GOMA, Congo -- The HEAL Africa hospital has a feeling of newness rare for this part of Africa, mainly because its previous facility was destroyed by lava from Mount Nyiragongo in 2002. One building holds people with bullet wounds -- shot through the pelvis, the thigh, the jaw. Another ward contains women recovering from fistula repair surgery -- the quiet victims of extreme sexual violence who tend to avoid your eyes.

In another room, families whose children have congenital defects such as clubfoot and cleft lip are gathered. A surgeon at the hospital introduced my group, "These are visitors from Obama country!" Everyone applauded.

Expectations for the president-elect are not just high in America. And eastern Congo will be an early foreign policy test for the administration -- its suffering not only engages our conscience, it is the most urgent expression of a difficult question: What does America do with failed states and regions?

After generations of mismanagement, the vastness of eastern Congo has become a vacuum of sovereignty. And the chaos has attracted some very bad elements -- Rwandan genocidaires, Lord's Resistance Army terrorists, militias of every ideology and description.

The Congolese government -- corrupt, inefficient and based in the faraway capital of Kinshasa -- is in no condition to exercise effective control. Its army often goes unpaid, turning whole units into armed gangs of looters. One Congolese commander in Goma reported that during recent fighting, he could count on the loyalty of only 50 out of several hundred men.

So the government tries to cling to sovereignty by cooperating with militia groups. Its forces are often based within a few kilometers of FDLR units (a genocidal Hutu group) or Mai-Mai militias (local defense forces also capable of atrocities). It is like a mayor turning to the mob for reinforcements. Adding insanity to incapacity, elements of the Congolese army have fired on United Nations forces (MONUC). And some government officials have incited riots in Goma against the peacekeepers, attempting to pin their own failures on a scapegoat.

The strategy of the main rebel group -- the CNDP, led by Laurent Nkunda -- is designed to exploit this weakness. In areas they conquer, the rebels establish civil administration, appointing mayors and judges and promising security. Some tribal leaders have switched sides to accept CNDP authority -- motivated by fear, but by also a desire for stability. Even Hutus have joined Nkunda's Tutsi-led militia -- where they get regular pay, and become part of a working institution. Continued...