The man who did the counting

Epidemiologist Les Roberts was hired by the International Rescue Committee to tally up the casualties of war in Congo

Les Roberts' personal account of his mission in the Congo

June 21, 2000
Web posted at: 4:39 a.m. EDT (0839 GMT)

EDITOR'S NOTE: Les Roberts, an epidemiologist who teaches at Johns Hopkins University, went to the Democratic Republic of the Congo this spring to oversee a series of surveys for the International Rescue Committee aimed at quantifying the level of civilian death in the war-torn country.

After two grueling months, of being "on" all of my waking hours, the peers, friends and press folks I speak with never want to ask the tough introspective questions.

They never ask, "How can it be; where almost every family has lost someone from this war, where they see and fear armed combatants on a daily basis, that small children will run up with smiles, and crowd around you just hoping to catch your eye, or better yet, hold your hand, with absolutely no fear in their hearts? Yet, in my safe country, saying more than hello to a child on the street will send them running for their mother who in turn will call the police."

No one ever asks, "How can you leave your wife and 'cush' life in exchange for two months of continuous dealings with illiterate 17-year-olds carrying Kalashnikovs?" (Perhaps that is lucky, because I don't know the answers.) Instead they want to know, "How can you possibly measure mortality amidst the chaos of what is now the eastern Democratic Republic of the Congo (DRC)?" I usually interpret that to mean, "Can the number of deaths you claim have happened possibly be right -- or are you completely wacko?" The other thing they want to know is, "How bad were the risks?" The answer to all three is that everything is relative.

Many years ago, the U.S. military established a network of satellites to guide projectiles and aid in a variety of types of navigation across the earth's surface. Since that time, the Global Positioning System (GPS) has become an important navigational tool for campers, boaters, fliers, surveyors, and a host of other folks for whom the military is usually not in the business of supporting. Among those are public health workers. In recent years, GPS technology has become part and parcel of public health research and service. I have used GPS units in rural Uzbekistan to record the position of households we were enrolling in a study so that they could be re-interviewed at a later date.

The nongovernmental organization (NGO) for whom I often work, the International Rescue Committee (IRC), uses these units to quickly measure the distance between water sources and the populations for whom they would like to supply water. This takes perhaps 2 percent of the time needed to measure a distance with a tape measure and one of those devices on a tripod you often see surveyors use at construction sites. That's the way the IRC did it just three years ago. I spent last winter teaching IRC workers in Central Africa how to estimate water consumption in a population with a survey technique that depends on sampling places evenly over space, something made possible with the advent of GPS technology.

A mother and child who fled violence wait in Bukavu, Congo. The woman told interviewers that lack of food would likely force her family to return home to an uncertain fate

The eastern DRC is now in a level of disarray which is ALMOST incomprehensible. Up until 1996, it was the neglected backwater of the former Zaire. Given that it was the food basket and held the main stores of diamonds and gold for the country, former President Mobutu was certainly not going to let it go. But when it came to supporting universities, or infrastructure projects, those in the eastern provinces often felt neglected. But, neglect turned to destruction in 1996 when a coalition of forces, led by Laurent Kabila and backed by Rwanda and Uganda, took over in the east, and then steadily marched westward with the Mobutu regime crumbling before it.

Unfortunately for the Congolese, after only 15 months in power, President Kabila had a falling-out with his former backers and Rwanda and Uganda were back trying again to over-throw the Kinshasa-based government. This second round of war has drawn on for almost two years. A rebel government (the RCD) backed by Rwanda, Uganda, and Burundi has run things in the east, and anti-rebel groups have sprung up and aligned themselves with Laurent Kabila. In most areas, it is not safe for NGO workers or civil authorities to travel. Thus, the roads have disintegrated, the clinics are often not stocked or are unmanned. The limited economy related to food exchange, lumber, and mineral harvesting has come to a screeching halt. Into this transportation and communication nightmare, enters the role for GPS technology.

Using satellites where no roads exist

The difficult part about sampling is finding a way so that everyone has the same chance of being visited. When the Gallup Poll folks or the students at your local research university want to sample, they dial random telephone numbers or choose from resident lists. In DRC, local officials often know how many people are in a village or an area, but there are no lists, or addresses, or even roads in most cases. Thus, these GPS units allowed us to sample random points in space. We would drive, or ride a motorbike, or walk to one edge of a village or clinic area, store that point in our GPS unit, and then go to the opposite side of the area and use the GPS to measure the distance across. If we had measured the area east to west, we might also measure the distance north to south or just ask a local nurse how far the north to south was compared to east to west. While they could rarely say in kilometers, they always knew quite precisely how long it took to walk to any edge of their area.

Thus, we had with some effort, a crude estimate of the area of the village or clinic zone, with one or two points on the periphery stored in the memory of the GPS. The GPS unit guided us over hills and through rivers until we arrived at the chosen spot.

In most of the five different areas we surveyed, we visited 40 different "random spots" and interviewed the families IN five houses closest to that spot. Because spatial sampling "over-samples" rural folks and "under-samples" folks in crowded areas, we recorded the distance we had to go from the original spot to encounter five houses. This way, after the fact, we could determine if death in this rural setting was or was not related to crowding. On average, we had to walk about two kilometers, for each cluster interviewed. Over the course of five surveys, I walked between two and three hundred kilometers over hills and through swamps, and two of us each rode motorcycles over 200 kilometers on roads and paths which were mostly impassable to cars.

At each of the households, we asked an adult just three questions: How many people are in your household? (and we would record the age and gender of each); Has anyone in your household died since last Christmas? (if so, we recorded the age of the person, the month of death, and what the family thought they died from); and, Did anyone in your family die last year, 1999?

Being a skeptical scientist, I was prepared to discard this last question since remembering if a death was during December 1998 or January 1999 seemed to me, beyond the capacity of these calendar-less households. That was just one of many of my under-estimations of the Congolese. Not only did they know, but most of the mothers remembered the exact day. These deaths were so vivid and painful for these people. While some reported deaths in a manner like one might report rainfall, many others, especially those recalling violent deaths, would cry or talk about how the fabric of the family was torn. In the areas with the most violence, many households had lost several people.

One teenage girl described how her village was overrun by the Interahamwe, the Rwandan Hutu militia, who were largely responsible for the genocide against Tutsis in Rwanda in 1994. This girl told us that she and her family fled to the forest with no food, no blankets, and no water containers. They stayed hidden as much as possible, foraging a little for food with little success. Within a month, five of her eight family members had died of malaria. In the beginning, I kept asking my interviewers, "Can this be true? Are you sure they are not telling us sad stories because they want our help?"

My interviewers were incredulous. They would assure me that the mothers cannot lie about this, that people here do not fake tears.

So, how can one measure mortality in the chaos of the Congo? The answer is walk and walk and walk, and go ask. The families have not forgotten.

Kisangani: Home to diamonds and warring factions

As far as, "How bad are the risks?" -- they were huge, but everywhere I went others seemed to be taking larger risks in order for us to get our work done.

The first really tense spot was in the city of Kisangani, DRC's second largest city in the north-east of the country. It is where the first rapids on the Congo River occur, beyond which boats traveling up-stream can not pass. Doctors without Borders (MSF) Holland works in Kisangani and acted as our host and co-investigators while we were there. Things had been tense in the city between the Rwandan and Ugandan forces over the past year, and in August 1999, fighting had broken out between these two "allies."

Non-Governmental Organization workers in Kisangani and locals felt these tensions were over control of the lucrative diamond and gold trade. A prestigious think tank in Washington attributes these tensions to differences in philosophical approaches. Given the fact that the only people I saw frequenting the diamond shops were soldiers, and that the Middle Eastern diamond dealers were often driving around with soldiers, and that the only two well-dressed businessmen with whom I had long conversations eventually acknowledged being Ugandan officers, my vote goes with the local gossip. Nonetheless, tensions had risen and eased repeatedly over the preceding year causing MSF to evacuate its staff by airplane on two occasions.

During all of my travels, I was accompanied by a jovial Congolese nutritionist named Charles Hail. Like so many of my Congolese counterparts, he was very hard working, and very smart. Although he seemed to me, at first, particularly un-enthused about the possibility of being killed. On April 30th, day 3 of our planned eight-day stay, rumors spread about building tensions between the Rwandan and Ugandan forces. On May 1st, a reported 12,000 Ugandan soldiers arrived in town by foot. My MSF counterpart, an American nurse and old hand in Africa named Karen Kasen, took this all very coolly with an analytical approach -- if fighting begins, we will call for a plane and depart within three hours; if the airport is taken, first we will congregate at the MSF Holland house where we have emergency stocks....and until that time, let's stop talking and get the work done. Our 10 interviewers, who happened to comprise a statistics class at the local university, were convinced fighting was going to break out but took this very light-heartedly and were primarily concerned that their rare opportunity for paid work might get cut short. Charles just looked sick.

On the night of May 1st, the streets were deserted after dark. Bicycle taxis (tolikas) usually swarm the flat and crumbled streets of Kisangani. Last round of fighting, hundreds of these tolika drivers were grabbed by soldiers and used at transport slaves, sometimes for days on end. Having learned their lesson, these guys were nowhere to be seen. Kisangani had the empty look of Manhattan without cars. Groups of soldiers were far more numerous in town. I called IRC's director in Bukavu, Michael Despines, and explained to him that tensions were rising. He agreed to check in with Airserve, the NGO which flew us in to Kisangani, to see if we could move the return up a day or so.

Tuesday, May 2nd, things were really tense. Most of the shops were closed. There was the feeling one occasionally experienced in high school when an unknown someone had done something to really upset the teacher. The teacher confronted the class demanding that the culprit come forward, and the request was met with a long, tense silence. That tense silence seemed to grip the entire city of 600,000.

Interviewing in the shadow of violence

Karen from MSF, per usual, took this calmly and in stride. She said something to the effect of, "I would like us to stay here at the office for an hour or so until we see what the morning will bring. If at 9, there are still no problems, we will make sure each car has a radio and get out to work." We went to work, the tension remained but no fighting broke out. In the hour wait, the MSF director pulled me aside and said that if MSF is evacuated by air, there would be a seat on the plane for me, but that Charles would have to stay behind because he was Congolese, and thus not neutral in this conflict. MSF policy was that only expatriate personnel from countries not involved in the conflict could be included in an evacuation of humanitarian personnel. That was it: I called IRC in Bukavu and said we wanted to get out NOW! Michael said he would work on it, but if I get the chance to leave on an MSF plane, I should give all of my cash to Charles and get out. He would be fine, this was his country. Needless to say, this gave me quite a sick feeling. ... Charles was the most lovely and trusting of companions and to abandon him ... was a repulsive thought. On the other hand, he does not stand out (like I do) should any looting and uncontrolled violence break-out and he had friends and family in the city to stay with.

When I told Charles of the MSF policy and what Michael had said, his already demoralized spirit virtually shriveled-up. I suggested that if fighting breaks out, we ignore the plane option and just take a canoe down the Congo River, which has a swift current at Kisangani and could carry us 60 kilometers to the next major town in just 4 or 5 hours. He could not swim and was terrified of water. This was certainly the least appealing plan he had heard thus far. I tried to comfort him by telling him that we would have to assume that Michael would get us a plane, in spite of my knowledge of just how booked that plane usually was mid-week.

Both teams worked frantically until late that day and completed the last two days of interviewing in one day. We were finished. Charles and I packed up from our insecure hotel, where the doors had recently been kicked in and where staff and soldiers always looked at our sat-phone longingly, and we moved to the MSF house. This house of four expatriates graciously allowed us to slip in and feel as safe as was possible, given the state of Kisangani. On the phone that night, Michael had talked the Airserve folks into getting us at 1 p.m. the next day. I worked on a draft of our report until 2 a.m., slept a bit, and started again at 6 a.m., ecstatic and energized by the fact that I could still not hear any fighting.

By 10 a.m., I had a draft report finished, which later I found to contain a couple of minor but glaring mistakes. Charles was also energized, less because the fighting had not begun than because he was getting out of Kisangani. On that day when the streets were empty and transport was not available, he managed to find and pay all 10 interviewers by 11 a.m.

As the plane departed, I was feeling a bit like I may have overreacted. There had been no fighting yet. The U.N. official who jumped on our plane to Goma assured me that talks had begun and there would not be any violence. MSF was not ready to call for their plane and they lived here and knew the risks. As I contemplated my level of cowardice, Charles turned to me and said, "I am so happy to get out. If any soldier had stopped me on the street and I spoke, they would know I was from South Kivu and think I was Mayi-Mayi and ... " He gestured that his throat would be cut.

Suddenly, I felt vindicated. The risks Charles held the day before probably far out-weighed mine. That evening, fighting broke-out between the Rwandans and Ugandans, a couple hundred people were killed, almost none of them soldiers. The MSF office received major damage and a mortar hit the MSF house causing a minor fire. The MSF folks put out the fire and no one was hurt. Before it was over, the entire dozen expatriates in the Kisangani humanitarian community spent 12 days crowded into the MSF Holland house. They had experienced far more risks than I. Charles had probably experienced more risk than I. Every Kisangani resident who did not have the option of scooting-out before the fighting began probably experienced more risks than I. The risks had been bad, but the question was for whom?

Most of the hazards encountered were a little more mundane than the major fighting in Kisangani. One of the most acute dangers was Charles on a motorcycle, a realization I made during the last of our five surveys, in the port city of Moba. Moba is on Lake Tanganyika, near the southern border with Zambia. In this dusty fishing town of 15,000, there was only one privately owned truck, and because the roads were impassable just a few kilometers outside of the port, the truck was of little use to us. Thus, when Airserve flew us down in their nine-seat Cessna Caravan, they took out the back seats and we flew in with two motorbikes.

I had owned and ridden motorcycles when I was in my twenties, but that was 15 years ago. Charles had paid his way through college by venturing into the interior and buying gold on behalf of a dealer in Bukavu. He was great on a motorbike. Riding from the airport to the Catholic Mission (whom we imposed upon for the week) with 60 liters of fuel and all of our baggage, it was nearly impossible to stay up with Charles. The next couple of days, with a locally hired interviewer on the back of each bike, we went our separate ways. This was primarily because a string of villages running 18 kilometers south of Moba along the lake shore were best reached by canoe, and Charles was not going to go in a canoe! In the end, the canoes were not operating on the day of our southern jaunt, so we rode the motorbikes as far as we could and then walked the last 12 kilometers down and back. When we finally started a major trek to the west on the third day of interviewing, I and the interviewers were pretty comfortable on a motorcycle.

The town of Kala was 35 kilometers west of the mission. There reportedly had been a Mayi-Mayi attack on a village in between the night before. The priests said that there should not be trouble in the daylight hours but to look at the military check point after 18 kilometers. If the post was manned, there is no trouble because as soon as the Mayi-Mayi showed up, the Burundian and RCD soldiers would always run away. Charles and I decided to ride about 200 meters apart so that if one of us ran into trouble, the other might be able to escape. Also, we agreed to move at a steady clip. Charles started out ahead.

This was a bad mistake. About 10 kilometers into the journey we bounced down a road of cobbles ranging in size from that of softballs to the size of basketballs. As we crashed down a slope, I looked up to see a bridge ahead, and that I was too close to Charles. The bridge consisted of a log, 20 feet long, a foot in diameter with a flat surface planes on the top. At 30 kilometers per hour, Charles just zipped across it as if he was a circus act. My brain was not responding properly due to all of the jarring. I meant to brake, I thought about braking, but for some reason I opened up the throttle.

Suddenly, I was six feet above a rocky riverbed with a 150-pound, trusting mother of three on the back of this machine which I clearly was not controlling. I let go of the throttle, the bike lurched forward, and before I knew what had happened we were across the log. I slammed on the brakes, thinking of how I had almost killed my interviewer, and stopped to find out if I was going to throw up or not. Charles stopped up ahead, pulled up his face shield to reveal a big smile, and gave me thumbs-up. I suddenly realized that on this journey, Charles was far more likely to kill me than the Mayi-Mayi.

Friendly villagers, jeering soldiers

Kala turned out to be the most depressing place we visited. Like everywhere else, the people were lovely and trusting. (Over our five surveys which included more than 1,000 households, barely half a dozen refused to answer our questions.) But, the military were paranoid and drunk, a common and bad combination. We could see the entire town as we reached the edge. We started our routine of quickly guessing the dimensions of the village, chose four pairs of random numbers to correspond to the four cluster locations we needed to visit in Kala. It often took us longer to explain to the local officials or military why we were in their village than it did for an interviewer to visit five households. Thus, we dropped each of the interviewers at a different cluster location and then went to visit the military commander.

It was 10 a.m., and a large fraction of the soldiers in Kala were drunk. As we rode up, dozens of the soldiers cheered and jeered at the sight of a white guy on a motorbike. The commander was found after what seemed an eternity, but was probably two minutes, and he invited us into his hut. It was a mud brick structure with a thatched roof and a floor which was dug down about two feet below grade. There must have been 50 of the rockets which are used in mortars spread around on the floor. One of the drunk soldiers who wandered in behind us kicked one of the rockets, which gave a bonk as it hit another. I clenched, but none of the 10 other people in this shack seemed to notice. We showed him our permission letters, our questionnaire, and went through the usual routine. He wanted to know half-heartedly if we could spare any money. We laughed that one off. In the end, he said we could work but that we must take his Captain with us for our protection. Onto the back of my bike the 5'6", 250-pound Captain went, and off we drove.

The interviewers had finished with the first two clusters so we moved on to the next spot and I applied myself to entertaining the Captain so that the interviewers could work without a soldier making the interviewees nervous. The Captain's name was Roberto. My last name, Roberts, seemed to him to have an uncanny similarity. He was drunk out of his mind. He kept saying, "Roberto, Roberts. Roberts, Roberto." I gave him my card; he kept kissing it. Between my bad French and his intoxication, our conversation stayed at a pretty basic level for about an hour until he mentioned that he had a 10-year-old son in school in France. This short, fat, former soldier in Mobutu's army did not conjure up an image of the proud parent at the graduation ceremony of a French boarding school. I said, "Isn't that expensive? How do you pay for this?" He said that it was not a problem, that he had lots of diamonds, and he puts his money in a bank account and it is transferred to the school directly.

I was dumb-founded. He was so drunk, and clearly being very honest. For all of the moments of fear on a motorbike and trepidation at check points, Roberto's revelation was one of the worst moments I had experienced. I knew that all of the civilians complained that the RCD forces would never engage the Interahamwe and Mayi-Mayi even when they knew where they were. I knew that the foreign soldiers were looting Congo's natural resources. Yet, only when I looked at Roberto's drunk, happy face did I realize how disastrous an end to this war would be for so many of these mid-level soldiers. He could never support a child in France and a wife in Kinshasa on a soldier's salary.

I recently read a book called "King Leopold's Ghost" about the Belgian rape of the Congo. In it, the author describes how the pursuit of ivory and rubber led to inconceivable abuse of the civilian population, in some large areas causing a dramatic de-population. In Moba, history is repeating itself. The commodities are now diamonds and gold, the invaders are now Africans, but the result is much the same.