Dr. Oscar Quijano touched his pinky to the hole in the head of the latest skeleton brought to the metal slab before him.
It was clear she had been killed "in a violent way," Quijano said as he examined the skull of one of the many people slain despite a controversial, now-broken "truce" between El Salvador's most powerful street gangs.
The forensic specialists here in the Salvadoran capital are routinely called to clandestine graves holding multiple corpses, or to neighborhoods where bodies have been dumped on the sidewalk. March was the deadliest month in a decade, according to tallies by the Prensa Grafica newspaper: 16 killings a day in a country with far fewer people than Los Angeles County.
The truce, brokered with the government's nod, was praised in some quarters for significantly reducing El Salvador's official homicide rate, which, along with that of neighboring Honduras, was the highest in the hemisphere.
Some in El Salvador believe gangs used the truce, which broke down after little more than a year, as cover to consolidate and grow. And they question whether violence truly ebbed as much as suggested, noting that homicides may have declined but disappearances increased.
Today, rival gangs — descendants of the Mara Salvatrucha and others deported from the United States in the 1990s — control entire neighborhoods, able to exact protection money, hold ad hoc tribunals and decide where residents can live and businesses can operate.
They act essentially, analysts say, as a parallel government.
And the killings continue to mount, as they battle for pieces of a drug-trafficking business that has expanded with the arrival of Mexican cartels.
In Quijano's lab at the state-run Legal Medicine Institute on a recent day, half a dozen metal tables displayed the bones of some of the latest discovered victims, all thought to have died as long as a year ago. The remains were pulled from hidden graves, the more shallowly buried exhibiting the teeth marks of dogs or other animals.
Some victims, like the young woman whose skull Quijano was examining, had been shot; the cause of death of others was not yet clear.
"If we find them in a clandestine grave, we assume their death was a violent one," Quijano said.
The latest group of 30 bodies reflected the current demographic of the dead, he said: About 60% were 16 to 22 years old, and of those at least 30% were female. According to international organizations, El Salvador has become the region's deadliest country for youths and women.
"The age is steadily getting lower," said Dr. Saul Quijada, another of the forensic physicians.
The team believes it has only begun to scratch the surface; additional hidden graves could contain hundreds of bodies. And, as has happened in Bosnia and elsewhere, the gangs here often dig up and move bodies if they know investigators are closing in, Quijada said.
"We don't even exhume many of the graves," Quijada said.
In scenes reminiscent of El Salvador's 1980-92 civil war, in which security forces and death squads routinely made opponents disappear, clusters of frantic, weeping relatives arrive at the morgue steadily in search of missing family members. Today the gangs are added to the mix of culprits.
Typically, the beseeching relatives are shown pictures of corpses in attempts to get an identification. Outside, families have hung photographs of the missing on bulletin boards.
Marvin Ruiz, a 23-year-old soldier, disappeared while on a motorcycle ride a couple of weeks ago.
"We've come here [to the morgue] a lot, and two times last week after they said they'd found a body, but it's pure bones," said his mother, Maria Julia Dugon.
She said the gangs that control so much of the country are increasingly targeting soldiers and police officers, an assertion borne out by official statistics. "Our lives have been sold out by this situation of violence," she said.
Sandra Avalos sat on the front steps of the morgue, sobbing and retching. Her 18-year-old son Christian, who works in a bakery, had not returned home for two days. They live in one of many neighborhoods controlled by a gang, and she feared the worst.
"We already checked at the police and he hasn't been arrested," she said, before breaking down again.
The Salvadoran police registered 2,392 missing people last year (only 456 reappeared alive), and the pace this year is about the same.
The gang "truce" officially began with a much-publicized religious ceremony by imprisoned leaders of the two main gangs, MS-13 (the Mara Salvatrucha) and the 18th Street gang, in March 2012. It had been negotiated under the auspices of former guerrillas of the now-ruling Farabundo Marti National Liberation Front and a prelate from the Roman Catholic Church.
The government of then-President Mauricio Funes at first denied, then was forced to acknowledge, participation in the negotiations.
In exchange for holding fire, the gangs were granted transfer of their leaders from a maximum-security prison to jails closer to their families — and their foot soldiers — with expanding visitation and access to cellphones.
From its inception, the truce was controversial, criticized by many in law enforcement, the legal establishment and conservative sectors, all of whom objected to negotiating with criminals.
Homicide rates initially dropped, then, about a year later, began to rise again, along with the vocal criticism of opponents. The truce formally broke down in May 2013.
Early this year, President Salvador Sanchez Ceren seemed to close the door permanently on efforts to renew a truce by transferring the gang leaders back to the maximum-security lockup at Zacatecaluca.
Raul Mijango, a former guerrilla and legislator who was one of the chief truce negotiators, said the government was making a terrible mistake by ending the possibility of talks with the gangs, citing electoral politics for the move and saying that violence would only soar out of control. Sanchez Ceren ordered the transfer a few days before midterm elections, appealing to voters by appearing tough on gangs, analysts said.
Mijango denied the criticism that gangs had used the truce to strengthen and expand. But, he acknowledged, "theirs is a power parallel" to that of the state.
That power has reached into every sphere of Salvadoran society.
At a gritty school named for a government minister slain in the civil war, children of members of both gangs attend class, carefully navigating the territory just across the street controlled by the 18th Street gang.
Alejandra, 9, in the school uniform of a white blouse, navy skirt and white knee socks, said she knows how to reach the school by lateral alleyways, never using the main road that is under 18th Street control.
Her family members are in a gang, she said, and her brother was recently killed. They endure routine police raids. "They arrive and take a lot of the boys away," she said. "They took my dad."
Her teacher, Gladys Garcia, said that everyone treads carefully at the school, but that the gangs generally leave it alone because they want their children to be educated. But forget the PTA. Only an occasional mom or, more likely, grandparents dare show up at the school in enemy territory, Garcia said.
The presence of soldiers or the police for the last five years has done little to settle the atmosphere.
The gangs "feel like they are the authority, and can do what they want," she said.
Principal Almicar Rivera has been working at the school for 22 years. Except for the bodies left on the sidewalk, or the seventh-grader who threatened to kill him the other day, or the knowledge that he dare not expel a student, not to mention the regular extortion payments, Rivera says he gets along just fine.
His nickname for the place? Vietnam. Why?
"Because Vietnam also was a war that could not be won."