Margaret Bourdeaux: Why civilians suffer more once a war is over
Margaret Bourdeaux: ¿Por qué la población civil sufre más cuando la guerra termina?
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
donde no existieran normas?
there are no rules
por el cual no hay normas
and there are no laws.
y no hay leyes.
have disappeared.
desaparecieron.
about what this is like,
de qué se trata,
a medical student in 1999,
in the Balkans during the Kosovo War.
los Balcanes durante la guerra de Kosovo.
from my medical school
increíblemente, me permitió
that I had befriended in the camp
había entablado amistad en el campo
life in this postwar setting.
en este marco de posguerra.
was a very interesting place
era un lugar muy interesante
the war didn't break out again.
que la guerra no estallara nuevamente.
it was actually a lawless place,
era, de hecho, un lugar anárquico,
both public and private,
públicas y privadas,
of these situations and settings,
por este tipo de situaciones y contextos,
before you run into a situation
en encontrarte con una situación
how incredibly vulnerable you are.
de lo extremadamente vulnerable que eres.
when I had to cross the first checkpoint,
cuando tuve que cruzar el primer control,
through this checkpoint
por aquel control
right then and there,
en ese mismo momento,
anything illegal.
ningún acto ilegal.
was absolutely nothing
que sentí no era nada
of the families that I got to know
de las familias que conocí
where there are no social institutions
donde no hay instituciones sociales
"What are we going to eat tonight?"
"¿Qué vamos a cenar hoy?"
when you don't have any security systems,
cuando no existen sistemas de seguridad,
with the neighbor down the block
con el vecino de la esquina
that will end my life
que podría terminar con mi vida
when there is no health system
cuando no hay sistemas de salud
had to sort through questions like,
hacerse preguntas del tipo,
What am I going to do?"
¿Qué voy a hacer?"
is bleeding. What should I do?
está sangrando. ¿Qué debo hacer?
where are the nurses?
y las enfermeras?
si son merecedores de confianza?
In what currency will I pay them?"
¿Con qué moneda les voy a pagar?"
where will I find them?
¿dónde los encuentro?
are they actually counterfeits?"
y en realidad son equivocados?
the dominant feature of life,
la característica principal de la vida
that people have to manage
en la que las personas viven
is incredibly difficult to explain
es sumamente difícil de explicar
who are living outside of it.
por aquellos que no la viven.
cuando me fui de Kosovo.
I became a physician,
me convertí en médica,
health policy researcher.
políticas sanitarias públicas mundiales.
Division of Global Health.
del Brigham and Women.
on this problem right away.
resolver este problema.
the crushing vulnerability
la vulnerabilidad devastadora
of fragile settings?
en este tipo de situaciones delicadas?
we can start to think about
comenzar a pensar sobre
that are critical to survival,
esenciales para la subsistencia,
I had amazing colleagues.
he tenido colegas increíbles.
question for them.
inusual para ellos.
"Oh, if you work in war,
en la guerra, entonces
you work on refugee camps,
en campos de refugiados,
mass atrocities?" --
very, very important.
es muy pero muy importante.
why I was so passionate about this issue,
por qué me apasionaba tanto este asunto,
the public health consequences of war
de la guerra en cuanto a la salud pública
provocative conclusion.
increíble y provocativa.
and disability from war
y discapacidades ocasionadas por la guerra
living in a conflict-affected state
en un estado afectado por el conflicto
has been achieved.
dicha solución política.
but of course it's not,
pero definitivamente no lo es,
by robbing them of their clinics,
al privarlas de sus clínicas,
they're on the run.
son asesinados; huyen.
and yet more deadly is the destruction
es la destrucción
and their finances.
de gobernanza de salud y de sus finanzas.
surprising at all to me.
en lo más mínimo.
and somewhat dismaying,
que ha tenido esta introspección,
about human suffering and war.
sobre el sufrimiento humano y la guerra.
country of Liberia.
país del África occidental.
about this group, Doctors Without Borders,
Médicos Sin Fronteras,
and calling for aid and assistance.
answered the question:
contestaba la pregunta:
even in Liberia?
Médicos Sin Fronteras en Liberia?
is an amazing organization,
es una organización increíble,
emergency care in war zones.
cuidado de emergencia en zonas de guerra.
terminado en el 2003,
before Ebola even struck.
el Ébola afectara al país.
in the entire country
en todo el país
se encuentra en Liberia
a functioning health system,
un sistema de salud en funcionamiento,
aid was phenomenal.
fue impresionante.
two percent of that funding
Haitian public institutions,
las instituciones públicas de Hatí,
from the earthquake even today.
a causa del terremoto incluso hoy en día.
in the northern autonomous region of Iraq,
de la región autónoma del norte de Iraq,
that in the last nine months,
que en los últimos nueve meses,
from four million people
de cuatro millones de personas
have experienced incredible trauma.
han sufrido grandes traumas.
16-hour days without pay.
16 horas por día sin percibir sueldo.
by 25 percent;
and to short-term relief efforts.
temas de seguridad y ayuda a corto plazo.
of the five million people in his region
de cinco millones de personas en su región
whether they should flee
this is a frustrating topic for me,
este es un tema frustrante para mí,
and security systems?
two arguments.
dos argumentos.
in these settings are corrupt
son corruptas
unsavory characters
personajes desagradables
in these situations.
en estos contextos.
is absolutely true
es completamente cierto
to Haiti, to Liberia --
Haití, Liberia --
for their country,
le llegó la hora,
to save their health institutions.
las instituciones de salud.
who wants to help
que quieren ayudar
esos individuos,
para que ellos lideren.
in Afghanistan.
lo que sucedió en Afganistán.
success stories
olvidadas y nunca contadas
in Afghanistan
una nación en Afganistán
investing heavily
del Banco Mundial en 2002
Afghani health sector leaders.
a líderes afganos del sector sanitario.
have pulled off an incredible feat
una gran hazaña
access to health care
el acceso a la asistencia médica
the health status
of Health does things
hace cosas
para elaborar políticas.
we just don't have the money.
no tenemos el dinero.
that the current situation
we could possibly conceive of.
que uno pueda imaginar.
is that when governments like the US --
cuando gobiernos como el de EE. UU.
of governments
and disaster relief worldwide.
y en casos de catástrofe en todo el mundo.
that's just disaster relief.
simplemente auxilio ante catástrofes.
goes to international relief agencies,
de asistencia internacional,
into these areas,
a estas zonas,
of temporary health system, let's say,
sistema sanitario provisorio,
when they run out of money.
cuando se quedan sin dinero.
community policy experts,
comunitarias de salud a nivel mundial,
in how to monitor
expertos en cómo observar
of health systems
en situaciones de amenaza.
and wave our arms.
y sacudir los brazos.
they don't need us to tell them that.
no necesitan que les digamos.
need to take their cue
deben seguir el ejemplo
in Afghanistan,
health sector leaders like these.
a los líderes de los sectores de salud.
with some support.
al brindar apoyo.
and make new partnerships.
de colaboración.
with NATO and other security policy makers
y otros responsables de la seguridad
to protect health system institutions
para proteger a las instituciones de salud
and other critical social institutions
y otras instituciones sociales esenciales
collateral damage;
de evitar el daño colateral;
we need to engage is you,
a los que debemos captar son Uds.,
and indeed, the world public.
y por supuesto el público mundial.
the value of social institutions,
de las instituciones sociales,
in these fragile settings,
en contextos delicados,
las iniciativas para salvarlos.
doctors are on the run in country X.
todos esos médicos están huyendo.
to, let's say, detect influenza."
de salud para detectar la gripe?"
That's what I'd tell you.
Eso es lo que les diría.
institution defenders and builders.
y creadores de instituciones favoritos.
the Marshall Plan
institutions after World War II.
a las instituciones económicas europeas.
really serves as the foundation
realmente sirve de cimiento
human rights organizations.
de derechos humanos.
in terms of creating institutions,
a la creación de instituciones,
country was threatened,
cuando nuestro país se veía amenazado,
to protect human security,
para proteger la seguridad humana,
should do the same.
debería hacer lo mismo.
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