the country or operate quietly from safer parts of the war-torn landscape.

According to officials at several aid organizations, most of whom did not want to be named due to security concerns, the November killing of Margaret Hassan (search), who had been directing CARE International's Iraq operations and had lived and worked in Iraq for 30 years, launched the exodus of non-governmental organizations. Ongoing violence continues to hobble relief and development efforts in the south and central regions of the country, in particular.

“Most organizations relocated to Amman (in Jordan), and to a lesser extent, Damascus (in Syria) and Kuwait,” said Rick McDowell, who returned to the United States from Baghdad two months ago with his wife Mary Trotochaud, following almost two years of aid work with the American Friends Service Committee. The couple said they considered Hassan a close friend.

McDowell said a number of high-profile kidnappings, continued violence against Iraqis and the sense that Western aid workers were being targeted along with coalition forces forced him and his wife home.

“It’s not even about our lives but if we’re targeted because we’re Americans and our driver gets killed, who takes care of his four kids?” asked McDowell.

While Hassan was one of six aid workers reported killed in Iraq since the initial invasion in 2003, kidnappings are a constant threat. Two Italian aid workers were held by insurgents and then released in September. On Monday, three Romanian journalists returned home after being held for two months by captors.

In April, 28-year-old Marla Ruzicka, who founded the Campaign for Innocent Victims of Conflict (CIVIC) and had conducted aid work for Afghan and Iraqi civilians since 2002, was killed by a roadside bomb in Baghdad.

Meanwhile, several aid groups and NGOs, some of which had grants through the U.S. Agency for International Development, have left Iraq in the last year, including CARE International, which left after Hassan’s kidnapping in October. The organization declined a request for an interview.

Doctors Without Borders, which provides emergency medical care through international volunteers, announced last November that it was pulling out of Iraq.

"Due to the escalating violence in the country, (DWB) considers it no longer acceptable to expose its staff to the serious risks that apparently come with being associated with an international humanitarian organization," the group said in a statement at the time. "Given the still considerable humanitarian and medical needs of the Iraqi people, the decision was reached with a great degree of regret and sadness."

In May, the Iraqi Ministry of Health said criminals and insurgents were targeting Iraqi doctors for killings and kidnappings — a total of 160 across the country in the last six months — driving the best medical professionals out of the country.

“It’s got to be one of the most dangerous places in the world right now, if not the most dangerous,” said Dean Owen, spokesman for World Vision, an international NGO that now operates in 100 countries, including hot spots in Sudan and North Korea. It pulled out of Iraq in October.

“It became untenable,” Owen told FOXNews.com. “We could not justify the risk to our staff and to the Iraqis who were working with us in there.”

The International Committee of the Red Cross has remained in the country, but its work has been radically diminished to direct emergency response and monitoring the conditions of the detainees at U.S. prison camps.

In an interview from Iraq, ICRC spokeswoman Dorothea Krimitsas said the agency began scaling back operations when its headquarters in Baghdad was bombed in October 2003.

"[Relief] is the most difficult thing to achieve right now, we don't move all over the territories — we have some activities in Kurdistan in Northern Iraq — but for the rest of the territories we've had to almost stop all activities related to relief work," Krimitsas said. "We are responding to specific events whenever possible."

The number of international and Iraq-based NGOs still working in Iraq today is unknown, though some sources suggested that there are more than 100, most of them operating outside of Baghdad.

Most international NGOs do not get funding from the U.S. government, instead preferring to honor a code of neutrality. They range from tiny to larger-scale operations. Many of the larger groups have shifted their headquarters outside Iraq, according to sources. Those who have received USAID grants and are still operating somewhere in Iraq today include Save the Children, Mercy Corps and International Relief and Development.

“In areas that haven’t been riddled by violence the programs have been very effective and have helped to change lives,” said one official with a group still operating in Iraq.

“They have helped to teach kids, they’ve helped to create water and sewer systems,” said the official, who did not want to be identified, noting that his organization worked with other NGOs to complete more than 500 projects so far.

USAID reports that their contracts and grants have helped to renovate 2,350 schools, expand and rehabilitate sewer and water plants, maintain emergency food distribution, vaccinate over 3 million children under the age of five and 700,000 pregnant women as well as provide vitamins, health screening and training to health professionals throughout the country.

Arthur Keys, president of IRD, told FOXNews.com that IRD still has 80 staffers in Baghdad and 120 in other Iraqi cities. Most are Iraqi, and despite the security situation, they have finished 390 projects and have spent $2 million a month on development in the last 12 months.

"I think it is challenging and you have to take precautions to both protect yourself and your staff and people working with you — but the key element for us is we have strong contacts in the neighborhoods. The Iraqi staff goes where it feels comfortable working," Keys said. "The good news is there are a lot of positive things still going on in Iraq."

But the good news has to be weighed against the setbacks, said Owen.

While the USAID-funded groups have been able to direct “some excellent work there,” Owen said violence has kept the relief efforts at a one-step-forward, two-steps-back pace, and has had a visible impact on the mission to improve living conditions for Iraqis. Reports of increased malnutrition rates among Iraqi children as well as the emergence of hepatitis, typhoid, tuberculosis and other waterborne diseases, have raised red flags.

According to the USAID, diarrhea is a “major killer” of children in Iraq, causing around 25 percent of child deaths.

Trotochaud said she and her husband are in contact with their old partners in Baghdad and believe their efforts will prevail as long as the international community does not forget them.

"It is their home and they want to rebuild their country," she said. "We know they are doing great work under the most difficult of conditions."