Heshima winces in pain as he tries to shift his weight, sweat beading on his face. The slight 13-year-old sits on a bed in a tent in the grounds of an overcrowded hospital in Goma city in the east of the Democratic Republic of Congo.

Heshima’s left leg is a bandaged stump, his stomach is streaked with burn marks, and both of his parents have been killed.

A relative, Tantine, tells us who is to blame: M23 rebels – backed by Rwanda and battling the Congolese army, known as the FARDC. The rebels now control the two largest cities in this mineral-rich area, which borders Rwanda.

“It was a Sunday,” she says. “There was fighting between them and the FARDC. They dropped the bomb, and I lost six members of my family.”

The M23 portray themselves as freedom fighters, bringing peace and order to a failed state, and a failed leader in Congolese President Félix Tshisekedi.

The rebel group, mainly comprised of ethnic Tutsis, has been on the march since early 2022, seizing swathes of territory – with the help of up to 4,000 Rwandan troops.

That is according to UN experts who say Rwanda has “de facto control” over the group – claims Kigali and Rwandan President Paul Kagame deny.

The price of the M23’s gains can be counted at Ndosho Hospital, where Heshima is being treated.

Doctors are struggling to clear a backlog of civilians and soldiers wounded at the end of January, when the rebels took Goma. The M23 say they “liberated” the city.

The death toll in the fighting was close to 3,000 people, according to a UN estimate.

Four operating rooms are in use – simultaneously – throughout the day and sometimes at night.

“It’s been a terrible situation for the doctors,” says Myriam Favier of the International Committee of the Red Cross (ICRC), which supports the hospital.

The medics have been sleeping in the operating theatres, she says.

“Our medical supplies were looted at the very beginning of the escalation of the conflict. And we had an influx that was unseen before – between 100 and 150 patients a day for weeks.”

That is now down to about 10 admissions per day, according to Ms Favier, and “right now people are just trying to live again”.

Drive around Goma and the streets hum with motorbikes. Many shops are open, and pavement sellers are back with their piles of onions and avocados and tomatoes.

There is little sign of well-armed M23 fighters. They do not stand on street corners. They don’t need to. Everyone knows they are in charge.

One local journalist said many in the media are “self- censoring” what they report, waiting to gauge how the new rulers will behave.

One activist told me many were “living in a big silence” because of fear of reprisals by the rebels.

“This is the most worrying period of Goma’s history,” he said. “I am afraid, the future is very uncertain.”

Not according to the M23.

“Expect peace, security, development, job creation… a future with zero refugees, zero corruption, zero hunger,” Willy Manzi, a newly appointed M23 vice governor who has recently returned from Canada, posted on the social media platform X.

But a different message was delivered to tens of thousands of people who have sought refuge from fighting in recent years in a network of camps in Goma.

They were given 72 hours to go. The M23 want the camps erased, along with any rival armed groups hiding in them.

“They came and told us, ‘You have three days to leave,'” says Divine, 19, who has one child on her hip, and another at her feet.

“We were very scared because we have nowhere to go. Our houses have been destroyed. Hunger is killing us here, but how we can go home to nothing?”

As she speaks a crowd gathers around us. There are silent nods and worried faces.

“They were our enemies and now they are our neighbours,” says one man, who asks not to be named.

Home for Divine is Bulengo camp – an expanse of scrappy white tents, perched on dark volcanic rock, surrounded by green hills.

Many of the shelters are little more than scraps of tarpaulin. But the camp was something to cling to – until the M23 ultimatum.

When we visited many were already packing up, salvaging bits of wood and plastic, and rolling up bedding.

After ordering people out the camps the M23 later said they were “encouraging voluntary returns”.

It does not feel voluntary to many of the displaced.

Human rights groups say it fits a pattern of abuses by the rebels who they accuse of indiscriminate shelling, gang rape and summary executions.

They level the same accusations at the Congolese army and their allies.

The decades long conflict has its roots – in part – in the Rwanda genocide of 1994, when around 800,000 people, mostly Tutis, were killed by Hutu extremists.

Afterwards many Hutus fled into DR Congo, including some involved the genocide. Rwanda says they remain a threat.

Critics say Kigali has its eye on DR Congo’s vast mineral wealth, crucial for much of the world’s technology including laptops and mobile phones.

There are growing fears that the scramble for control of these riches could trigger a new regional war, with implications far beyond Africa.

Either way – if history is any guide – the treasures beneath the soil are unlikely to benefit the people here.

Back at Bulengo camp we met Alphonsine, who was leaving with her extended family, bent double with the weight of belongings tied to her back.

She said it would be a two day walk to reach her area, and there was nothing to go back to. Her home had been destroyed.

“How will you survive?” I asked.

“I came from suffering,” she said, “and I leave in suffering.”

Additional reporting from the BBC’s Wietske Burema and Göktay Koraltan.