buildings that make up the Harvard School of Public Health's campus. The skylight makes everything bright and open. The rooftop ventilation system hums white noise. Professor Jennifer Leaning's railway-flat of an office--narrow but well-windowed on one end--does nothing to ruffle the airy tranquility. It's neat as a pin: books and reports stand at attention on long shelves attached to one wall, and the desk is free of clutter.
It's an afternoon in early April, and the war in Iraq is less than 48 hours old. The professor of international health is a critic. She explains why in long, fast sentences that pile words one on top of another to the point of toppling: The calculus of risk is phenomenally ambitious and flawed. Saddam Hussein might use biological or chemical weapons. The United States is running roughshod over the United Nations. The last nine to ten months have been "a remarkable demonstration of American diplomatic ineptitude, aggression, brashness, and arrogance."
The ideas and analysis continue to tumble out, all of it smart and articulate and carefully expressed but with passion. She's on a roll. Antiwar, yes. Disinterested in it--far, far from it.
As a physician, Leaning is trained in emergency medicine; incredibly, she still somehow puts in ER shifts at the Harvard-affiliated Brigham and Women's Hospital in Boston. At the School, she is known for her work in the emergency rooms of public health. Leaning is an expert on health crises and human rights violations amid wars, conflicts, and disasters. She is one of the few physicians anywhere thoroughly versed in the Geneva Conventions and the rules of humanitarian law. As a volunteer for Physicians for Human Rights (PHR), a group based in Boston, she has been on "missions" (her word) to ravaged places that most of us experience only as fleeting headlines: the West Bank, Somalia, Soviet Georgia, Rwanda, the Democratic Republic of Congo, and Afghanistan. She's traveled to Kosovo nine times.
The purpose of these trips has varied. In 1988, on her very first investigation in the West Bank and Gaza Strip, she and her PHR colleagues reported on the mistreatment of arrested Palestinians during the first Intifada. In 1992 in Somalia, she was an eyewitness to worsening famine and the horrendous conditions in what remained of the country's crumbling health care system. In Kosovo, she investigated Serbian abuses of medical neutrality, including the assassination of Kosovar Albanian physicians and the neglect and abuse of patients; today she continues to work with physicians there to rebuild the region's shattered health infrastructure. Last year, while investigating an overcrowded prison in northern Afghanistan, Leaning and another PHR investigator, John Heffernan, found evidence of a mass grave nearby. Their discovery led to the Aug. 26, 2002, Newsweek cover story about hundreds of Taliban prisoners being left to suffocate to death in back of trucks by allies of the United States. Leaning describes her heroic efforts in modest, detached terms: "I go out to try to understand and describe, in disciplined frameworks of explanation and criticism, large-scale suffering and pain in order to go back to a peaceful and rich world and say, 'Help fix it.'"
them see your eyes
Human rights work has a glorified image--all that altruism and pursuit of truth in the face of danger. In reality, there are hours of tedious travel on bad roads and strings of meetings with local medical officials, relief workers, nongovernmental organizations--anybody who might have information or give permission to get it. People who have worked with Leaning say she is a marvel in these meetings: a great diplomat, respectful, and very quick about asking the important questions without being confrontational. "People just like to talk to her," says Heffernan. "She has this way of making you feel like you're the only person in the room. She has those piercing eyes. She's just a great listener."
Leaning, a 1970 graduate of the School, joined the faculty full time in 1999. She is head of the humanitarian crises and human rights program in the School's François-Xavier Bagnoud (FXB) Center for Health and Human Rights. She teaches courses on disaster management, bioterrorism, and the public health and human rights aspects of war. Leaning is a popular teacher, partly because she brings so much "on the ground" experience into the classroom. But she has no trouble being abstract and academic: words like "pluripotential" and phrases like "homogenized discourse" come naturally to her. She is a prolific writer (her editorials in the British Medical Journal are particularly lucid) and former editor-in-chief of Medicine and Global Survival, a peer-reviewed journal on global health threats.
But Leaning is refreshingly this-worldly. In a telling moment this spring, during the small "people in war" seminar course she teaches with Bruderlein, Leaning politely interrupted a guest speaker's presentation on children's rights to point out that all of the UN peacekeepers depicted in a group of childrens drawings were wearing sunglasses. "Don't wear Bay Rans--or whatever the hell they're called," she told the class. "Regardless of anything else, if they can't see your eyes, they're not going to trust you."
and a bleeding heart
Bringing human rights into the public health equation takes the "political spin" out of some issues that, in Leaning's opinion, might be framed as matters of class and privilege. But she applauds the addition: "It is so hard to argue for the good. Very few people are effective moral philosophers. To stand up for what you feel is right and not have an argument is a very disquieting thing. Human rights gives people an accessible leg to stand on. It's a way of being principled without looking like a bleeding heart--and this is a cynical enough world that we need that."
A distinction is often drawn between human rights and Leaning's specialty, humanitarian law and human rights in conflict settings. All-encompassing human rights is an ambitious concept. Its touchstone document is the 1948 Universal Declaration of Human Rights (which is handed out at the School's graduation ceremony every year). Humanitarian law focuses on conduct during war and includes humane treatment of prisoners of war, protection of medical professionals neutrality, and prevention of civilian causalities. These principles are spelled out in the 1949 Geneva Conventions, with some important revisions in 1977.
Human rights in peacetime is "far more problematic and completely filled with disputes," says Leaning, which is one reason she gravitated toward violations in war and conflict: the rules are clearer. Her approach also reflects her medical background. Leaning says she looks for patterns (the symptoms) to determine what aspects of those patterns might be evidence of violations of international law (the disease). But as more wars are fought within countries rather than between them--and as events like famine are seen as political rather than natural catastrophes--the line between human rights and humanitarian law has gotten murkier. Stephen Marks, the Francois-Xavier Bagnoud Professor of Health and Human Rights and director of the FXB Center, sees Leaning's work as part of the Centers efforts to apply Manns health and human rights connections to other areas of public health beyond HIV/AIDS. "She brings an intellectual vision to human rights in times of conflict that is more than just a response to hot issues in the news."
Leaning's maternal grandfather, Arthur Jorgensen, was a strong influence on her. He was a missionary for the YMCA in Japan from 1911 to 1939. Leaning credits him with giving her a wider view of the world. She happily recalls the night she couldn't go to a third-grade school play because she had a fever. "He spent the whole evening telling me the history of the Tokugawa regime--the warriors, the samurai, Shintoism, the industrialization of Japan, Commodore Perry--the whole thing." He also made sure Leaning set her sights high. Oliver Wendell Holmes was one of his heroes. "He thought a very good career for me would be to be on the U.S. Supreme Court," she smiles.
Her father's experience may partly explain why Leaning, for all of her moral and physical courage and 1960s antiwar sentiments, never threw herself wholeheartedly into politics. She describes her antiwar activities as "quasi-watchful, quasi-militant." "I had a sense that I didn't want to ruin my chances for making a difference in a more mainstream mode." Nevertheless, in 1969 she was on the steps of student-occupied University Hall in Harvard Yard when baton-wielding police charged. "The only reason I didn't get my head hit is that I knew Harvard Yard better than they did--and I was running fast."
the medical lens
But it has been the innovation of Leaning and others to take these fine brushstrokes and paint much bigger--and often quite bleak--pictures. They've used medical expertise and observation to document widespread violations of humanitarian law and human rights in dozens of war zones around the world. "There had not been the recognition that the lens of medicine, applied to human rights, could really illuminate what was going on," says Leaning.
Historians say Rudolf Virchow's 1848 investigation of a typhus epidemic in Upper Silesia foreshadowed this role of doctors employing medicine in a broader context. Instead of making the expected medical recommendations to Prussian authorities, Virchow made the connection between the epidemic and education and economic conditions, and insisted upon reforms. In Leaning's personal history, it was her work for Physicians for Social Responsibility (PSR) in the 1980s. She and her PSR confederates were the expert medical witnesses of the nuclear disarmament and freeze campaigns of the 1980s. They gave grim, yet clinical, accounts of the radiation and blast injuries that a nuclear bomb would cause and did in-depth critiques of the civil defense system. It was a prime example of how medical expertise could be used to sway public opinion and policy on an issue that wasnt strictly medical.
for Human Rights
Even now, The Casualties of Conflict: Medical Care and Human Rights in the West Bank and Gaza Strip makes for chilling reading. Palestinian rioting had started in late 1987. Leaning and three other doctors were sent to investigate the "medical consequences" of what the report dispassionately terms "civil disturbances" and "police and military actions." What they found made front-page news: injuries among people who had been taken into custody by the Israelis that strongly suggested a deliberate policy of smashing hands and arms with gun butts or other heavy objects. Equally telling as the injuries they saw were those that they didn't: the broken collarbones, knuckles, bruises to the chest, all of which might have occurred while resisting arrest or in fighting with police. Israeli policy changed soon after the PHR report came out and made headlines.
Leaning says some of the lessons she learned during that investigation she still follows today: Meet with everybody. Keep everything anonymous--these are health and human rights not war crime investigations. Work in a small group and debrief at night: "It is sort of like the advice that you shouldn't go to bed angry. You're seeing so much that is upsetting you. You can't get locked into your own perspective." And try to stay detached. Leaning has been in many situations where she might have jumped in as an emergency room physician and tried to save some lives. In Mogadishu, Somalia, she saw hospital casualty areas being run by third-year medical students that were "staggeringly disorienting because they were so awful." She remembers a baby in the ICU in a hospital in Tbilisi, Soviet Georgia, who was grey, probably septic, and not getting enough oxygen. But unless she was going to take charge of the case for weeks or months, there was little she could do. "It was just impossible," says Leaning.
Kosovo, though, has been different. Leaning and Dr. Ruth Barron, a fellow PHR investigator, became close to a group of ethnic Albanian physicians persecuted by the Serbs. The two women fled the province when the NATO bombing started in March 1999 but returned to the region a month later to look for their Kosovar doctorfriends among the many refugees.
Early in the course of their investigations in Kosovo, Leaning and Barron went to the house of Dr. Nuradin Zejnullahu in Peja to pay their respects. Zejnullahu had been shot and killed in his home by Serb paramilitary in front of his children. Although Muslim tradition dictates that men and women mourn separately, Leaning and Barron, because of their doctor status, were allowed to join the men. "So there we were, the two of us, surrounded by 30 to 40 men, "Barron recalls. "Jennifer made a formal statement about how sorry we were and how this killing was a terrible violation of human rights and medical neutrality. Listening to her eloquent words in translation and watching the assembled mourners well up with tears, I knew that she had managed to convey the human rights standpoint as well as the warm support of the international community."
Leaning and Barron were then asked if they wanted to meet the doctor's four teenage children, who were now orphans (their mother had died a year before from cancer). Unplanned, they ended up spending the next three hours with them. "They were just so traumatized," remembers Barron. "As the psychiatrist, I couldn't help but respond when they asked us to sit with them. Jennifer was very clear about the medical situation. Their father had been shot in the femoral artery and ultimately bled to death. The kids felt guilty that they had not done enough. Jennifer explained the medical situation very clearly--what could have been done, what couldn't be done. She also helped them realize that some Serbs had killed their father and that other Serb colleagues of his had come to his aid at the hospital. She was wonderful with them."
On their later mission to help refugees expelled from Kosovo, Leaning and Barron guided the four Zejnullahu children in traveling out of Montenegro, where they had sought refuge, and brought them into Albania, where their aunt awaited them. When the war ended four years ago, at the request of the teenagers, Leaning and Barron arranged for them to relocate to the Boston area. This migration has required the assistance of many people, including members of a church in Concord, MA, and two good friends of Leaning and Barron, Diana Eck and Dorothy Austin, masters of Lowell House, where the four young people lived for their first couple of years in the U.S. Barron describes them now as all doing well, getting on with their education, thriving in their new country. "It was kind of unusual to bring kids home. It is not the thing you do as a human rights investigator, actually," says Barron.
groves of academe
She is working with Professor Peter Berman, director of the School's International Health Systems Group, and another faculty member, Thomas Bossert, to develop programs in medical ethics and human rights for Kosovo that might be used elsewhere. Leaning says that if a country's physicians are properly trained, they can become an important bulwark to human rights violations--as well as trusted eyes and ears once hostilities break out. "Doctors tend to be, until the war really contaminates the situation, among the most objective and fair people you'll find. And they are almost always good observers because of their training."
She is also developing a broader theory of "human security" as a way of systematically measuring the effects of conflicts. Building on the ideas of Nobel prize-winner HSPH faculty member Amartya Sen and others, she has broken human security into three psychosocial dimensions: home and safety; family and social supports; and acceptance of the past and a positive grasp of the future. Leaning envisions relief organizations designing humanitarian aid to meet these needs. And she is looking forward to testing the theory in a prospective study in Angola. Eventually, Leaning hopes that human security assessments might be done before a conflict breaks out so timely intervention might prevent it.
War, conflict, and disaster may be hell, but they also have a perverse pull on many of us. Amid the killing and the destruction are acts of selfless sacrifice, bravery, and loyalty. What could be nobler than saving lives? And you cant save a life until it is threatened. So as Leaning talks with such energy and passion about war and conflict, an impudent thought comes to mind: Does she really like war and disaster? Why does she keep going back to these dangerous places and times? The question finally wells up--awkward and far too informal, but there it is: "So be honest, aren't you just a little jazzed by all of this?"
Her answer, in part: "My dream, my ultimate dream, is to have it be the way it felt when I was a kid when it was June and school was out and I had this unlimited sense of time and opportunity. Summer was endless. I still have this yearning for the time to write and think and analyze everything that is rushing through too quickly now. I would cherish the uninteresting time. I can only do this overseas work in bits and spurts. I can't do a steady diet of it."
Several weeks later, Leaning was on a plane to Ethiopia to assess the public health response to a famine there.
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