Margaret Bourdeaux: Why civilians suffer more once a war is over
Margaret Bourdeaux: Por que os civís sofren máis cando xa rematou a guerra
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster. Full bio
Double-click the English transcript below to play the video.
what it would be like
pola que non hai normas
there are no rules
and there are no laws.
have disappeared.
desapareceron,
about what this is like,
a medical student in 1999,
estudante de medicina no 1999,
in the Balkans during the Kosovo War.
nos Balcáns durante a guerra de Kosovo.
from my medical school
un permiso da facultade
that I had befriended in the camp
coas que trabara amizade no campo
life in this postwar setting.
nun contexto de posguerra.
era un lugar moi interesante
was a very interesting place
the war didn't break out again.
que non volvese estalar a guerra,
it was actually a lawless place,
o certo é que era unha zona sen lei
both public and private,
tanto públicas coma privadas,
of these situations and settings,
ou nunha situación coma esa
before you run into a situation
o que tardas en bater cunha situación
how incredibly vulnerable you are.
do incriblemente vulnerábel que es.
when I had to cross the first checkpoint,
ao ter que cruzar o primeiro control
through this checkpoint
o paso por este control
right then and there,
anything illegal.
non estaría a facer nada ilegal.
was absolutely nothing
que eu sentín non era absolutamente nada
of the families that I got to know
das familias que coñecín
where there are no social institutions
sen institucións sociais
"What are we going to eat tonight?"
“que imos cear hoxe?”
when you don't have any security systems,
cando non hai sistema de seguridade ningún
with the neighbor down the block
que tiven co veciño de abaixo
that will end my life
que acabe coa miña vida
when there is no health system
cando non hai sistema de saúde
had to sort through questions like,
facerse preguntas como
What am I going to do?"
Que podo facer?”
is bleeding. What should I do?
está a sangrar. Que fago?
where are the nurses?
U-los enfermeiros?
In what currency will I pay them?"
En que moeda lles pago?”
where will I find them?
are they actually counterfeits?"
non serán falsificacións?”
the dominant feature of life,
o aspecto dominante da vida,
that people have to manage
coa que teñen que lidar as persoas
is incredibly difficult to explain
incriblemente difícil de explicar
who are living outside of it.
que viven alleas a el.
I became a physician,
health policy researcher.
de políticas de saúde pública mundiais.
Division of Global Health.
do hospital Birgham and Women.
on this problem right away.
neste problema de contado.
a vulnerabilidade devastadora
the crushing vulnerability
of fragile settings?
neste tipo de situacións tan fráxiles?
we can start to think about
comezar a pensar
that are critical to survival,
para a supervivencia,
I had amazing colleagues.
uns colegas marabillosos e,
question for them.
esa pregunta era algo estraña.
"Oh, if you work in war,
“Iso de traballar na guerra
you work on refugee camps,
en campos de refuxiados
mass atrocities?" --
very, very important.
why I was so passionate about this issue,
por que me apaixonaba tanto este asunto,
un estudo sen precedentes
as consecuencias da guerra
the public health consequences of war
provocative conclusion.
incrible e provocadora:
and disability from war
e discapacidades provocadas pola guerra
living in a conflict-affected state
que viven nun estado en conflito
has been achieved.
but of course it's not,
mais abofé que non o é,
by robbing them of their clinics,
roubándolles as súas clínicas,
they're on the run.
e asasínanos. Teñen que fuxir.
and yet more deadly is the destruction
aínda máis letal é a destrución
and their finances.
e os seus medios financeiros.
surprising at all to me.
non me resulta nada sorprendente
and somewhat dismaying,
dalgún xeito, desalentador
que esta percepción tivo
about human suffering and war.
no sufrimento humano e a guerra.
country of Liberia.
o país de África occidental.
about this group, Doctors Without Borders,
a un grupo, Médicos Sen Fronteiras,
and calling for aid and assistance.
e a pedir axuda e medios.
answered the question:
respondían á seguinte cuestión:
even in Liberia?
os de Médicos Sen Fronteiras?
is an amazing organization,
é unha organización magnífica
emergency care in war zones.
de emerxencia en zonas de guerra.
before Ebola even struck.
chegase sequera o ébola.
in the entire country
para todo un país
a functioning health system,
cun sistema de saúde operativo
aid was phenomenal.
foi fantástico,
two percent of that funding
só un 2 por cento deses fondos
Haitian public institutions,
as institucións públicas haitianas,
from the earthquake even today.
seguen a morrer a causa do terremoto.
in the northern autonomous region of Iraq,
da rexión autónoma do norte de Iraq,
that in the last nine months,
que nos últimos nove meses
from four million people
da súa rexión, aumentou de catro
have experienced incredible trauma.
experimentaron traumas incribles.
16-hour days without pay.
xornadas de 16 horas sen cobrar.
by 25 percent;
non aumentou un 25 por cento,
and to short-term relief efforts.
e medidas de auxilio a curto prazo.
of the five million people in his region
da súa rexión
whether they should flee
this is a frustrating topic for me,
un tema frustrante para min.
a protexer e apoiar
and security systems?
e de seguridade autóctonos.
two arguments.
dúas preocupacións, dous argumentos.
in these settings are corrupt
que está nestas situacións
unsavory characters
con varios personaxes indesexables
in these situations.
nestas situacións,
is absolutely true
tamén é completamente certo
to Haiti, to Liberia --
pasando por Kosovo, Haití, Liberia...
for their country,
se viu nunha encrucillada,
to save their health institutions.
as súas institucións sanitarias.
who wants to help
que queiran axudar
no que farán de guías.
in Afghanistan.
o que aconteceu en Afganistán.
success stories
esquecidos e descoñecidos
in Afghanistan
de consolidación nacional en Afganistán
investing heavily
o Banco Mundial no 2002
Afghani health sector leaders.
os líderes do sector sanitario afgáns.
have pulled off an incredible feat
conseguiron toda unha fazaña
access to health care
o acceso aos servizos sanitarios
the health status
a situación sanitaria
of Health does things
afgán fai cousas
we just don't have the money.
non hai cartos para iso.
that the current situation
we could possibly conceive of.
que poderiamos concibir.
is that when governments like the US --
como o dos EE.UU.,
of governments
de dólares todos os anos
and disaster relief worldwide.
e para catástrofes en todo o mundo.
that's just disaster relief.
só a axuda para catástrofes.
goes to international relief agencies,
van ás axencias de axuda internacional,
into these areas,
recursos a esas zonas
of temporary health system, let's say,
de sistema sanitario temporal
when they run out of money.
cando se esgotan os cartos.
community policy experts,
da comunidade sanitaria mundial,
in how to monitor
é facernos expertos en observar
of health systems
dos sistemas sanitarios
and wave our arms.
e sacudir os brazos.
they don't need us to tell them that.
non precisan que llelo digamos nós.
need to take their cue
en Harvard deben seguir o exemplo
in Afghanistan,
en Afganistán,
health sector leaders like these.
estes líderes do sector sanitario.
with some support.
ao seu valor con algo de apoio.
and make new partnerships.
formar novas alianzas.
with NATO and other security policy makers
e máis creadores de política de seguridade
to protect health system institutions
para protexer as institucións sanitarias
and other critical social institutions
e outras institucións sociais fundamentais
collateral damage;
we need to engage is you,
ao que cómpre que impliquemos sodes vós,
and indeed, the world public.
por suposto, os de todo o mundo,
the value of social institutions,
o valor das institucións sociais,
in these fragile settings,
nestas situacións fráxiles,
as iniciativas para salvalos.
doctors are on the run in country X.
do país X están fuxindo.
to, let's say, detect influenza."
por exemplo, detectar a influenza”.
That's what I'd tell you.
Iso é o que vos diría eu.
institution defenders and builders.
de institucións estadounidenses favoritos.
the Marshall Plan
institutions after World War II.
de Europa tras a Segunda Guerra Mundial.
really serves as the foundation
dos dereitos humanos é a base
human rights organizations.
de dereitos humanos.
in terms of creating institutions,
no que se refire a crear institucións,
country was threatened,
cando o noso país estaba ameazado,
to protect human security,
para garantir a seguridade humana,
should do the same.
debería facer o mesmo.
ABOUT THE SPEAKER
Margaret Bourdeaux - Physician, global health policy analystMargaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster.
Why you should listen
Margaret Ellis Bourdeaux, MD, MPH spearheads the Threatened Health Systems Project at Harvard Medical School -- an initiative that brings together public sector leaders, health care providers, academics, military strategists and private sector stakeholders to generate creative approaches to protecting valuable health system resources in countries affected by armed conflict and acute political crisis.
Bourdeaux's journey in global health began when she took a year of leave from Yale Medical School to work in refugee camps during the Kosovo War in 1999. She returned on her own after the war to trace families she had befriended in the camps and find out what had happened to them. Living in villages of Kosovo's countryside, she documented how these families struggled to care for their children, find health services and make a living in a society decimated by genocide and ethnic conflict. This experience impressed upon her the stark truth that war kills people by stripping them of their personal, community and national resources and institutions. Far more people died in Kosovo from the depleted health systems and institutions than from wounds sustained during the armed conflict.
Later experiences in Haiti, Afghanistan, Libya, Sierra Leon, Madagascar and Liberia revealed a similar pattern: armed conflict would decimate indigenous health institutions that never recovered, leaving people helpless when later crises -- earthquakes, epidemics, renewed conflict -- invariably struck. Strong, resilient health systems are the key to making war, disasters and epidemics less deadly.
After completing a joint residency in Internal Medicine and Pediatrics at the Harvard Combined Med/Peds Program, Bourdeaux was among the first graduates of Brigham and Women's Global Women's Health Fellowship. She has worked with the Office of the Secretary of Defense Policy to analyze the US Department of Defense’s global health projects and programs. She led a joint Harvard-NATO team of analysts to evaluate the impacts, challenges and opportunities international security forces have in protecting and rebuilding health systems in conflict affected states. She joined the faculty of the Division of Global Health Equity at Brigham and Women’s Hospital and Harvard Medical School in 2011.
This year she was awarded the prestigious Harvard Global Health Institute's Burke Fellowship in Global Health to investigate the responsiveness of foreign aid to health system distress and disruption. She is co-developing the first executive education course between Harvard Medical School and Harvard Kennedy School of Government for senior security policy makers on health system threat detection and response. In addition, she is launching Harvard Global Health Institute's first Summit on Threatened Health Systems in June 2017.
Margaret Bourdeaux | Speaker | TED.com