Since 1982, South African destabilization of Mozambique has caused children's health to deteriorate. Destabilization has functioned through support of a surrogate movement and economic pressure. Attacks on economic and civilian targets have included the health services, leading to closure of 48% of the primary health care network. The war has caused displacement of over 3,000,000 persons and an estimated 494,000 excess childhood deaths between 1981 and 1988. An estimated 200,000 children have been separated from their families or orphaned; many children have also witnessed atrocities and suffered violence. A deepening economic crisis has been followed by an economic structural adjustment programme. Responses to the war include changes in vaccination strategy and programmes to reunite families and heal psychological trauma.