Margaret Bourdeaux: Why civilians suffer more once a war is over
마가렛 부르도 (Margaret Bourdeaux): 민간인들이 전후에 더 고통받는 이유
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
어떤 느낌일지
there are no rules
and there are no laws.
have disappeared.
사라져버린거죠.
about what this is like,
a medical student in 1999,
in the Balkans during the Kosovo War.
난민캠프에서 일했었거든요.
from my medical school
that I had befriended in the camp
그들을 고향에 함께 돌아가서
life in this postwar setting.
가져도 좋다는 허락을 받았습니다.
was a very interesting place
the war didn't break out again.
it was actually a lawless place,
both public and private,
사설기관들이 파괴됐습니다.
of these situations and settings,
말씀드릴 수 있습니다.
before you run into a situation
깨닫게 되는 상황에 놓이는 데
how incredibly vulnerable you are.
when I had to cross the first checkpoint,
검문소를 지날 때 찾아왔습니다.
through this checkpoint
검문소 통과를 협상해야 한다는 걸
right then and there,
총살할 수도 있었고
anything illegal.
was absolutely nothing
of the families that I got to know
느낀 것과 비교했을 때
where there are no social institutions
살아가는 것은
"What are we going to eat tonight?"
간단한 질문도
when you don't have any security systems,
안전에 관한 질문들은
with the neighbor down the block
이웃과 벌인 말다툼이
that will end my life
앗아갈 폭력적인 사건으로
when there is no health system
건강에 대한 걱정도
had to sort through questions like,
답을 찾는 걸 들었습니다.
What am I going to do?"
어떻게 해야 하나요?"
is bleeding. What should I do?
뭘 해야 하나요?
간호사는 어디에 있나요?
where are the nurses?
In what currency will I pay them?"
어떤 통화로 지불해야해요?"
where will I find them?
are they actually counterfeits?"
the dominant feature of life,
that people have to manage
is incredibly difficult to explain
그 밖에서 살고 있는 사람들에게
who are living outside of it.
떠났을 때 깨달았습니다.
I became a physician,
내과의사가 되었습니다.
health policy researcher.
Division of Global Health.
일하게 되었습니다.
on this problem right away.
즉시 착수하고 싶었습니다.
the crushing vulnerability
"이런 취약한 환경에서 사는 사람들을
of fragile settings?
어떻게 줄일 수 있을까?
we can start to think about
that are critical to survival,
I had amazing colleagues.
question for them.
생소한 질문이었다는 것입니다.
"Oh, if you work in war,
"음, 전쟁통에서 일하는 건
you work on refugee camps,
mass atrocities?" --
기록하는 거 아니야?"
very, very important.
why I was so passionate about this issue,
설명하는 데 오랜 시간이 걸렸습니다.
the public health consequences of war
provocative conclusion.
and disability from war
living in a conflict-affected state
살기에 가장 위험한 때는
has been achieved.
but of course it's not,
사실 그렇지도 않아요.
by robbing them of their clinics,
they're on the run.
도망다닙니다.
and yet more deadly is the destruction
더 치명적인 것은
and their finances.
그들의 재정 파탄입니다.
surprising at all to me.
놀랍지도 않아요.
and somewhat dismaying,
실망스러운 것은
about human suffering and war.
주는 영향이 매우 미미했다는 것입니다.
country of Liberia.
라이베리아를 덮쳤습니다.
about this group, Doctors Without Borders,
보도가 많이 나왔었는데요,
and calling for aid and assistance.
도움과 원조를 요청했습니다.
answered the question:
많지 않았습니다.
even in Liberia?
왜 라이베리아에 가 있지?
is an amazing organization,
응급 치료를 제공하기 위해
emergency care in war zones.
종식되었습니다.
before Ebola even struck.
11년 전의 일입니다.
in the entire country
a functioning health system,
보건 제도가 없어서 있었던 겁니다.
아이티를 강타했을 때
aid was phenomenal.
two percent of that funding
Haitian public institutions,
from the earthquake even today.
지진으로 인해 죽어나가고 있습니다.
in the northern autonomous region of Iraq,
쿠르디스탄의
that in the last nine months,
지난 9개월동안
from four million people
400만 명에서 500만 명으로
have experienced incredible trauma.
엄청난 트라우마를 가져왔습니다.
16-hour days without pay.
하루 16시간을 일하고 있고
by 25 percent;
and to short-term relief efforts.
기금이 들어갔기 때문입니다.
of the five million people in his region
whether they should flee
사람들의 의사결정에
this is a frustrating topic for me,
제게 좌절감을 줍니다.
and security systems?
안 하려고 하는걸까?
two arguments.
두 가지로 구분짓습니다.
in these settings are corrupt
unsavory characters
종사하는 사람들 중
in these situations.
만난 적이 있다는 건 인정합니다.
is absolutely true
to Haiti, to Liberia --
아이티, 라이베리아까지
for their country,
to save their health institutions.
모든 것을 걸었습니다.
who wants to help
풀어야 하는 문제는
in Afghanistan.
success stories
in Afghanistan
investing heavily
아프가니스탄의 보건 부문 지도자들을
Afghani health sector leaders.
많은 돈을 투자했습니다.
have pulled off an incredible feat
아프가니스탄에서 놀라운 업적을
access to health care
의료 서비스에 대한
the health status
건강 상태를 빠른 속도로
of Health does things
바라는 것들을 해요.
we just don't have the money.
그럴 돈이 없어요.
that the current situation
우리가 처해있는 현 상황과
we could possibly conceive of.
가장 비싸고, 비효율적인 시스템이에요.
is that when governments like the US --
of governments
and disaster relief worldwide.
that's just disaster relief.
그냥 재난구조만이에요.
goes to international relief agencies,
into these areas,
물자를 들여와서
of temporary health system, let's say,
보건 시스템을 짭니다.
when they run out of money.
해체시키고 보내버리죠.
community policy experts,
in how to monitor
위기 상황인 지역의
of health systems
and wave our arms.
시선을 주목시켜야 해요.
they don't need us to tell them that.
우리가 말해줄 필요가 없어요.
need to take their cue
근무하는 데와 같은 곳에서는
in Afghanistan,
예시에서 배워야해요.
health sector leaders like these.
만들어야 하고, 만들 거예요.
with some support.
용기를 내줄 수 있다고 생각해요.
and make new partnerships.
만들어야 합니다.
with NATO and other security policy makers
새로운 프로젝트를 시작했습니다.
to protect health system institutions
수호하기 위해 무엇을 할 수 있는지
and other critical social institutions
그들이 지닌 임무의
보여주고 싶었어요.
collateral damage;
피하기 위한 것만이 아닙니다.
we need to engage is you,
가장 중요한 파트너는 당신입니다.
and indeed, the world public.
the value of social institutions,
의료 제도같은 사회제도의 가치를
in these fragile settings,
제도들을 살리려는 노력을
클릭하지 않겠죠.
doctors are on the run in country X.
국가를 떠나고 있어요.
to, let's say, detect influenza."
능력에 관해서는 뭘 의미할까요."
That's what I'd tell you.
institution defenders and builders.
설립자 세 분을 띄워놓았습니다.
the Marshall Plan
경제 제도를 구하기 위한
institutions after World War II.
really serves as the foundation
human rights organizations.
기반이 되고 있습니다.
벤자민 프랭클린입니다.
in terms of creating institutions,
country was threatened,
물러서지 않았습니다.
대한 대화를 하지 않고
to protect human security,
사람들의 안전을 지키기 위한
대한 대화를 했어요.
should do the same.
한다고 생각합니다.
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