A bundle of bloodstained rags lies on a wickerwork stretcher in the forecourt of Gisenyi hospital in north-western Rwanda. Yet another victim of fighting has been brought down from the hills which ring this town on Rwanda's border with the Democratic Republic of Congo (formerly Zaire).
This time it is a farmer from the Hutu majority who has been badly injured in a machete attack. The men who take him to hospital say his assailants were from Mudende, a nearby refugee camp of some 12,000 ethnic Tutsis from Congo.
"This is happening all the time now," said Celestin Ndarasi, the hospital administrator. "They are usually brought down to us in the morning after a night-time attack."
Not long afterwards news filters into town that 37 Tutsis were killed on Monday night at Arusha, a nearby settlement for Rwandans who returned from refugee camps in Zaire/Congo shortly before the 1994 Rwandan genocide. They are reported to have been attacked by Hutu militants and soldiers from the former Rwandan army who themselves returned recently from refugee camps inside Congo.
The dynamics of the conflict are complex, but the results are violently clear. More than three years after the genocide which claimed the lives of at least half a million people, mostly Tutsis, Rwanda is still locked in a vicious circle of murder and revenge. The Rwandan-backed victory of Laurent Kabila over the Mobutu regime in neighbouring Congo has not, as many hoped, brought peace to central Africa.
There is still widespread unrest in eastern Congo, and fighting has spilled over into Uganda. Meanwhile, Rwanda's Hutu extremists are back in business inside their own country, having been driven out of Congo where they sought refuge after the genocide.
The insurgents are making their strikes from bases among the tree-lined hills of Rwanda's north-west, a traditional Hutu stronghold. Some feel they are bent on a suicide mission but others fear they pose a more serious threat.
Gisenyi's inhabitants live in constant fear of attack. One morning last week they awoke to the rattle of machine-gun fire and the crump of mortars. The sound of battle came from the hills by the airport on the outskirts.
Never before had there been such a raid on the town by the bandes armees, official Rwandan shorthand for the Hutu rebels who roam the border region. And never before had they come in such large numbers. At least 1,000 insurgents took part in the attack, according to estimates of the Rwandan Patriotic Army (RPA).
"We treated about 15 injured [RPA] soldiers here," said the hospital administrator. When asked if any injured rebels were brought in, he smiled, then looked at the ground.
The inference is clear: this is a bloody war and few prisoners are taken. An average of 1,000 Rwandans are dying violent deaths every month in the north-west. A high number of these casualties are unarmed civilians, caught up in the army's attempts to flush out the rebels.
"We're very concerned by the high number of deaths," said UN spokesman Jose-Luis Herrero, "particularly by the number of extra-judicial killings by the RPA."
The Rwandan government, however, insists the security situation inside the country is improving as a result of the army's counterinsurgency measures. The Tutsi-dominated regime now in power has little doubt that it is fighting for its survival, and little quarter is to be shown to its enemies.
"These people [Hutu rebels] need to be hit hard," said Claude Dusaidi, political adviser to the vice-president and army chief, Paul Kagame. "We're not willing to treat them with kid gloves. They still have some local support but we put an end to the genocide and we'll get rid of this problem."
The concerns of the international community and human rights agencies, it is made clear, are not to be allowed stand in the way of eradicating armed opposition to the government. This is a fight to the death.