When mothers hid here in swamps from the government soldiers who would shoot them on sight, they were under orders to keep their breasts pressed into the mouths of their babies.
In these killing fields two hours north of Uganda's capital of Kampala, a crying child was a liability of the worst sort -- a signal for soldiers to open fire with their Soviet-made AK47s.
According to Dr. Paul Sebuliba, a prominent Ugandan pediatrician who himself fled soldiers here, mothers with infants also were ordered to hide in separate forests away from rebel encampments. He said this strategic segregation of babies went on throughout much of the five-year civil war that ended in January of this year with a rebel victory. "Children under two years of age were a hazard," Sebuliba said. "They could not be trusted not to cry. Most of them died."
Uganda, a country that 20 years ago offered its children perhaps the best health services and education of any country in black Africa, is the continent's most graphic case study of what political chaos can do to a nation's children.
During the civil war, the most recent chapter in more than 15 years of government-inspired murder in this East African country, U.N. officials estimate that more than 200,000 civilians were killed in the lush land of bananas, mangoes and elephant grass known as the Luwero Triangle. The split skulls and manacled arm bones of the dead remain visible to anyone who walks in the weeds near old barracks of government soldiers.
"Of the 200,000 who were killed in Luwero, many were women and children -- those who could not run fast enough to get away from the murder squads," said Cole Dodge, the U.N. Children's Fund country representative here for the past five years.
"Because of bad government, Uganda has fallen from one of the best developed, most pleasant places in sub-Saharan Africa to one of the 31 least developed countries in the world," said Dodge. He added that the standard UNICEF prescriptions for improving child health -- clean water, immunization and primary health care -- accomplish little if soldiers are shooting mothers and babies.
A U.N. report this spring on famine across Africa arrived at a similar conclusion, saying that the 18 million people threatened by starvation on the continent are at risk primarily because of civil strife. The report, by the U.N. Office for Emergency Operations, said civil war, not drought, in Ethiopia, Sudan, Angola and Mozambique is primarily to blame for bad crops, as well as for interfering with the distribution of relief food.
With the victory here of the rebel National Resistance Army, Uganda finally appears to have found a measure of stability. President Yoweri Museveni, the former rebel leader who chased out the brutal and inept six-month-old military government of Gen. Tito Okello, has imposed rigid discipline on his troops. For the first time in nearly a generation, soldiers are not routinely robbing and abusing civilians.
Those who have lived through Uganda's years of violence -- doctors and mothers, international aid officials and local government leaders -- agree that a stable government that does not terrorize its population is by far the most important precondition for improving the health and education of Uganda's children.
Before the reigns of presidents Idi Amin (under whose rule 300,000 Ugandans were estimated to have been killed), Milton Obote (more than 200,000 estimated killed) and Tito Okello (widespread reports of killing, no reliable estimates), Uganda's civil service had built one of Africa's most highly developed social service networks. Unlike many war-scarred African countries, therefore, there are a whole range of records here that document how violence and the resulting governmental collapses victimized children.
According to UNICEF, child immunization peaked in 1973, two years after Amin came to power. Then, 73 percent of children under 15 years of age were immunized against tuberculosis. By 1980, fewer than 10 percent were immunized.
In that same period, UNICEF says the total number of hospital admissions for measles jumped from 1 percent to 25 percent. Measles is now the country's leading cause of death, according to Uganda's Ministry of Health.
In the years of killing, government statistics show that about 40 percent of the country's 978 doctors fled the country, as did half the 42 dentists and 96 percent of the 116 pharmacists. Amin kicked out almost all the Asians, who had been the primary suppliers of drugs and medical equipment in rural areas, where nine out of 10 of the country's 14 million people live.
In the past two decades, infant mortality rose in Uganda as it declined in every other East African country. It is now estimated by local UNICEF officials at 120 for every 1,000 live births (nearly 11 times higher than in the United States).
Here in the Luwero Triangle, a 10,000-square-mile region with a pre-war population of about 750,000 people, the Red Cross estimated two years ago that the infant mortality rate was 305 per 1,000, nearly one-third higher than war-stricken Afghanistan, which has the world's highest infant death rate.
Behind all these statistics lies the fact that nearly half of all Ugandans were born since Idi Amin's soldiers began terrorizing the countryside in 1971. Dr. Chris Ndugwa, chairman of the department of pediatrics at Kampala's Makerere University, said many of these children have "lived in a world of guns, violence, people running away. They have never known any peace." A Sustaining Land
Uganda is probably the most fertile country in Africa. Through the years of violence, it never needed to import staple foods. Studies of the nutritional status of children here during the height of the insecurity found little severe malnutrition. Children alone, on the run in the bush, usually found enough fruit to keep themselves alive.
"The basic agricultural wealth of the country has put a floor under what otherwise would have been gross starvation and death," said UNICEF's Dodge. "You would have had far, far more people dying had any other country in this region undergone the same amount of political turmoil."
Tens of thousands of Ugandan children, because of the natural bounty of their country, have survived -- with memories of the soldiers and the killing.
In the Luwero Triangle, Chris Ndugwa, the pediatrician who led a study of 79 of these children of violence, said there is "not a single village that was undisturbed. All the children were affected.
"Everything that you can think of that a child would possess or enjoy was destroyed or disrupted. These children have seen their parents killed, relatives killed. They have spent days in the bush running from soldiers, without food for days, separated from everyone. They have had too much."
Paulina Nanuukiye, now 14 years old, a diffident girl with large eyes, thin arms and bare feet, is one of these children. Until 1983, she lived with her father, mother and older brother on a farm not far from this town. She said in an interview that her family was at home when the soldiers came.
"We heard gun shots and then we took off. We ran 10 miles, across the swamp and across a river. After that, we lived by begging farmers to let us dig cassava. We stole bananas," she said.
The Luwero Triangle is inhabited primarily by members of the Baganda tribe, an ethnic group widely hated by soldiers of the Obote government, most of whom were from the northern Acholi and Langi tribal groups. Paulina said her parents ran because they feared they would be shot for being Baganda.
According to witnesses, the soldiers frequently tortured and killed Baganda whom they suspected of supporting the rebel National Resistance Army.
"My mother died of dysentery when in the bush," Paulina said. "After that some soldiers found us and told my father it was safe to go home. My father thought we were a little bit innocent of involvement with the rebels and we walked back to our house.
"The soldiers came to our house. They collected my father and took him for death. They shot him at the government hospital. My brother and I stayed in the bush because of fear. . . . Later we lived alone together in my parents' house.
"Once, when my brother was gone, the soldiers found me at home taking my porridge. They asked me for money and said if you don't give us money, we are going to slaughter you. I was lucky because another soldier came and told them to leave me alone."
Since the fighting stopped in her area last year, Paulina has gone to live with her uncle and started school. Until this spring, the 14-year-old had never been in a classroom. She is in the Ugandan equivalent of first grade.
Paulina has nothing that belonged to her or to her parents before the soldiers came. She now owns one green, brown and tan checkered dress, given to her by her uncle. Her other possession, she said, is a new red pencil. The Children Remember
Last year, pediatrician Ndugwa and Magne Raundalen, a clinical psychologist from Norway's University of Bergen, interviewed 79 Luwero Triangle children such as Paulina Nanuukiye. In 80 percent of the children -- who were between 5 and 15 years old and about half of whom knew of no living relatives -- they found signs of clinical depression.
"The majority of the children interviewed showed emotional arrest. They described horrible events without accompanying feelings," according to a report on the interviews. "They had encapsulated their reaction or somehow dissociated themselves from strong emotional responses. . . . This 'shelling' is a sign of highly traumatized children who have had little or no opportunity of working out emotionally what they have experienced."
The report said that most children remembered "running desperately because of shooting . . . Their descriptions can be summarized with the word, horror." The children dreamed, according to the report, about "running, hearing shots, seeing parents or siblings shot and seeing mutilated or dead bodies. Some of the dreams were wishful images of being visited by dead relatives. "Distrubing Role Models
Besides causing widespread emotional damage, the years of violence have weakened family structures and established disturbing role models among Ugandan children for "normal" adult behavior, according to international aid officials, doctors and social scientists interviewed here.
Before the new government put a stop to it in January, Kampala civilians for years were pestered and sometimes shot by government and free-lance soldiers with AK47s who set up roadblocks around the city, demanding money in exchange for passage.
A favorite schoolyard game of Kampala children is now "roadblock." The object of the game is for the make-believe soldier or policeman, usually the biggest child, to extract as much imaginary money or goods as possible from those who play travelers. To avoid paying bribes, the travelers pretend to have political influence, for example, with a powerful government minister.
"The whole role-model structure in this country has eroded," said Dr. Elizabeth Hillman, a Canadian lecturer in pediatrics at Makerere University. Hillman, who has lived in Uganda since 1980, is a specialist in community-based health care, and has wide contacts in Uganda.
"There is a slice of society that will be a wipe-out," she said, referring to some of the teen-agers she has treated and observed. "They will be bad parents, I think, because they have never known how to care or be cared for."
Hillman's assessment is echoed by Josephine Wanja Harmsworth Andama, a social anthropologist who does family research here for UNICEF and the U.S. Agency for International Development. Andama said the pervasive insecurity of the past 15 years has reduced the number of formal marriages in Uganda, encouraging temporary relationships between men and women that often produce children.
Andama, a British-born widow of a Ugandan businessman, has lived in the country for 23 years and raised five children here. She said children often see their friends' parents looting or buying looted goods. She added that children say that some of their teachers demand bribes to give passing grades on major examinations.
"Children see that no matter how hard their parents work at their proper jobs, they cannot feed their families. Money comes from all sorts of unlikely sources and enterprises," writes Andama in a forthcoming anthology titled "War, Violence and Children."
"At the extreme, if you rob you usually manage to keep most of your ill-gotten gains," she writes. "If you murder, unless you are unpopular politically or otherwise expendable, you continue in whatever job you hold to murder again if you wish."
Under the Museveni government, Uganda's culture of violence has changed dramatically, according to doctors and many observers here. But these Ugandans doubt that it will be as easy to reeducate and remold the values of half the country's population -- the children -- as it was to take machine guns away from the soldiers.
In their report on children from the Luwero Triangle, pediatrician Ndugwa and psychologist Raundalen concluded from their extensive interviews with some of the most severely traumatized children in the country that it would be short-sighted to be pessimistic about the future of those who were strong enough to survive.
"It is worth noting that the future plans of this highly victimized group of children center around the strong wish to help others as they have been helped themselves. They want to be doctors, nurses, teachers, relief workers," Ndugwa and Raundalen wrote.
"These are not fanatics. Most of these youths are not indoctrinated with hatred and desire for revenge. They have no real enemies, but are tired of war, violence and Army men. They do not hate. They do not love. They hope."
Next: South Africa -- malnutrition in "Africa's Breadbasket"