Margaret Bourdeaux: Why civilians suffer more once a war is over
マーガレット・ボルドー: 市民の苦しみが終戦後に更に増すわけ
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
どんなものか
ありませんか?
there are no rules
and there are no laws.
have disappeared.
about what this is like,
私は多少わかります
a medical student in 1999,
in the Balkans during the Kosovo War.
難民キャンプで働いたからです
from my medical school
私は大学から許可を得られて
that I had befriended in the camp
life in this postwar setting.
見守りました
was a very interesting place
とても興味深い場所で
the war didn't break out again.
駐留していて
it was actually a lawless place,
そこは無法地帯でした
both public and private,
ほぼあらゆる機関の建造物が
of these situations and settings,
before you run into a situation
どれほど危うい状況にいるのかを
how incredibly vulnerable you are.
when I had to cross the first checkpoint,
通過する時でした
through this checkpoint
私をいきなりその場で撃ち殺そうと思えば
right then and there,
anything illegal.
was absolutely nothing
難民だった家族が経験した心細さとは
of the families that I got to know
where there are no social institutions
社会での生活は
"What are we going to eat tonight?"
という単純なことですら
とても難しい問題なんです
when you don't have any security systems,
身の安全を守るというのは
with the neighbor down the block
暴力沙汰を招いて
that will end my life
when there is no health system
健康問題を考えると
had to sort through questions like,
こんな質問をするのを聞きました
What am I going to do?"
どうしたらいいでしょう?」
is bleeding. What should I do?
どうしたらいいですか?
where are the nurses?
看護師さんはどこですか?」
In what currency will I pay them?"
どの通貨で支払えば?」
where will I find them?
どこで手に入るでしょう?
are they actually counterfeits?"
the dominant feature of life,
that people have to manage
日常的に直面しなければならないことです
日常的に直面しなければならないことです
is incredibly difficult to explain
このような日常を説明したり
who are living outside of it.
非常に難しいんです
これがわかりました
I became a physician,
health policy researcher.
Division of Global Health.
国際保健学部に入り
on this problem right away.
the crushing vulnerability
of fragile settings?
we can start to think about
生き延びる為に不可欠な機関を守り
that are critical to survival,
I had amazing colleagues.
普通では無い類の問いでした
question for them.
"Oh, if you work in war,
「戦場で働くってことは
you work on refugee camps,
大量殺戮行為の
mass atrocities?" --
なんてことにならない?」
very, very important.
大事な仕事なんですが
why I was so passionate about this issue,
この問題に熱心な理由を力説してきました
「戦争が公衆衛生へもたらす影響」についての
the public health consequences of war
provocative conclusion.
and disability from war
living in a conflict-affected state
最も危険な時期は
has been achieved.
but of course it's not,
もちろん 当然なことです
by robbing them of their clinics,
診療所や
they're on the run.
逃げ出します
and yet more deadly is the destruction
財源が断たれることです
and their finances.
surprising at all to me.
and somewhat dismaying,
残念に思ったのは
人々の苦しみや戦争に関する我々の見方に
about human suffering and war.
country of Liberia.
リベリアを襲いました
about this group, Doctors Without Borders,
and calling for aid and assistance.
求めていましたが
answered the question:
even in Liberia?
is an amazing organization,
素晴らしい団体です
emergency care in war zones.
before Ebola even struck.
in the entire country
a functioning health system,
機能していないため
aid was phenomenal.
two percent of that funding
Haitian public institutions,
ハイチの公的機関の再建に
from the earthquake even today.
地震からの後遺症で亡くなっています
in the northern autonomous region of Iraq,
イラク北部の自治地域の
that in the last nine months,
from four million people
4百万人から5百万人へと
have experienced incredible trauma.
驚くべきトラウマを体験してきています
16-hour days without pay.
by 25 percent;
予算は増加されるどころか
and to short-term relief efforts.
緊急救援活動へとまわされたからです
崩壊するでしょう―
of the five million people in his region
whether they should flee
this is a frustrating topic for me,
これは私にとって喫緊の課題で
守り保全するのに
and security systems?
two arguments.
in these settings are corrupt
unsavory characters
in these situations.
is absolutely true
to Haiti, to Liberia --
あらゆるケースで
for their country,
医療機関を
to save their health institutions.
私は感銘を受けました
who wants to help
in Afghanistan.
起こりました
success stories
in Afghanistan
investing heavily
アフガニスタンの
Afghani health sector leaders.
多大な投資を行いました
have pulled off an incredible feat
保健セクターの指導者たちは
access to health care
the health status
of Health does things
していることを
we just don't have the money.
that the current situation
現在の状況下
we could possibly conceive of.
非効率的なシステムです
is that when governments like the US --
of governments
and disaster relief worldwide.
出資しています
that's just disaster relief.
対外援助は全く含まれません
goes to international relief agencies,
into these areas,
of temporary health system, let's say,
when they run out of money.
取り去られてしまうでしょう
community policy experts,
政策専門家たちはまず
in how to monitor
医療システムの
of health systems
監視する専門家に
and wave our arms.
they don't need us to tell them that.
起きている時ではないんです
need to take their cue
in Afghanistan,
経験などから学び
health sector leaders like these.
強固な基盤を築くのです
with some support.
援助を提供できるはずです
and make new partnerships.
新たなパートナーシップを組むべきです
with NATO and other security policy makers
新たな取り組みを始め
to protect health system institutions
医療機関施設を守れるかを
and other critical social institutions
他の重要な社会機関を守るのは
1部だと理解してもらいたいんです
collateral damage;
それだけではないんです
we need to engage is you,
みなさんです
and indeed, the world public.
the value of social institutions,
医療機関のような
in these fragile settings,
doctors are on the run in country X.
to, let's say, detect influenza."
できなくなったりするだろうな
That's what I'd tell you.
そういうことです
institution defenders and builders.
私の敬愛する3人のアメリカ人がいます
the Marshall Plan
institutions after World War II.
全てのヨーロッパの金融機関を救いました
really serves as the foundation
human rights organizations.
基礎となっています
in terms of creating institutions,
創立しましたが 何より
country was threatened,
to protect human security,
自分たちの世代のために
彼らは話し合いました
should do the same.
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