Every night, up to 7,000 children stream into the northern Ugandan town of Gulu to seek refuge from the conflict that simmers around them. Walking as far as 10 kilometers from displacement camps and the periphery of Gulu Town, these children are the so-called night-commuters, one of the most vivid symbols of the violence which continues to wrack the region.
For two decades, the rebel Lords Resistance Army (LRA) has pitted itself against the government forces in a low intensity war. Reputed to have kidnapped over 20,000 children over the past two decades, the LRA today numbers perhaps less than a tenth of that. While its forces may be small, the regular - and often gruesome - attacks on civilians ensure that it is still capable of instilling fear.
Citing the menace of the LRA, in 1997 the Ugandan government called on the population of Northern Uganda to regroup themselves into camps following horrendous massacres. The official stated aim of these so-called protected villages was to provide security for the population, which had previously been scattered in mainly rural areas.
Nearly a decade later, around 1.6 million people - 90% of the total population - still languish in around 200 camps, unable to work or farm and therefore reliant almost completely on external assistance for survival.
Nor is the protection offered in the camps anything more than a veneer. Violence is everywhere and no parties in the conflict are exempt. Even within the camps themselves, fuelled by frustration, social violence has become part of daily life. In Lalogi camp health centre, MSF treats around 20 cases of violence per month. Only a minority is due directly to the conflict.
"It is no exaggeration to say that over the past two decades, the fabric of society has been torn apart," explains MSF head of mission Amaia Esparza. "The effect of living in the camps has crushed the life out of many people. Alcoholism is rife and violence, especially domestic violence, is common. What we treat is only the tip of the iceberg. A study conducted by MSF in December 2004 showed depression to be quite common among the displaced. People are not living in the camps, they are surviving. Nothing more."
The round thatched huts are packed together. Farming is impossible, facilities are limited and life is turgid. Fires often break out in the dry season and incidents occur with alarming regularity.
"Three women were abducted over there yesterday," says Komaketch, an MSF driver, pointing to the hills on the edge of the Awoo camp where MSF runs a primary healthcare centre. He says this matter-of-factly, no hint of surprise in his voice, seemingly resigned to the situation.
Over the years, the camps have superficially come to resemble the traditional villages of the Acholi community. But this is a mirage. Their old villages, and vast swathes of the north of Uganda, have been abandoned to the rebels, while the camps are an undesirable new home. But with the insecurity raging, it is a life sentence with little hope of parole. Locked inside, a productive life is virtually impossible and the sense of futility is palpable.
Health conditions are also poor. Overcrowded and ill-equipped, malaria is particularly prevalent and sanitation is often dire. Mortality rates are often worryingly high, especially among children.
Due to a mixture of government negligence and incapacity, the quality of healthcare in the camps is left, to a large extent, to aid agencies, which means the quality of assistance varies enormously from one camp to the next.
MSF currently provides basic healthcare through clinics in 19 camps across three districts in the north. Needs are high. In five camps in the district of Kitgum, MSF carries out around 6,000 medical consultations per month. A centre for the severely malnourished located in Lira Town is regularly filled with over 100 children.
It is against this background that the night-commuters of Gulu continue their daily trek to the shelters; as much a symptom of the disintegration of society as of the direct effect of the insecurity which continues to haunt the north.
"The on-average 1,200 children who seek refuge every evening come for a number of factors," explains the MSF psychologist who runs the shelter project. "When I speak to them, they say that they have fled rebels and robbers. Their parents, if they are still alive or at home, prefer to send their children to the shelters rather than risk them staying in the camps. But it is too simplistic to say that they are coming here to escape the LRA alone. There is a general atmosphere of violence in this region with the children caught in the middle."
Insecurity is compounded by an often shattered life at home.
"The night-commuters are very much part of the wider devastating effects of the conflict on the people," continues the MSF psychologist. "They come here to find peace of mind as well as safety."
Be it directly or indirectly related to the conflict, the effect on the mental health of many children is clear. A recent study of 170 children in the MSF shelter showed that 23.5% were demonstrating signs of severe psychological distress, with a further 37.5% were at risk of slipping into this bracket. Through a psycho-social programme, one of the aims of Fran Miller and her team is to stop this happening.
While the situation in the north of Uganda remains so fragile, her battle is an up-hill one.