Interview with Les Roberts

Les Roberts is an Associate Clinical Professor of Population and Family Health in the Program on Forced Migration and Health in the Mailman School of Public Health at Columbia University.

ePulse: What is the name of the program you are affiliated with?

Les Roberts: I teach in the School of Public Health at Columbia in a program on Forced Migration and Health.

ePulse: Do you consider yourself an activist?

LR: No, I consider myself an advocate. That’s different from an activist. I guess I think every one of my opinions is open to be changed if evidence shows me that my assumptions were wrong. I think that makes me a scientist.

ePulse: I was going to say, “more so than a scientist”, but you have already answered that. I was going to ask how you see science and activism intersecting, but how about if we say, “how do you see science and advocacy intersecting?”

LR: Science defines problems for us. It’s not the only thing it does, but in public health, that’s one of the main things it does. When the response to a problem isn’t appropriate, isn’t adequate, the scientist who made that measurement - who understands the meaning of that measurement - suddenly then has a responsibility to society to continuously point out that that response is inadequate or inappropriate, as the case may be ... just like a legal scholar has a unique responsibility to point out to society when something is unconstitutional.

ePulse: Well, the next few questions are based on activism. I didn’t expect the “no” (Les laughs), but we’ll continue on anyway. When did you first consider yourself an advocate?

LR: In 1993, I went to Bosnia and I didn’t want to go. It was during the Clinton administration and the State Department wanted an assessment done. I had just been married and two days after my wife moved to Atlanta I had to go to Bosnia and leave her alone in Atlanta and I wasn’t happy with it.

ePulse: You were with the Center for Disease Control?

LR: Centers for Disease Control. A colleague from CDC, Brent Burkholder, and I travelled around in central Bosnia and people kept telling us all of these absurd rumors. For example, the Bosnians kept telling us the Croats were buying German castration devices to castrate [their] boys. And another rumor we’d heard was that snipers would shoot children in the legs as bait. And in times of war these rumours run wild. So Brent Burkholder and I went to the Main hospital in Sarajevo (it’s called Kosovo Hospital) and we went through the recovery or surgical ward. In a city where only a tiny fraction of the people were children because the children had all been sent off to live with other relatives, more than half the people in that surgical ward were children and they had almost all been shot in the legs. I realized that this rumour that we had scoffed at was true.

About a year before, my boss had written an editorial in the San Francisco Chronicle essentially saying how inhumane and unacceptable this war was and in particular [in reference to] the actions of the Serbs in this war. As a scientist, when I read his op-ed, I thought that it was stretching beyond science. But then I saw these little kids and just thought of the notion that systematically soldiers were being trained to shoot little kids in the legs as bait. That wasn’t an individual wacko, this was a national strategy for a military. I realized that when you start witnessing events like that, like my boss had a year earlier, that it is incumbent upon you as a human to translate that exceptional horror in a way that the public can respond appropriately. Because we don’t have good ways of quantifying horror. But in public health, horror is one of the things we encounter and record.

I think that’s when I fully understood the need to step beyond peer review journals and statistical analyses if you are going to do effective public health work in times of war.

ePulse: From limited exposure to your work and from meeting you, I have the sense that you are sort of a full-time advocate at this point in your career. That it’s kind of your job.

LR: I think so, and well, I think that’s because we are here in a place where I have come to speak. If you met me in the middle of a war in Africa, I would seem like this sort of busy, boring guy who is focused on getting numbers.

ePulse: But that would still be, I guess what I am saying is that, that is ...

LR: ... that’s all part of the package.

ePulse: Yeah, being in the middle of a war in Africa, that would be the activism portion, I guess. Your career is ...

LR: Peace and justice.

ePulse: Yes, social justice, peace and justice, exactly. So, when did you make the transition to your entire, your career, your job, your everything, your being, this peace and justice ...

LR: That was 1984. I went to Kenya to teach high school - to teach high school physics - and when I got there, I saw these women carrying water on their heads unbelievable distances. It was just heart-breaking. And I thought, “if these women need to carry water on their heads miles every day, the world doesn’t need more physicists.” The world needs more water and food and medicine and some pretty humble things.

ePulse: So environmental engineering.

LR: I went to Public Health school to advance justice in the world. It just so happens that when your topic is water, the way you advance it is by helping people organize, raise money, understand science, have access to technology so that they can get their water. That’s your mission.

When you start working documenting events in war, the public health response - the most important public health response - is ending the war. Which is innately far more political than getting a village water. Getting a village water can be political, but ending war is by its very nature more political.

ePulse: Did you have a mentor?

LR: Yes. I had a couple. The most important one was at the Centers For Disease Control, my boss, Mike Toole. He was a physician, an Australian, and he was probably the world’s foremost authority on refugee health. He really nurtured and pushed me. He had a very wonderful blend of kindness and high expectation. Which was annoying on certain days (Laughs).

ePulse: On Monday mornings?

LR: When he wanted me to go to Bosnia and I didn’t want to go. But he was and still remains a wonderful mentor. When I think about changing jobs, when I have struggled with the hardest things ... quitting my job at the International Rescue Committee in protest of their participating in the Coalition [of the Willing in the war on Iraq], he is the main person in my profession whose advice I seek.

ePulse: What motivates you to go into these intense war zones?

LR: Catholic induced guilt. It happens that I have been trained to do this, fate hasn’t brought us children and I have an incredibly idealistic and supportive wife. There aren’t many people who are willing to have a conversation in which you decide there is a really high chance you are going to die in Iraq, but that this is more important than your life so you should go and do this anyway. And when I went to Iraq, I’m not sure I expected to die, but I thought the probability was really, really high ...

ePulse: Actually, I was going to ask you about that. On the radio [This American Life, "What's In A Number"], you said, “I had consciously made the decision that it was worth trading my life for a chance at getting a realistic estimate of how many Iraqi civilians had died and how they had died.” You also said, “I was at peace with the notion of dying”. Where does that come from?

LR: More extraordinarily, my wife ... no she wasn’t at peace with it. She was not even close to being at peace with it. But she was willing to tolerate it.

Where does that come from? I don’t understand the question.

ePulse: I had a couple possibilities ... Does it come from a passion to right wrongs? Does it come from anger? That’s an intense personal decision.

LR: I just don’t understand this. We’re now probably close to a million Americans [that] have been willing to go risk their lives to go serve and kill in Iraq. How is it possible, in a nation that paints themselves as Christians, that my being willing to go and take a risk - perhaps comparable - in order to help document wrong-doing and serve the Iraqis, is different?

ePulse: It’s not.

LR: It’s bizarre. The way you asked it was very kind and flattering. A few people said something like I can’t really love my wife if I would leave her and go do this. We [as Americans] have this notion that it is more noble to go fight and die for your country than it is to go wage peace for your country or your species.

ePulse: I hadn’t even considered that. I’m glad I asked.

What is your experience of the reaction to your reports on Iraqi Civilian mortality?

LR: My experience this second time around ... I’m not sure anyone has made serious criticisms of it to my face other than a couple of reporters who asked questions. I think I have pretty clear responses to all the criticisms they make. A few reporters haven’t been convinced but I think that is because they have mostly made up their minds in advance of calling me. They are not calling me to collect information. They are calling me to write a piece whose basic conclusion is already formed in their mind.

ePulse: But nothing [written] really attacking the soundness of it.

LR: No scientist has. Scientists have asked good questions, but no scientist has said, “I’m convinced this is wrong because of this.” There are a couple of folks in England who have essentially said this, reporters, but I haven’t heard them say this essentially face-to-face. And I think they have another agenda. And they are not people who [have] ever done this before and who have any credibility in the field.

ePulse: Do you ever get angry? I guess there are two parts to this: 1) Do you ever get angry at the scrutiny of your reports, and 2) Do you get angry at what you see when you enter these war zones, when you are in Iraq or the Congo?

LR: The answer to [the second] is “Absolutely!” Yeah. What could make you get madder than - in the case of the Congo - society getting pushed so hard that children die like flies. Or in Bosnia, snipers shooting children as bait. What could be worse than that?

But as far as anger about in particular the press spin, which I think is what you are talking about. Scrutiny is more people saying they didn’t go to enough places to make a representative sample or there wasn’t really enough time for them to have possibly done this many interviews. Even though if you just look at the math in the paper, it’s more than an hour in the field per team and its absurd that a four question interview couldn’t be done in an hour per average. No, those things don’t make me angry. They make me disheartened and sad when I see them given so much credibility when they are so profoundly stupid in basis.

But the active spin on this, and in particular the need for President [George] Bush to deny this within an hour or two of it coming out, I see as testimony to how pertinent and important this is.

ePulse: Do you experience detachment when you enter a war zone in terms of personal safety in what you see around you?

LR: No. In terms of personal safety, you are always making decisions, making judgments to maximize your safety, and in particular the safety of your coworkers. I think, in fact, when you talk to a family who has lost someone and when in my case, I’m away from my wife for windows of months, I actually value life more. So in terms of some of the things we have heard soldiers say, for example at this conference, I don’t think I get reckless at all in settings of war. In fact, I probably start valuing my life more than I did before I came.

ePulse: Makes sense. [That] is something that someone like myself couldn’t see without experiencing that. So how do you prepare yourself to enter a war zone?

LR: Study. The most important thing is having colleagues who value you and want you to stay alive. By far that’s the most important thing for staying safe. [It is] infinitely more important than armed guards or all these strategies about driving in different ways to work every day and not putting your seat belt on until your driving and all those things they teach you in your security classes. Those things are trivial compared to having really competent, in-tuned colleagues that care for you.

ePulse: [Let’s] shift gears a little bit. Would you describe the program that you are currently teaching in?

LR: Yeah. It’s a really small program. There are three professors there most of the time and one or two more who wander in for a day or two for eight weeks in a row, so it’s very small. About thirty master’s students. Its purpose is to prepare people to be NGO and UN type workers in emergency settings. I have a lot of friends who teach in undergraduate schools and tell me how unmotivated their students are or my brother’s girlfriend who teaches graduate students and tells me how unmotivated in theater they are. I have brilliant students who work incredibly hard. It verges on inconceivable that they pay me to do this. It’s a really nice setup.

ePulse: Awesome. What sort of projects are you working on?

LR: One thing that I’m working on actively over a couple of years in our little group at Columbia is working on getting a method developed - a simple reproducible method for estimating the number of women that are raped in any window of time. Rape is about the hardest thing to interview for. I share an office with a doctoral student who is working on that and so I spend a little of my time and I expect I will spend a significant amount of time over the next couple of years with many, many master’s students going to different places and repeating this method for trying to estimate the incidence of rape in a population.

ePulse: How do you conduct your research on civilian mortality?

LR: Every war is different and so the answer is different in every setting. In Darfur, I attempted to do the survey through an international NGO. In Congo, I did it with the International Rescue Committee who had wonderful local staff; just amazing Congolese staff who made it all possible. In Iraq, it was just essentially me and a professor and we just set up everything we needed in terms of drivers and interviewers and finding out about security without any institutional support. So it is different in every setting.

ePulse: Are there others doing research similar to the civilian mortality research?

LR: Yeah. There are. I wouldn’t say lots. But there are a couple of dozen people who have done this before. And every year there is one or two more wandering into the field.

ePulse: What sort of education did you receive to get into the field?

LR: The education I had was not very relevant to what I am doing, except for introductory classes in statistics and epidemiology. My years of studying physics and engineering and the vast majority of my public health classes did not ... I take that back. The physics actually might have been the most important foundation of what I do now just because the world of physics is about making rules so that you can explain things and describe things either in categories or probabilities and that’s what measuring mortality is about as well.

ePulse: Have you ever considered doing such an analysis in a non-war zone that has high mortality such as South Los Angeles or El Salvador?

LR: The answer is yes. In a place like South Los Angeles, even though you think the mortality is high, you would knock on a lot of doors before you found someone who has died. The death rates we measured in Congo would be many times higher than the death rates in South Los Angeles. That’s thought number one. Thought number two is measuring mortality with surveys is really only a good option when the vital registration process has broken down. In the United States, it is very rare that a death does not get recorded.

So if you want to understand, what are the dynamics, or what are the neighborhoods, or what are the risks in South Los Angeles, associated with someone dying or dying violently, it would be easier and more fruitful to analyze data from a coroner’s office that has already been collected than it would to go knock on doors when nine out of ten houses hasn’t had anyone die in the last five years.

ePulse: This is a last best option.

LR: This is when everything else won’t work.

ePulse: What about in a country such as El Salvador?

LR: This is how the UN measures mortality in most dysfunctional countries. The reason we know what the death rate is in Angola and Columbia is because the United Nations goes and does a cluster survey because they don’t trust the registration processes.

ePulse: That brings an interesting question: If it works everywhere else, why doesn’t it work in Iraq?

LR: Oh, it works.

ePulse: That was a setup, I guess. Can you describe the situation in the Congo?

LR: Now?

ePulse: When you did your research in the Congo.

LR: Well, describing the situation in the Congo is a lot like describing the situation in California. There are pockets where its really posh, and there are pockets where things seem really bad. The war in the Congo involved gangs of guys running around in the forest and periodically appearing and stealing food and raping women and then they would go back into the forest. So it was, as wars go, very low intensity. On any given day, it probably wasn’t one in a thousand people that saw a combatant.

But because people were so poor and living so close to the edge already, having these soldiers come and having to all flee into the forest to hide from them made it so people just died at an extraordinary rate.

There was one area in 2000 called Moba. I think it was a health zone with, if I’m not mistaken, 60,000 people. And when we did our survey about two-thirds of children died by the age of two. They weren’t shot by bullets, [it was] just the economy didn’t work. People wouldn’t dare drive trucks down roads. No clinics functioned. Periodically almost everyone in this district would repeatedly run into the hills and hide from rebels who were coming.

But it looked beautiful.

ePulse: The country itself

ePulse: How was your report [on the Congo] received?

LR: Incredibly well. The first time around, IRC, to their credit, wanted to try to release it through the newspapers. I wanted to get it published through a journal. In the end, they convinced me that their approach was right. We got it on the front page of the New York Times. The results spread around the world and were on the BBC, covered very widely.

Given that we just went to five little pockets and extrapolated our results out to twenty million people, it was very weak science, compared to Iraq which was a nationwide sample. Other than the Minister of Health of the invading country, there was not much scepticism.

I think part of that was that we were very upfront about our limitations. We said that this is the best we could do, here’s what we think, here’s why it might be too high, here’s why it might be too low. I think the critics for the most part said, well they’ve pointed out why this might be too high and why this might be too low. By being so forthright about our limitations, I think it prevented a lot of criticism that would have come otherwise.

ePulse: How have the situation and results differed from those in Iraq?

LR: The Iraq study is far better.

ePulse: Scientifically?

LR: Scientifically, but this time, the belligerents have the capacity to spin the story.

ePulse: Isn’t there a difference in the way people are dying in Iraq as well?

LR: Yes, I didn’t realize that’s what you were asking about. Yes, in the Congo, most deaths were from infectious diseases induced by violence. In Iraq, people are dying of violence primarily.

ePulse: How many times have you been to Iraq?

LR: Just once.

ePulse: Do you know anyone who has been killed in Iraq?

LR: Yeah.

ePulse: People you have worked with?

LR: Well, the first person that I started this study with, Riyadh Lafta’s best friend died in an auto accident in the middle of our email exchanges with him. There was an American gal named Marla [Ruzicka] and she worked with this group in Washington called CIVIC. They essentially tried to find families who had lost someone so that they could get reparations from the U.S. government and she was killed in Iraq.

ePulse: How should the U.S. proceed in Iraq?

LR: Apologetically. I think that, in spite of what others would say, our study shines no light on the question of what to do next. Our study is about what has been and we started out using too much force and being extremely cavalier about being respectful and inclusive of Iraqis in our efforts. And now it has evolved so that it is mostly Iraqis killing Iraqis.

I think that Iraq is like California. There is not one situation. There are many places right now where neighbourhoods are ecstatic to have America soldiers there. There are many neighbourhoods where the vast majority of people want the Americans killed. There isn’t one right answer

ePulse: What’s your impression of the media coverage of your reports?

LR: It’s been mixed. Most has been reasonable. The media needs to make things controversial. The New York Times wrote a mostly favourable article when this came out, but I know they called several people who were supportive that they didn’t quote. They shopped around until they found a statistician in Texas with no experience in this area who said he thought the methodology was inappropriate.

I think that there is a certain shallowness in the media today, by which essentially, out of incompetence or cowardice, they are afraid to take a stand or to sound like they are endorsing something. They need to find a contrary voice even if they have to call ten people to find it. In Al Gore’s movie, An Inconvenient Truth, he has a lovely vignette describing this. Over a window of time, every peer-reviewed article that they could find - I think it was up to around 800 articles - concluded that global warming was happening and from most of them that man wa causing it. Over half of newspaper articles in the same window of time cited contradictory evidence or opinions. That’s one thing that’s disheartening.

Another thing is that there are a couple of numbers essentially all based on the Iraqi government's figures that the press continues to quote. And if you believe these numbers, then New Orleans and Baltimore have been more violent over the last four years than has Iraq, as a rate. That’s just asinine. I’m sorry that because it is safe and easy, people quote the Iraqi government or quote the UN who is quoting the Iraqi government without any consideration of the absurdity of those estimates.

ePulse: Do you feel that your reports are more accepted now than when you released them?

LR: Yes.

ePulse: Do you think that that is a function of the increasing disapproval of the war?

LR: Let’s talk about the 2006 report. Is it more accepted today, five months on? Yes. I think the reason is in the week after it came out, most of the commentary and criticisms were by people with no expertise in this area. Over time, more and more people have seen public letters by scientists chiding Prime Minister John Howard for example for dismissing the study. People have had a chance to talk to someone who knows the science. I just think that once the original hoopla and spin had subsided, the strength of the work speaks for itself.

ePulse: How have the Iraqis reacted to your work?

LR: The minister of health tripled his estimate from 50,000 to 150,000 in the months after the study came out, but the Iraqi people for the most part know that this is true. Our study is saying that one in seven families has lost someone. The Iraqi government was up until then saying that one in eighty or one in a hundred families had lost someone. Most Iraqi families know that, while at first the number was probably shockingly high, when they started thinking about it, everyone has lost a cousin or someone and they realized that it is true.

ePulse: Has it been picked up al-Jazeera or other global news outlets?

LR: In the Middle East, in most of the world, our estimate is the estimate, because it is certainly a far more complete way of estimating than any of the other efforts.

ePulse: Did the Iraq Study Group consider your work?

LR: Our second report came out just before they were finished, but I can’t answer that, I’m not sure. But I can say that they pointed out that the U.S. military’s monitoring of attacks was very incomplete. In particular, they cited one day in July, where the U.S. government reported 100 something attacks and when they went out and started collecting information for themselves for that one day, they found about eleven hundred.

So the Hamilton-Baker report essentially confirmed our findings that surveillance is extremely incomplete, although that was attack data and we were talking about deaths. My guess is that the incomplete nature of the surveillance is similar between the two.

ePulse: Are you optimistic?

LR: Am I optimistic for our species? Absolutely. Am I optimistic about Iraq? Yeah. It’s absolutely going to get better? Am I optimistic about the next two years in Iraq? No, I’m just sick at the notion that I can’t see things getting better in the next year.

ePulse: Thank you very much for sharing your words with me and with medical students the world over.

LR: I hope that medical students the world over will do better than my generation has at convincing the world how obscene war is. It is so crazy that we could have hundred of thousands of people that were willing to get together to go over there and invade Iraq. And to the best of my knowledge there was only one American who stayed there to work as a health worker to benefit the Iraqis during that process and he was working for the Red Cross.

What does that say about us as a society? That we can easily marshall two hundred thousand to go kill and only one out of three hundred million is inspired to go save?

ePulse: Not much.

LR: Well, it’s been a pleasure.

ePulse: Thank you. Again, thank you.

Les Roberts is an Associate Clinical Professor of Population and Family Health in the Program on Forced Migration and Health in the Mailman School of Public Health at Columbia University. Joshua Cook teaches Algebra in South Los Angeles.

An Interview With Les Roberts

Dr. Les Roberts

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