Margaret Bourdeaux: Why civilians suffer more once a war is over
Margaret Bourdeaux: Warum die Zivilbevölkerung nach Kriegsende stärker leidet
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.
gefragt, wie es wäre,
what it would be like
there are no rules
and there are no laws.
have disappeared.
sind verschwunden.
about what this is like,
vorstellen, wie das ist,
a medical student in 1999,
in the Balkans during the Kosovo War.
von meiner Universität
from my medical school
ich mich im Lager angefreundet hatte,
that I had befriended in the camp
life in this postwar setting.
nach dem Krieg wiederaufbauten.
was a very interesting place
ein sehr interessanter Ort,
the war didn't break out again.
Kriegsausbruch zu verhindern.
it was actually a lawless place,
faktisch ein gesetzloser Ort,
gesellschaftlichen Institutionen
both public and private,
of these situations and settings,
before you run into a situation
bis man in eine Lage gerät,
how incredibly vulnerable you are.
unglaublich verwundbar man ist.
when I had to cross the first checkpoint,
beim Durchqueren des ersten Checkpoints.
through this checkpoint
durch diesen Checkpoint
Gegenüber verhandeln würde,
mich an Ort und Stelle zu erschießen,
right then and there,
anything illegal.
was absolutely nothing
stand in keinem Vergleich
of the families that I got to know
where there are no social institutions
ohne gesellschaftliche Institutionen
"What are we going to eat tonight?"
"Was essen wir heute?"
when you don't have any security systems,
with the neighbor down the block
oder meine Familie das Leben kosten?
that will end my life
when there is no health system
gesundheitliche Sorgen beängstigend.
wie die folgenden stellen:
had to sort through questions like,
Was soll ich jetzt tun?"
What am I going to do?"
hat Blutungen. Was soll ich tun?"
is bleeding. What should I do?
where are the nurses?
In what currency will I pay them?"
In welcher Währung?"
where will I find them?
wo bekomme ich sie her?
are they actually counterfeits?"
in Wahrheit Fälschungen?"
das dominierendste Merkmal,
the dominant feature of life,
that people have to manage
gesellschaftlichen Systeme gibt.
is incredibly difficult to explain
who are living outside of it.
nur schwer zu verstehen.
als ich den Kosovo verließ.
I became a physician,
health policy researcher.
zur öffentlichen Gesundheit.
Abteilung globale Gesundheit.
Division of Global Health.
dieses Problem sofort anpacken.
on this problem right away.
die erdrückende Verwundbarkeit
the crushing vulnerability
of fragile settings?
we can start to think about
that are critical to survival,
und schnell wiederaufbauen können?
I had amazing colleagues.
question for them.
"Wenn du im Kriegseinsatz bist,
"Oh, if you work in war,
you work on refugee camps,
nicht in Flüchtlingslagern
mass atrocities?" --
very, very important.
äußerst wichtig ist.
why I was so passionate about this issue,
warum mir die Sache so wichtig war,
einer bahnbrechenden Studie
the public health consequences of war
auf die öffentliche Gesundheit.
provocative conclusion.
war sehr provokant.
and disability from war
und kriegsbedingten Behinderungen
living in a conflict-affected state
in einem vom Krieg gezeichneten Land
has been achieved.
gefunden wurde.
but of course it's not,
doch natürlich ist es das nicht,
by robbing them of their clinics,
indem er ihnen ihre Praxen raubt,
getötet und flüchten.
they're on the run.
and yet more deadly is the destruction
tödlicher ist die Zerstörung
and their finances.
und deren Finanzierung.
surprising at all to me.
and somewhat dismaying,
menschliches Leid und Krieg blieb.
about human suffering and war.
country of Liberia.
in Liberia, in Westafrika.
about this group, Doctors Without Borders,
Ärzte ohne Grenzen berichtet,
and calling for aid and assistance.
und Unterstützung bat.
answered the question:
beantworteten die Frage:
überhaupt in Liberia?
even in Liberia?
is an amazing organization,
ist eine tolle Organisation,
emergency care in war zones.
dringend nötige Hilfe leistet.
endete im Jahr 2003 --
before Ebola even struck.
in the entire country
mit 4,5 Millionen Einwohnern
a functioning health system,
auch ganze 11 Jahre später
ein Erdbeben ereignete,
aid was phenomenal.
two percent of that funding
mit zwei Prozent dieser Gelder
Haitian public institutions,
wie etwa das Gesundheitswesen
from the earthquake even today.
in the northern autonomous region of Iraq,
nördlichen autonomen Region des Irak,
that in the last nine months,
dass sein Land, seine Region,
from four million people
von vier Millionen Menschen
have experienced incredible trauma.
hatten unvorstellbare Traumata erlebt.
16-hour days without pay.
16 Stunden unbezahlt.
um 25 Prozent gewachsen;
by 25 percent;
and to short-term relief efforts.
und kurzfristige Nothilfe geflossen sind.
Recht behält, wird es das --
wird das die Entscheidungen
of the five million people in his region
in seiner Region beeinflussen,
whether they should flee
Lebensumständen flüchten sollten?
frustriert mich dieses Thema,
this is a frustrating topic for me,
einheimische Gesundheitssysteme
and security systems?
zu schützen und zu unterstützen?
two arguments.
zwei Sorgen, zwei Argumenten ab.
in these settings are corrupt
unter solchen Umständen
widerliche Menschen getroffen habe,
unsavory characters
im Gesundheitswesen arbeitete.
in these situations.
is absolutely true
den Kosovo und Haiti bis Liberia --
to Haiti, to Liberia --
hart auf hart gekommen ist,
for their country,
to save their health institutions.
um das Gesundheitswesen zu retten.
who wants to help
damit sie führen können.
in Afghanistan.
unbesungenen Erfolgsgeschichten
success stories
in Afghanistan
um Staatsbildung in Afghanistan
um für das Gesundheitswesen
investing heavily
Afghani health sector leaders.
auszubilden und zu fördern.
have pulled off an incredible feat
access to health care
hat nun viel leichter Zugang
the health status
schlimmste der Welt war.
of Health does things
in Afghanistan handelt so,
basieren auf Daten. Unglaublich.
we just don't have the money.
that the current situation
we could possibly conceive of.
das man sich vorstellen kann.
Regierungen wie die der USA --
is that when governments like the US --
of governments
und Katastrophenhilfe weltweit
and disaster relief worldwide.
that's just disaster relief.
nur für Katastrophenhilfe.
goes to international relief agencies,
internationale Hilfsorganisationen,
into these areas,
importieren und verteilen
of temporary health system, let's say,
ein Gesundheitswesen zusammenstoppeln,
when they run out of money.
wenn das Geld ausgeht.
community policy experts,
für globale Gesundheitspolitik
in how to monitor
von Gesundheitssystemen
of health systems
die Mittel ausgehen,
and wave our arms.
und mit den Armen wedeln.
they don't need us to tell them that.
das müssen wir nicht erklären.
need to take their cue
müssen aus der Erfahrung
in Afghanistan,
stabile Plattformen bauen,
health sector leaders like these.
Gesundheitswesen zu unterstützen.
with some support.
etwas Unterstützung verdient.
neue Partnerschaften eingehen.
and make new partnerships.
with NATO and other security policy makers
und anderer Größen der Sicherheitspolitik,
to protect health system institutions
wie Institutionen des Gesundheitswesens
unterstützt werden können.
and other critical social institutions
sozialer Institutionen
collateral damage;
Kollateralschäden vermeiden;
we need to engage is you,
die wir überzeugen müssen,
Amerikas und der ganzen Welt.
and indeed, the world public.
the value of social institutions,
sozialer Institutionen schätzen,
in these fragile settings,
in solch prekären Umständen,
einen Artikel anklicken,
doctors are on the run in country X.
fliehen gerade alle Ärzte.
to, let's say, detect influenza."
in jenem Gesundheitswesen bedeutet."
That's what I'd tell you.
Das würde ich Ihnen antworten.
institution defenders and builders.
und Architekten von US-Institutionen.
the Marshall Plan
institutions after World War II.
wirtschaftliche Institutionen zu retten.
really serves as the foundation
Menschenrechtsorganisationen.
human rights organizations.
in terms of creating institutions,
von Institutionen leistete,
unserer Verfassung war.
country was threatened,
unsere Welt bedroht wurden,
to protect human security,
für die Sicherheit der Menschen,
should do the same.
sollte es ihnen gleichtun.
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