Nsimenya Kinyama carried her 3-day-old baby outside bundled in rags and gingerly placed his tiny, jaundiced body in a rusty blue crib. As the first healing rays of the morning sun reached him, he fussed and wriggled and stretched his arms up.
Kinyama, 36, stared at her new son with a flat, empty look in her eyes. She was wondering if this child, like the six who had come before him, would die.
"God help me," she prayed, "so that this child can live."
It is a common prayer in Shabunda, a former trading center in eastern Congo that was ravaged by war, then left poor and isolated by the destruction of roadways that had long given it life. A recent survey by the International Rescue Committee found that Shabunda's children were dying in such numbers that more than half would not see their fifth birthdays.
Such is the nature of death in modern African conflicts. For every soldier felled by a bullet, countless children die quietly of preventable and treatable maladies while fleeing to safety, waiting for care at an understaffed clinic or huddling terrified and hungry in a jungle hideout.
"It's the war that has caused these problems," said Kinyama, who has a gentle voice and hair woven into braids. "It has made us poor. It has brought hunger, and it has given us a hard life."
A horrible legacy
Children die faster in Congo than in all but 10 other countries in the world, according to U.N. statistics. A house-by-house survey in Shabunda by the International Rescue Committee found that the child death rate was four times that for Africa as a whole. If conditions remain unchanged, 515 of every 1,000 children will die before turning 5, the organization said. In developed nations such as the United States, the comparable statistic is six deaths for every 1,000, according to the United Nations, which relies on somewhat different statistical methods.
The statistics mirror what mothers and medical personnel report. In a place where women often become pregnant seven or eight times, many say they have buried several children, generally after they died of malnutrition, malaria, diarrhea, fever or other ills that rarely kill in places with adequate nutrition and medical care.
These deaths have continued long after the shooting stopped. A peace deal has been in place in eastern Congo since 2002, but the International Rescue Committee survey conducted last year found that 1,000 Congolese a day -- largely children -- were still dying from the indirect consequences of the war.
In total, the group estimated that the war and its aftermath have led to the deaths of nearly 4 million Congolese since 1998.
'Ignorance is the biggest disease'
Instability imperils even those health services that do exist. Armed men last month robbed an office of the French aid group Doctors Without Borders in Kabati, a town in the province north of here, forcing it to temporarily shut down most operations. In Shabunda, a hospital dispute led to the barring of two Doctors Without Borders physicians for several days recently, leaving only one doctor working in a region of 150,000 people.
Limited education, especially for girls, has contributed to the death toll. Many mothers, with little or no formal education, bring their children to the hospital only when they are near death and often after trying traditional potions or enemas to cure them, medical personnel say.
"Ignorance is the biggest disease," said Marisa Osodo, a Kenyan nurse and midwife working here for Doctors Without Borders. Osodo, who previously worked in trouble spots such as southern Sudan and the Congo Republic, said she had never seen death become so commonplace. "Most women have lost at least half of their children," she said.
Shabunda, a riverside town in the border province of South Kivu, decayed after the Belgian colonialists left abruptly in 1960, leaving fewer than 20 university graduates in all of Congo, a country the size of the eastern United States. The population is estimated at about 60 million.
The remnants of Belgian rule can be seen dimly amid the decay. One stolid but underused building still says "Poste/Posterijen," French and Flemish words marking the former post office. Rows of palm trees and unused electrical poles still line the wide, though no longer paved, boulevards.
The ethnically charged wars of the past decade, ignited by the 1994 genocide in neighboring Rwanda, finished off what remained of Shabunda's economic vitality.
Soldiers from a hodgepodge of armed groups stole goats, pigs and chickens and emptied the fields of cassava, rice and other vegetables. They also chased townspeople into the forest, making it impossible for many to resume planting or reach doctors. Starving people ate their seeds and emptied ponds and rivers of fish.
Surrounded by death
Meanwhile, the lush equatorial jungle reclaimed roadways, reducing them to narrow, muddy footpaths. Shabunda's access to the rest of Congo closed off.
Along the way, children began dying in numbers matched by few places on Earth.
Mpala Kikuni bore four children, all now dead. Her year-old daughter was in the hospital with a high fever when rebel attacks forced the doctors and nurses to evacuate. Her 19-year-old son was killed by a grenade as he fled from a soldier.
"It's very painful for me," said Kikuni, who did not know her age but appeared to be about 40. "In all my life, I don't have a living child."
Another mother, Zamwana Mutuza, 52, lost her teenage son Alfonce when the family was fleeing from soldiers and tried to cross the swift-moving Ulindi River at night. His body was never found.
"It went with the river," Mutuza said. Of her 12 children, six are dead. "My children would have lived if there had been peace."
In a culture where a woman's most important function is to bear and raise children, such deaths take an especially severe toll, causing not only grief but also loss of stature in the community. Grown sons and daughters also are counted on to provide support for aging parents in a society with few pensions, savings accounts or other safety nets.
One 30-year-old woman, Godeliva Madelena, said she had given birth to 11 children, including one last month. Six were dead, mostly from severe malnutrition that swelled their legs and made their hair yellow and thin. The condition is preventable by adding protein to a child's diet, and it is treatable with basic medical care.
"I have been very sad," Madelena said wearily. "I deliver and they die. What I would like to do now is take a rest."
For Kinyama, the course of the wars that have devastated the region can be traced in the grave sites of her children.
One is buried in Shabunda. Four are in her home village 30 miles away. A sixth, wrapped in cloth instead of a coffin, is near one of the family's grass-covered hideouts, deep in the equatorial forest. She marked each grave by planting flowers but has not returned since.
The deaths of her children began in the 1990s, shortly before a militia group raided her home village for the first time. Her oldest son, Kalfando, had recently died of tuberculosis. As Kinyama and her husband raced into the woods, her oldest daughter, Madeline, was developing a worrisome cough.
Before the war, the family had fields of cassava and rice, five goats, and 22 chickens that provided both meat and eggs -- vital protein in a region with few other sources.
By the time they emerged for good, after years of shuttling back and forth on foot, the fields were bare, the animals stolen. And Kinyama was childless.
Madeline had died at age 10 of tuberculosis. Daviko, Masudi, Kambala and Kinyama (his father's first name, also used by his mother as her last name) were all gone before their third birthdays from a mixture of malnutrition, fever and, in one case, jaundice.
Kinyama said she has done little in the past few years but grieve. The sight of other children caused her intense pain. She wished, above all, to bear another child.
Her new son, not yet named because his father is traveling, arrived smaller than she would have liked, about five pounds, and he had jaundice, a condition caused in babies by improper liver function. It is easily cured through exposure to sunlight and, even here, is rarely fatal.
But Kinyama worries.
For a woman who has suffered such loss, she has a surprisingly quick and warm smile. When the subject is something other than the deaths of her children, she often laughs.
As she walked from the hospital to the home of a relative on the fifth day of her son's life, Kinyama appeared joyful. It was a pleasure, she said, to be a mother again.
Yet there were moments when her eyes lost their focus, her smile slackened. And Kinyama looked like nothing so much as a mother who had suffered more than anyone could bear -- and who fears that her suffering may not be over.
"I don't know whether this child will survive," she said. "It is God's will. Maybe I will keep this child. Or not."