The first time a knife was put to Anna Alwoch's face, her lips were hacked off by rebels. The following two times, surgeons rebuilt her mouth - and the process is almost complete.
Alwoch, 55, is on a list of candidates for plastic surgery to repair her face, along with other victims who were mutilated by members of the rebel Lord's Resistance Army (LRA) in northern Uganda. The LRA massacred thousands and abducted more than 10,000 children to be soldiers and sex slaves during its 20-year rebellion against the central government. More than two million people were uprooted in the conflict between the rebels and Kampala's troops before a ceasefire was declared in July 2006.
The group became notorious for extreme brutality, including cutting the lips, ears and noses of civilians, chopping off villagers' body parts and beating victims to death.
Alwoch and her two children, one only seven months old at the time, were captured on a clear afternoon after a nearby clash between government and rebel forces. After being raped, she and the children were moved to a secluded shed for torture.
"The rebel commander ordered for my lips to be cut off. But he said that if I made any noise of pain, I and my kids were to be killed," Alwoch says, sitting on a straw mat in a bright blue dress, a cross on a pearl necklace hanging around her neck.
A breeze sweeps through the quiet cement compound where tiny, grass-thatched huts mingle with robust mango trees. As chicks and children scamper about, Alwoch describes how a rebel used a rusted piece of tin to slice into her mouth.
After he finished cutting, the rebel then ripped her lips off - and Alwoch promptly fainted from the pain. When she woke up, her children were gone. She later found them hiding near her home, but recalling the event that occurred in 1992 still brings Alwoch to tears.
In the late 1990's, a nearby hospital offered to perform reconstructive surgery on this housewife and broom-maker. She jumped at the chance. "I thought I could be made the way I was before," Alwoch says, scooping up little children as they wander by.
And she was, to an extent. Her bottom lip was completely restored. But Alwoch says the painful operations have made her wary of undergoing another procedure. In November, the Catholic charity Caritas arranged corrective plastic surgery for 16 war victims in Gulu, a town at the epicentre of the conflict.
"Many people from the community were coming for counselling because of trauma related to their deformities," says John Komakech, deputy director of Caritas Uganda. Counsellors thought the surgery could help victims fit back into society. Komakech said that some patients have said they already feel psychologically better after the procedures. "That, to me, is success," he says.
The 16 awaiting surgery were selected out of a massive list of nearly 3,000, a number that continues to grow as more victims find out about the programme and register.
"We are trying to organise with Mulago Hospital (in the Ugandan capital Kampala) a way to operate on the other victims," says Richard Todwong, special presidential advisor on northern Uganda. Thick books filled with grim pictures and files on disfigured war survivors crowd the shelves of Todwong's office. The list of needed procedures ranges from minor facial corrections to full limb replacements.
Todwong said most mutilation victims have suffered some level of ostracism upon return to their communities, adding to the trauma of torture by the LRA. This was the case for Alwoch, who said some neighbours mocked her or made disparaging remarks about her disfiguration. Though she still has difficulty performing certain simple tasks like blowing out a candle, she has not yet decided whether she will go under the knife again. She says she does not need more surgery to feel comfortable. "I accept the way I am. Once you have a scar, you have a scar."