Margaret Bourdeaux: Why civilians suffer more once a war is over
مارجريت بوردو: لماذا يعاني المدنيون أكثر بعدما تنتهي الحرب؟
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster. Full bio
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what it would be like
كيف قد تكون الحياة
there are no rules
and there are no laws.
ولا قوانين.
have disappeared.
about what this is like,
طبيعة هذا الشعور،
a medical student in 1999,
طالبة طب سنة 1999
in the Balkans during the Kosovo War.
في شبه جزيرة البالكان خلال حرب الكوزوفو.
from my medical school
على تصريح من الجامعة
that I had befriended in the camp
التى أقمت صداقات معهم في المعسكر
life in this postwar setting.
في ظل أوضاع ما بعد الحرب.
was a very interesting place
كانت مكاناً مشوقاً جداً
the war didn't break out again.
الحرب مرة أخرى.
it was actually a lawless place,
كان المكان في الواقع بلا قوانين،
both public and private,
الحكومية والخاصة،
of these situations and settings,
before you run into a situation
قبل أن تواجه موقفاً
how incredibly vulnerable you are.
إلي أي مدى أنت معرض للخطر.
when I had to cross the first checkpoint,
عند إقترابي من أول لجنة تفتيش،
through this checkpoint
سوف أتفاوض
right then and there,
في تلك اللحظة وذلك المكان،
anything illegal.
was absolutely nothing
of the families that I got to know
التي تعرفت عليهم
where there are no social institutions
بدون مؤسسات اجتماعية
"What are we going to eat tonight?"
"ماذا سنأكل اليوم؟"
when you don't have any security systems,
في ظل عدم وجود نظام أمني،
with the neighbor down the block
that will end my life
تنهي حياتي
when there is no health system
في ظل عدم توفر نظام صحي
had to sort through questions like,
وهم يطرحون أسئلة مثل:
What am I going to do?"
ماذا سوف أفعل؟"
is bleeding. What should I do?
ماذا يجب علي أن افعل؟"
where are the nurses?
أين الممرضون؟"
هل هم أهل للثقة؟"
In what currency will I pay them?"
وأي عملة سوف استخدم؟"
where will I find them?
أين سأجده؟"
are they actually counterfeits?"
هل من الممكن أن يكونوا مزيفين؟"
the dominant feature of life,
that people have to manage
والذي يجب علي الناس مواجهته
is incredibly difficult to explain
من الصعب جداً أن يفسر
who are living outside of it.
الذين يعيشون خارجه.
I became a physician,
وأصبحت طبيبة،
health policy researcher.
Division of Global Health.
شعبة الصحة العالمية.
on this problem right away.
the crushing vulnerability
الشعور الساحق بالضعف
of fragile settings?
في هذه الأوضاع الحساسة؟
we can start to think about
that are critical to survival,
للبقاء على قيد الحياة
I had amazing colleagues.
أني كان لدي زملاء ممتازون.
question for them.
"Oh, if you work in war,
"أليس العمل في فترة الحرب
you work on refugee camps,
mass atrocities?" --
very, very important.
why I was so passionate about this issue,
لماذا كنت متحمسة جدا لهذه المسألة،
the public health consequences of war
provocative conclusion.
and disability from war
الموت والعجز بسبب الحرب
living in a conflict-affected state
شخص يعيش في دولة بها قتال
has been achieved.
إلى ذلك الحل السياسي.
but of course it's not,
ولكنه بالطبع ليس كذلك،
by robbing them of their clinics,
بسلبها لهم عياداتهم الطبية،
they're on the run.
إنهم دائماً في حالة هروب.
and yet more deadly is the destruction
and their finances.
ومواردها المالية.
surprising at all to me.
غير مفاجئ إطلاقاً بالنسبة لي.
and somewhat dismaying,
و المزعج الى حدٍ ما.
about human suffering and war.
country of Liberia.
في غرب إفريقيا.
about this group, Doctors Without Borders,
عن مجموعة أطباء بلا حدود،
and calling for aid and assistance.
وينادون لطلب المساعدة والعون.
answered the question:
على النحو الكافي:
even in Liberia?
موجودة في ليبيريا؟
is an amazing organization,
هي منظمة رائعة،
emergency care in war zones.
عناية لحالات الطوارئ في مناطق الحرب.
كانت قد انتهت في سنة 2003 --
before Ebola even struck.
الإيبولا بأحد عشر عاماً.
in the entire country
أقل من خمسين طبيباً
a functioning health system,
نظام صحي حقيقي،
aid was phenomenal.
two percent of that funding
2 في المائة من هذا التمويل
Haitian public institutions,
المؤسسات العامة الهايتية،
from the earthquake even today.
يموتون بسبب الزلزال حتى اللآن.
in the northern autonomous region of Iraq,
الشمالية فى العراق،
that in the last nine months,
في التسعة أشهر الأخيرة،
from four million people
من أربعة ملايين
have experienced incredible trauma.
واجهوا أذىً لا يصدق.
16-hour days without pay.
بدون أجر.
by 25 percent;
بخمسة وعشرين في المئة؛
and to short-term relief efforts.
و جهود الإغاثة قصيرة المدي.
التاريخ دليلاً --
of the five million people in his region
الموجودين في المنطقة
whether they should flee
إذا ما كان يجب أن يفروا هاربين
this is a frustrating topic for me,
هذا موضوع محبط بالنسبة لي،
and security systems?
لسكان المنطقة؟
two arguments.
أو وجهات النظر.
in these settings are corrupt
unsavory characters
in these situations.
في هذه الأحوال.
is absolutely true
صحيح تماماً
to Haiti, to Liberia --
وليبريا --
for their country,
to save their health institutions.
لكي ينقذوا مؤسسات دولتهم الصحية.
who wants to help
أن يقدم المساعدة
in Afghanistan.
success stories
in Afghanistan
investing heavily
سنة 2002
Afghani health sector leaders.
القطاع الصحي الأفغاني.
have pulled off an incredible feat
إنجازً مذهلاً
access to health care
الحصول على رعاية صحية
the health status
للشعب الأفغاني
of Health does things
تقوم بأشياء
لوضع السياسات.
أسمعه كثيراً هو:
we just don't have the money.
المال الكافي.
that the current situation
we could possibly conceive of.
ومع ذلك الآقل فاعلية.
is that when governments like the US --
تكون حكومة مثل الولايات المتحدة --
of governments
and disaster relief worldwide.
و الطارئة عالمياً.
that's just disaster relief.
فقط إغاثة الكوارث.
goes to international relief agencies,
يذهب إلى وكالات الإغاثة الدولية،
into these areas,
المطلوبة إلى هذه المناطق،
of temporary health system, let's say,
النظام الصحي المؤقت،
when they run out of money.
عندما ينفذ المال.
community policy experts,
in how to monitor
في كيفية مراقبة
of health systems
في النظم الصحية
and wave our arms.
والتلويح بأذرعنا.
they don't need us to tell them that.
فهم ليسوا بحاجة لنا أن نخبرهم بذلك.
need to take their cue
في جامعة هارفرد
in Afghanistan,
في أفغانستان،
health sector leaders like these.
قادة القطاعات الصحية المماثلة.
with some support.
ببعض الدعم.
and make new partnerships.
ونبني شراكات جديدة.
with NATO and other security policy makers
الناتو وصناع سياسات أمنية آخرون
to protect health system institutions
مؤسسات النظام الصحي
and other critical social institutions
والمؤسسات الاجتماعية الأساسية الأخرى
collateral damage;
الدمار المباشر؛
we need to engage is you,
هو أنتم،
and indeed, the world public.
بل الجمهور العالمي في الحقيقة.
the value of social institutions,
قيمة المؤسسات الاجتماعية،
in these fragile settings,
في تلك المواقف الحساسة،
يفتح مقالة تتحدث
doctors are on the run in country X.
يعملون بصفة متواصلة في دولة ما.
to, let's say, detect influenza."
على دعنا نقول كشف الإنفلونزا."
That's what I'd tell you.
هذا ما سوف أقوله لكم.
institution defenders and builders.
إلي من المدافعين عن والبنائين للمؤسسات.
the Marshall Plan
خطة المارشال
institutions after World War II.
بعد الحرب العالمية الثانية.
really serves as the foundation
حقاً بمثابة الأساس
human rights organizations.
حقوق الإنسان العالمية.
بالنسبة إلي بن فرانكلين،
in terms of creating institutions,
country was threatened,
to protect human security,
لحماية الأمن البشري،
should do the same.
يجب أن يفعل نفس الشيء.
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