Margaret Bourdeaux: Why civilians suffer more once a war is over
Margaret Bourdeaux: 为什么战争结束后人们会遭受更大的苦难
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
将会是怎么样一种情形?
there are no rules
and there are no laws.
have disappeared.
about what this is like,
a medical student in 1999,
in the Balkans during the Kosovo War.
在巴尔干半岛的一个难民营工作过。
from my medical school
that I had befriended in the camp
life in this postwar setting.
如何在战后环境中生活。
was a very interesting place
the war didn't break out again.
不再重燃战火。
it was actually a lawless place,
其实它是一个无法无天的地方,
both public and private,
私有的社会机构
of these situations and settings,
你会感到毛骨悚然,
before you run into a situation
所需要的时间,
how incredibly vulnerable you are.
多么难以置信的脆弱。
when I had to cross the first checkpoint,
就体会到了这种感觉,
through this checkpoint
right then and there,
anything illegal.
算不上什么违法的事情。
was absolutely nothing
丝毫比不上
of the families that I got to know
where there are no social institutions
会让你的生活
"What are we going to eat tonight?"
譬如:今晚我们吃什么,
when you don't have any security systems,
with the neighbor down the block
that will end my life
when there is no health system
关于健康问题的担忧
had to sort through questions like,
不得不把它们进行分类,
What am I going to do?"
我该怎么办?
is bleeding. What should I do?
我该怎么办?
where are the nurses?
他们值得信任吗?
In what currency will I pay them?"
付哪种货币?
where will I find them?
我该去哪儿买?
are they actually counterfeits?"
它们会不会是假的?
the dominant feature of life,
that people have to manage
is incredibly difficult to explain
who are living outside of it.
得出了以上这些结论。
I became a physician,
成为了一名医生。
health policy researcher.
全球公共卫生政策研究员。
Division of Global Health.
on this problem right away.
the crushing vulnerability
人们的脆弱感?
of fragile settings?
we can start to think about
that are critical to survival,
I had amazing colleagues.
我有一群特别棒的同事。
question for them.
这竟然是个非常规问题。
"Oh, if you work in war,
如果你在战争中工作,
you work on refugee camps,
mass atrocities?" --
very, very important.
why I was so passionate about this issue,
为什么我对这件事情如此关心,
这一具里程碑意义的研究被发表,
the public health consequences of war
provocative conclusion.
爆炸性的结论。
and disability from war
living in a conflict-affected state
最危险的时段
has been achieved.
but of course it's not,
by robbing them of their clinics,
从而造成人的死亡。
they're on the run.
他们在不停的逃亡。
and yet more deadly is the destruction
and their finances.
财政体系的破坏。
surprising at all to me.
并没什么吃惊的。
and somewhat dismaying,
about human suffering and war.
并没什么影响。
country of Liberia.
西非国家利比里亚。
about this group, Doctors Without Borders,
关于无国界医生
and calling for aid and assistance.
answered the question:
even in Liberia?
在利比里亚做这些事?
is an amazing organization,
emergency care in war zones.
早在2003年就结束了,
before Ebola even struck.
整个利比里亚的时候,
in the entire country
a functioning health system,
仍然没有一个
aid was phenomenal.
two percent of that funding
Haitian public institutions,
from the earthquake even today.
因为那次地震而死亡。
in the northern autonomous region of Iraq,
克库尔德斯坦自治区域
that in the last nine months,
from four million people
have experienced incredible trauma.
经历了令人无法想象的创伤。
16-hour days without pay.
而且还没有任何酬劳。
by 25 percent;
不仅没有按照25%的比例进行增长
and to short-term relief efforts.
以及提供短期救助了。
of the five million people in his region
whether they should flee
this is a frustrating topic for me,
对我来说这是个令人沮丧的话题,
and security systems?
two arguments.
in these settings are corrupt
都是腐败且
unsavory characters
遇到过
in these situations.
is absolutely true
相反的例子绝对存在,
to Haiti, to Liberia --
还是海地、利比里亚。
for their country,
to save their health institutions.
who wants to help
如果想支持这种行为,
通向领导岗位的道路。
in Afghanistan.
success stories
in Afghanistan
investing heavily
识别、培训并推举
Afghani health sector leaders.
have pulled off an incredible feat
access to health care
the health status
全世界最差的。
of Health does things
我听到过很多的就是:
we just don't have the money.
我们没有足够的钱。
that the current situation
we could possibly conceive of.
也是最低效的。
is that when governments like the US --
of governments
and disaster relief worldwide.
就花费了150亿美元。
that's just disaster relief.
仅仅是赈灾资金。
goes to international relief agencies,
流向了国际救援组织,
into these areas,
of temporary health system, let's say,
when they run out of money.
这些卫生系统人员会被解散遣返。
我们要做的工作就很清晰了。
community policy experts,
in how to monitor
of health systems
and wave our arms.
开始行动的时刻了。
they don't need us to tell them that.
不需要我们来告知他们。
need to take their cue
in Afghanistan,
得到一些提示。
health sector leaders like these.
去扶植那些卫生部门的领导人。
with some support.
回应他们的勇气。
and make new partnerships.
with NATO and other security policy makers
发起了一项新的倡议,
to protect health system institutions
能为保护卫生系统的机构
and other critical social institutions
collateral damage;
we need to engage is you,
and indeed, the world public.
事实上也是全世界人民。
the value of social institutions,
in these fragile settings,
它们在脆弱环境中的价值,
doctors are on the run in country X.
to, let's say, detect influenza."
比如说流感这样的疾病?”
That's what I'd tell you.
institution defenders and builders.
美国的机构创建者及捍卫者。
the Marshall Plan
institutions after World War II.
所有欧洲的经济体系。
really serves as the foundation
human rights organizations.
本杰明·富兰克林
in terms of creating institutions,
country was threatened,
to protect human security,
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