TEDxBeaconStreet
Margaret Bourdeaux: Why civilians suffer more once a war is over
瑪格麗特·布爾多: 為什麼平民在戰爭結束後遭受更多的痛苦？
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在戰爭中，事實證明暴力並不是平民最大的殺手。 什麼才是？疾病、飢餓、貧窮──因為戰爭破壞了運行社會的公共機構，像基楚建設、銀行、食品系統和醫院等。 瑪格麗特·布爾多醫生（Margaret Bourdeaux）提出了一個大膽的方案來解決衝突後之重建任務，確定什麼才是修復的優先重點。
Margaret Bourdeaux - Physician, global health policy analyst
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster. Full bio
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.
請問你有曾想過，
00:12
So have you ever wondered
what it would be like
what it would be like
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生活在一個不受管制的地方
是怎樣感覺嗎？
是怎樣感覺嗎？
00:16
to live in a place with no rules?
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聽來是蠻酷的。
00:19
That sounds pretty cool.
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00:21
(Laughter)
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（笑聲）
00:22
You wake up one morning, however,
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可是，大早醒來後，
你發現沒有管制的原因
00:23
and you discover that the reason
there are no rules
there are no rules
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卻是因為已沒有政府了，
而且也沒有任何法律了，
而且也沒有任何法律了，
00:26
is because there's no government,
and there are no laws.
and there are no laws.
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00:29
In fact, all social institutions
have disappeared.
have disappeared.
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甚至一切社會體制都不存在了：
00:34
So there's no schools,
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沒有學校，
00:36
there's no hospitals,
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沒有醫院，
00:37
there's no police,
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沒有警察，
00:38
there's no banks,
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沒有銀行，
00:40
there's no athletic clubs,
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沒有健身會所，
00:42
there's no utilities.
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沒有水電等供應。
00:44
Well, I know a little bit
about what this is like,
about what this is like,
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我倒是知道這是什麼的感覺。
00:48
because when I was
a medical student in 1999,
a medical student in 1999,
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因為在 1999 年，
我為醫學院學生時，
我為醫學院學生時，
00:50
I worked in a refugee camp
in the Balkans during the Kosovo War.
in the Balkans during the Kosovo War.
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在科索沃戰爭中，曾在巴爾幹的
一個難民收留中心工作。
一個難民收留中心工作。
00:57
When the war was over,
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當戰爭結束後，
00:58
I got permission -- unbelievably --
from my medical school
from my medical school
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難以置信，
我居然獲得醫學院的允許，
我居然獲得醫學院的允許，
01:01
to take some time off
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拿到假期，
01:02
and follow some of the families
that I had befriended in the camp
that I had befriended in the camp
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跟著我在營地結識的一些家庭，
01:06
back to their village in Kosovo,
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回到他們在科索沃的家鄉。
01:09
and understand how they navigated
life in this postwar setting.
life in this postwar setting.
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去觀察他們在戰火後，
是如何作生活的安排。
是如何作生活的安排。
01:16
Postwar Kosovo
was a very interesting place
was a very interesting place
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戰後的科索沃
是一個非常有趣的地方，
是一個非常有趣的地方，
01:19
because NATO troops were there,
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因為有北約部隊在那裡，
01:22
mostly to make sure
the war didn't break out again.
the war didn't break out again.
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目的是為了確保戰爭
不會再度爆發。
不會再度爆發。
01:26
But other than that,
it was actually a lawless place,
it was actually a lawless place,
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但除此之外，科索沃實際上已是
一個無法無天的地方，
一個無法無天的地方，
01:30
and almost every social institution,
both public and private,
both public and private,
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而且幾乎所有的社會體制，
不論是公營或私營，
不論是公營或私營，
01:33
had been destroyed.
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都已被毀掉了。
01:35
So I can tell you
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所以我可以告訴你，
01:39
that when you go into one
of these situations and settings,
of these situations and settings,
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當你置身在這種情況和環境中，
01:44
it is absolutely thrilling ...
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它是會令你絕對毛骨悚然......
01:47
for about 30 minutes,
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長達 30 分鐘左右，
01:49
because that's about how long it takes
before you run into a situation
before you run into a situation
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因為這就是發現自己
是何等的脆弱，所需要的時間。
是何等的脆弱，所需要的時間。
01:53
where you realize
how incredibly vulnerable you are.
how incredibly vulnerable you are.
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01:59
For me, that moment came
when I had to cross the first checkpoint,
when I had to cross the first checkpoint,
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個人來說，那一刻發生在當我要
通過第一個檢查站時，
通過第一個檢查站時，
02:03
and I realized as I drove up
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當車子開近時，我就意識到
02:05
that I would be negotiating passage
through this checkpoint
through this checkpoint
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我必須跟一名全副武裝的人討價還價
02:09
with a heavily armed individual
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才能通過這個檢查點；
02:11
who, if he decided to shoot me
right then and there,
right then and there,
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如他想在此時此地把我射殺的話，
02:15
actually wouldn't be doing
anything illegal.
anything illegal.
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也是完全合法之事。
02:18
But the sense of vulnerability that I had
was absolutely nothing
was absolutely nothing
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但當時我體會到的脆弱感，
是絲毫比不上
是絲毫比不上
02:23
in comparison to the vulnerability
of the families that I got to know
of the families that I got to know
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我將在未來一年認識的家庭
02:27
over that year.
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所體會的脆弱感。
02:29
You see, life in a society
where there are no social institutions
where there are no social institutions
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你要明白，生活在一個沒有
任何社會體制的社會裡，
任何社會體制的社會裡，
02:34
is riddled with danger and uncertainty,
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是充滿危險和不確定性的。
02:38
and simple questions like,
"What are we going to eat tonight?"
"What are we going to eat tonight?"
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甚至一個簡單的問題，
像「今晚我們要吃什麼呢？」
像「今晚我們要吃什麼呢？」
02:42
are very complicated to answer.
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要回答也很複雜了。
02:46
Questions about security,
when you don't have any security systems,
when you don't have any security systems,
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至於安全問題，
當你沒有任何保安系統時，
當你沒有任何保安系統時，
02:51
are terrifying.
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是非常可怕的。
02:52
Is that altercation I had
with the neighbor down the block
with the neighbor down the block
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我與街頭那邊的鄰居吵得面紅耳赤，
02:55
going to turn into a violent episode
that will end my life
that will end my life
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會不會演變成暴力事件，
終結我的生命
終結我的生命
02:58
or my family's life?
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或我家人的生命呢？
03:00
Health concerns
when there is no health system
when there is no health system
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沒有衛生系統時，健康問題
03:02
are also terrifying.
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也是非常可怕的。
03:05
I listened as many families
had to sort through questions like,
had to sort through questions like,
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我聽到很多家庭必須解決這類問題：
03:08
"My infant has a fever.
What am I going to do?"
What am I going to do?"
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「我的嬰兒在發燒。我該怎麼辦？」
03:12
"My sister, who is pregnant,
is bleeding. What should I do?
is bleeding. What should I do?
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「我懷孕的姐姐正在出血，
我該怎麼辦？
我該怎麼辦？
03:16
Who should I turn to?"
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我該去找誰呢？」
03:17
"Where are the doctors,
where are the nurses?
where are the nurses?
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「醫生在哪裡？護士在哪裡？」
03:19
If I could find one, are they trustworthy?
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如果我能找到一位，會可靠嗎？
03:22
How will I pay them?
In what currency will I pay them?"
In what currency will I pay them?"
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我該怎麼付錢？
我要用哪國貨幣支付？」
我要用哪國貨幣支付？」
03:25
"If I need medications,
where will I find them?
where will I find them?
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「如果我需要藥物，
我在哪裡可以找到？
我在哪裡可以找到？
03:28
If I take those medications,
are they actually counterfeits?"
are they actually counterfeits?"
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如果我服用了這些藥物，
它會是假冒的嗎？」
它會是假冒的嗎？」
03:31
And on and on.
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連綿不斷的問題。
03:34
So for life in these settings,
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所以在這環境之下生活，
03:37
the dominant theme,
the dominant feature of life,
the dominant feature of life,
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生活的主要特徵，
03:41
is the incredible vulnerability
that people have to manage
that people have to manage
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就是人民日以繼夜要懂得掌控
03:45
day in and day out,
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這難以置信的脆弱感，
03:47
because of the lack of social systems.
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起因就是缺乏社會制度。
03:50
And it actually turns out
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原來，
03:51
that this feature of life
is incredibly difficult to explain
is incredibly difficult to explain
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這生活特徵是很難解釋的，
03:55
and be understood by people
who are living outside of it.
who are living outside of it.
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難以得到身置其外的人理解的。
03:59
I discovered this when I left Kosovo.
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當我離開科索沃時，
我才發現這一點。
我才發現這一點。
04:03
I came back to Boston,
I became a physician,
I became a physician,
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我回到了波士頓，我成了一名醫生，
04:07
I became a global public
health policy researcher.
health policy researcher.
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我成了一名
環球公共衞生政策研究員。
環球公共衞生政策研究員。
04:11
I joined the Harvard Medical School
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我加入了哈佛醫學院
04:12
and Brigham and Women's Hospital
Division of Global Health.
Division of Global Health.
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和布萊根婦女醫院的全球衞生部門。
04:15
And I, as a researcher,
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我作為研究員，
真的很想立即就研究這問題。
04:17
really wanted to get started
on this problem right away.
on this problem right away.
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我在想：
「對生活在這種匱乏環境的人，
「對生活在這種匱乏環境的人，
04:19
I was like, "How do we reduce
the crushing vulnerability
the crushing vulnerability
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04:23
of people living in these types
of fragile settings?
of fragile settings?
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我們如何能減少
這令人窒息的脆弱感？
這令人窒息的脆弱感？
04:27
Is there any way
we can start to think about
we can start to think about
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我們可以開始思考用什麼方法
04:29
how to protect and quickly recover
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去保護和迅速恢復
04:32
the institutions
that are critical to survival,
that are critical to survival,
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這些對生存至關重要的體制，
04:35
like the health system?"
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像醫療衞生系統？」
04:36
And I have to say,
I had amazing colleagues.
I had amazing colleagues.
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我不得不說，我有了不起的同事，
04:40
But one interesting thing about it was,
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但有一件有趣的事情是：
04:42
this was sort of an unusual
question for them.
question for them.
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對他們來說，
這是一種不尋常的問題。
這是一種不尋常的問題。
04:45
They were kind of like,
"Oh, if you work in war,
"Oh, if you work in war,
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他們的反應是：
「哦，你在戰場中工作，
「哦，你在戰場中工作，
04:47
doesn't that mean
you work on refugee camps,
you work on refugee camps,
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那是不是你是在難民營工作？
04:49
and you work on documenting
mass atrocities?" --
mass atrocities?" --
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在記錄戰爭暴行？」
04:52
which is, by the way, very,
very, very important.
very, very important.
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順帶一提，這些工作都是非常重要。
04:55
So it took me a while to explain
why I was so passionate about this issue,
why I was so passionate about this issue,
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所以我必得花上一段時間來解釋
我為什麼對這個問題那麼熱衷，
我為什麼對這個問題那麼熱衷，
05:00
until about six years ago.
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直至大約六年前。
05:02
That's when this landmark study
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當時這份重點研究被發表，
05:04
that looked at and described
the public health consequences of war
the public health consequences of war
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內容是探討和描述戰爭對公共衞生
05:08
was published.
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所帶來的後果。
05:09
They came to an incredible,
provocative conclusion.
provocative conclusion.
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研究人員作出一個
意想不到的驚世結論：
意想不到的驚世結論：
05:15
These researchers concluded
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這些研究人員的結論
05:18
that the vast majority of death
and disability from war
and disability from war
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就是絕大多數因戰爭
死亡和殘疾的事情
死亡和殘疾的事情
05:22
happens after the cessation of conflict.
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是發生在衝突停止之後。
05:24
So the most dangerous time to be a person
living in a conflict-affected state
living in a conflict-affected state
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所以活在受衝突影響的國家中
最危險的時候，
最危險的時候，
05:29
is after the cessation of hostilities;
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是在敵對行動停止之後；
05:31
it's after the peace deal has been signed.
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是在和平協議簽署之後；
05:33
It's when that political solution
has been achieved.
has been achieved.
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是在政治解決方案已經實現之後。
05:36
That seems so puzzling,
but of course it's not,
but of course it's not,
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這表面看來令人費解，但當然不是，
05:39
because war kills people
by robbing them of their clinics,
by robbing them of their clinics,
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因為戰爭之所以殺人，
是因為它摧毀了診所，
是因為它摧毀了診所，
05:45
of their hospitals,
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摧毀了醫院，
05:47
of their supply chains.
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摧毀了供應鏈。
05:48
Their doctors are targeted, are killed;
they're on the run.
they're on the run.
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醫生們被狙擊、殺害，以至逃命。
05:52
And more invisible
and yet more deadly is the destruction
and yet more deadly is the destruction
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而且雖無形但更致命的，
就是衞生管治體制及其財政崩潰。
05:56
of the health governance institutions
and their finances.
and their finances.
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06:01
So this is really not
surprising at all to me.
surprising at all to me.
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我對這些並不驚訝，
06:05
But what is surprising
and somewhat dismaying,
and somewhat dismaying,
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但令我驚訝和有一點沮喪的是：
06:08
is how little impact this insight has had,
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從這份研究得出的見解，
只能稍微改變
我們對人類苦難和戰爭的看法。
我們對人類苦難和戰爭的看法。
06:12
in terms of how we think
about human suffering and war.
about human suffering and war.
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06:16
Let me give you a couple examples.
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讓我給你幾個例子。
06:19
Last year, you may remember,
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你可能會記得去年
06:21
Ebola hit the West African
country of Liberia.
country of Liberia.
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伊波拉病毒侵襲西非國家賴比瑞亞。
06:26
There was a lot of reporting
about this group, Doctors Without Borders,
about this group, Doctors Without Borders,
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當時有很多關於
無國界醫生這個組織的報導，
無國界醫生這個組織的報導，
06:30
sounding the alarm
and calling for aid and assistance.
and calling for aid and assistance.
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叫人提高警覺並呼籲作出援助。
06:33
But not a lot of that reporting
answered the question:
answered the question:
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但沒有很多報導解答到這個問題：
06:37
Why is Doctors Without Borders
even in Liberia?
even in Liberia?
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為什麼無國界醫生會在賴比瑞亞呢？
06:39
Doctors Without Borders
is an amazing organization,
is an amazing organization,
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無國界醫生是一個令人敬佩的組織，
06:42
dedicated and designed to provide
emergency care in war zones.
emergency care in war zones.
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盡心盡力在戰區提供緊急護理。
06:47
Liberia's civil war had ended in 2003 --
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賴比瑞亞的內戰在 2003 年已結束，
06:50
that was 11 years
before Ebola even struck.
before Ebola even struck.
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亦是伊波拉病毒爆發的 11 年前。
06:54
When Ebola struck Liberia,
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當伊波拉病毒衝擊賴比瑞亞時，
06:56
there were less than 50 doctors
in the entire country
in the entire country
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在全國 450 萬人口之中，
醫生不到 50 名。
醫生不到 50 名。
07:00
of 4.5 million people.
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07:02
Doctors Without Borders is in Liberia
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無國界醫生駐守在賴比瑞亞，
07:04
because Liberia still doesn't really have
a functioning health system,
a functioning health system,
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是因為賴比瑞亞依然沒有
一個能運作的醫療系統，
一個能運作的醫療系統，
在 11 年後仍沒有。
07:08
11 years later.
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07:10
When the earthquake hit Haiti in 2010,
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在 2010 年，地震衝擊海地後，
07:13
the outpouring of international
aid was phenomenal.
aid was phenomenal.
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來自國際社會的援助排山倒海。
07:16
But did you know that only
two percent of that funding
two percent of that funding
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但你知不知道國際社會
捐款中只有 2%
捐款中只有 2%
07:20
went to rebuild
Haitian public institutions,
Haitian public institutions,
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用去重建海地的公共體制，
07:23
including its health sector?
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包括衞生部門？
07:25
From that perspective,
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從這個角度看，
07:27
Haitians continue to die
from the earthquake even today.
from the earthquake even today.
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海地人民可謂到了今天
還因地震而繼續死亡。
還因地震而繼續死亡。
07:31
I recently met this gentleman.
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我最近認識了這位先生，
07:33
This is Dr. Nezar Ismet.
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他是尼薩‧伊斯密特醫生。
07:36
He's the Minister of Health
in the northern autonomous region of Iraq,
in the northern autonomous region of Iraq,
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他是伊拉克北部自治區庫爾德斯坦的
07:39
in Kurdistan.
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衞生部長。
07:41
Here he is announcing
that in the last nine months,
that in the last nine months,
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他正在宣佈在過去九個月中，
07:45
his country, his region, has increased
from four million people
from four million people
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他所屬地區的人口從 400 萬
07:49
to five million people.
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增加到 500 萬。
07:50
That's a 25 percent increase.
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這是增加 25％ 之多。
這些數以千計的新移民
經歷了難言的創傷。
經歷了難言的創傷。
07:52
Thousands of these new arrivals
have experienced incredible trauma.
have experienced incredible trauma.
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07:57
His doctors are working
16-hour days without pay.
16-hour days without pay.
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他轄下的醫生們
每天無薪的工作 16 小時。
每天無薪的工作 16 小時。
08:03
His budget has not increased
by 25 percent;
by 25 percent;
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可是他的財政預算
並沒有增加 25 ％，
並沒有增加 25 ％，
08:05
it has decreased by 20 percent,
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而是減少了 20％。
08:08
as funding has flowed to security concerns
and to short-term relief efforts.
and to short-term relief efforts.
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因為撥款已調去應付保安問題
和短期救援工作。
和短期救援工作。
08:13
When his health sector fails --
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所以當他的衞生部門崩潰時—
08:15
and if history is any guide, it will --
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如果歷史有任何預告能力，
它是一定會的——
它是一定會的——
08:17
how do you think that's going to influence
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你覺得這會怎樣影響
當地 500 萬居民的決定呢？
08:19
the decision making
of the five million people in his region
of the five million people in his region
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他們正在考量是否應該逃跑，
08:23
as they think about
whether they should flee
whether they should flee
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08:25
that type of vulnerable living situation?
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離開這危機重重的生活環境。
08:29
So as you can see,
this is a frustrating topic for me,
this is a frustrating topic for me,
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所以你可以看到，
這是個令我沮喪的議題。
這是個令我沮喪的議題。
08:32
and I really try to understand:
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我很用心去嘗試理解：
08:34
Why the reluctance to protect and support
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大家為什麼不願意維護和支持
08:37
indigenous health systems
and security systems?
and security systems?
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本土的衞生和保安系統呢？
08:41
I usually tier two concerns,
two arguments.
two arguments.
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我常聽到兩個關注點或論點。
08:44
The first concern is about corruption,
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第一個關注點是貪污：
08:47
and the concern that people
in these settings are corrupt
in these settings are corrupt
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在這些系統工作的人都是腐敗的，
08:49
and they are untrustworthy.
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都是不可信的。
08:52
And I will admit that I have met
unsavory characters
unsavory characters
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我承認我是有見過品德不良的人物，
08:55
working in health sectors
in these situations.
in these situations.
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在這種情況下之衞生部門工作。
08:57
But I will tell you that the opposite
is absolutely true
is absolutely true
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但我也可告訴你，
相反的也是絕對有的，
相反的也是絕對有的，
09:01
in every case I have worked on,
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在我有參與的每一個案件中都有——
從阿富汗到利比亞、到科索沃、
到海地、到賴比瑞亞——
到海地、到賴比瑞亞——
09:03
from Afghanistan to Libya, to Kosovo,
to Haiti, to Liberia --
to Haiti, to Liberia --
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09:07
I have met inspiring people,
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我都遇到鼓舞人心的人，
09:09
who, when the chips were down
for their country,
for their country,
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他們都在國家存亡的一刻，
09:11
they risked everything
to save their health institutions.
to save their health institutions.
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冒著一切風險來
挽救他們的衞生體制。
挽救他們的衞生體制。
09:15
The trick for the outsider
who wants to help
who wants to help
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所以，對真心想幫忙的局外人來說，
09:18
is identifying who those individuals are,
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難題是如何識別這些人，
09:21
and building a pathway for them to lead.
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並建立渠道讓他們走上領導位置。
09:23
That is exactly what happened
in Afghanistan.
in Afghanistan.
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這也正是在阿富汗能做到的。
09:27
One of the unsung and untold
success stories
success stories
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我們在阿富汗國家建設上付出的努力
其中一個無聲無聞的成功故事，
09:31
of our nation-building effort
in Afghanistan
in Afghanistan
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09:34
involved the World Bank in 2002
investing heavily
investing heavily
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就是世界銀行在 2002 年
投放大量資金
投放大量資金
去發掘、培訓和提拔
阿富汗的衞生部門領袖。
阿富汗的衞生部門領袖。
09:37
in identifying, training and promoting
Afghani health sector leaders.
Afghani health sector leaders.
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5135
09:44
These health sector leaders
have pulled off an incredible feat
have pulled off an incredible feat
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這些衞生部門領袖在阿富汗
排除萬難完成壯舉。
09:47
in Afghanistan.
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09:49
They have aggressively increased
access to health care
access to health care
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他們積極增加醫療服務
讓大部分人口可以使用。
09:53
for the majority of the population.
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09:55
They are rapidly improving
the health status
the health status
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2204
他們正在迅速改善
阿富汗人口的健康狀況，
09:57
of the Afghan population,
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09:58
which used to be the worst in the world.
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586856
1986
而它曾經是世界上最糟糕的。
10:01
In fact, the Afghan Ministry
of Health does things
of Health does things
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2822
事實上，阿富汗衞生部所做的事
是我希望我們也能在美國做到的。
10:04
that I wish we would do in America.
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10:06
They use things like data to make policy.
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他們用數據資料來製定政策。
簡直不可思議。
10:08
It's incredible.
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1185
10:10
(Laughter)
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2392
（笑聲）
10:12
The other concern I hear a lot about is:
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我經常聽到的另外一個關注點是：
10:14
"We just can't afford it,
we just don't have the money.
we just don't have the money.
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2602
「我們負擔不起，我們真的沒錢。
這是不可能持續的。」
10:17
It's just unsustainable."
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1355
10:19
I would submit to you
that the current situation
that the current situation
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2733
但讓我告訴你：我們現有的情況
10:22
and the current system we have
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1735
和我們現有的制度
10:23
is the most expensive, inefficient system
we could possibly conceive of.
we could possibly conceive of.
201
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4038
是我們可以想像
最昂貴、效率最低的制度。
最昂貴、效率最低的制度。
10:27
The current situation
is that when governments like the US --
is that when governments like the US --
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3378
目前的情況是美國等多國政府——
10:31
or, let's say, the collection
of governments
of governments
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2064
或者說組成歐盟委員會的
一眾成員國政府——
10:33
that make up the European Commission --
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1874
10:35
every year, they spend 15 billion dollars
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2649
每年就要花費 150 億美元
10:38
on just humanitarian and emergency
and disaster relief worldwide.
and disaster relief worldwide.
206
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4006
在全球的人道、緊急和災難救援上。
10:42
That's nothing about foreign aid,
that's just disaster relief.
that's just disaster relief.
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3321
這數字不包括外援，只是賑災而已。
10:46
Ninety-five percent of it
goes to international relief agencies,
goes to international relief agencies,
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5045
這費用 95% 給了國際救援機構，
10:51
that then have to import resources
into these areas,
into these areas,
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4337
然後他們必須把資源引進這些地區，
10:55
and knit together some type
of temporary health system, let's say,
of temporary health system, let's say,
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4389
並且拼湊一個臨時衞生系統，
10:59
which they then dismantle and send away
when they run out of money.
when they run out of money.
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3569
錢用光後就要把它瓦解，
把人員遣散。
把人員遣散。
11:04
So our job, it turns out, is very clear.
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3930
所以我們的工作原來是非常清楚的。
11:09
We, as the global health
community policy experts,
community policy experts,
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4775
我們作為全球衞生政策專家，
11:13
our first job is to become experts
in how to monitor
in how to monitor
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5545
首要工作就是要專注監控
在政局不定環境下，衞生部門的
11:19
the strengths and vulnerabilities
of health systems
of health systems
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2447
各個強項和弱項。
11:22
in threatened situations.
216
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2567
11:24
And that's when we see doctors fleeing,
217
672611
2010
當我們看到醫生逃跑時，
11:26
when we see health resources drying up,
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1937
當我們看到衞生資源枯竭時，
11:28
when we see institutions crumbling --
219
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2435
當我們看到體制崩潰時，
11:31
that's the emergency.
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1613
這就是緊急情況。
11:32
That's when we need to sound the alarm
and wave our arms.
and wave our arms.
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3110
這就是我們需要發出警報
並揮手求救之時。
並揮手求救之時。
11:35
OK?
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1394
行嗎？
11:37
Not now.
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685254
1151
還等什麼？
11:38
Everyone can see that's an emergency,
they don't need us to tell them that.
they don't need us to tell them that.
224
686429
3912
大家都可以看到這是緊急情況，
他們不需要我們告訴他們吧。
他們不需要我們告訴他們吧。
11:43
Number two:
225
691122
1939
第二點：
11:45
places like where I work at Harvard
need to take their cue
need to take their cue
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693085
3337
我在哈佛任職的機構和類似機構
需要從世界銀行
在阿富汗的經驗中學習，
在阿富汗的經驗中學習，
11:48
from the World Bank experience
in Afghanistan,
in Afghanistan,
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2198
11:50
and we need to -- and we will --
228
698668
1657
我們需要並將會
11:52
build robust platforms to support
health sector leaders like these.
health sector leaders like these.
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5263
建立一個強大的平台來支援
這些衞生部門領袖。
這些衞生部門領袖。
11:58
These people risk their lives.
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1702
這些人都是冒著生命危險，
12:00
I think we can match their courage
with some support.
with some support.
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3712
我們應該以行動來支持他們的勇氣。
12:04
Number three:
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1154
第三點：
12:05
we need to reach out
and make new partnerships.
and make new partnerships.
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2578
我們需要積極溝通，
並建立新的伙伴關係。
並建立新的伙伴關係。
12:08
At our global health center,
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1874
在我們的環球衞生中心，
12:10
we have launched a new initiative
with NATO and other security policy makers
with NATO and other security policy makers
235
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4012
我們與北約和其它安全決策者
發起了一個新舉措，
發起了一個新舉措，
12:14
to explore with them what they can do
to protect health system institutions
to protect health system institutions
236
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5366
與他們探討如何
在部署期間維護當地的衞生系統。
12:19
during deployments.
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1715
12:21
We want them to see
238
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1540
我們希望他們明白，
12:22
that protecting health systems
and other critical social institutions
and other critical social institutions
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4700
維護當地衞生系統和
其它關鍵社會體制
其它關鍵社會體制
12:27
is an integral part of their mission.
240
735556
2443
是他們任務的重要一環。
12:30
It's not just about avoiding
collateral damage;
collateral damage;
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3137
這不僅是為了避免附帶損害，
更是為了締造和平。
12:33
it's about winning the peace.
242
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1805
12:36
But the most important partner
we need to engage is you,
we need to engage is you,
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3583
但我們最需要的合作夥伴還是你們：
12:40
the American public,
and indeed, the world public.
and indeed, the world public.
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748332
3432
美國大眾，以至世界大眾。
12:43
Because unless you understand
the value of social institutions,
the value of social institutions,
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5696
除非你們能明白
社會體制的寶貴價值，
社會體制的寶貴價值，
就像政局不穩環境下的衞生體制，
12:49
like health systems
in these fragile settings,
in these fragile settings,
246
757508
2511
12:53
you won't support efforts to save them.
247
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2248
否則你們是不會支持維護它們的。
12:55
You won't click on that article
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2398
你不會點擊那篇文章，
12:57
that talks about "Hey, all those
doctors are on the run in country X.
doctors are on the run in country X.
249
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4966
它在談論，「嘿，所有這些醫生
正從某國逃命。
正從某國逃命。
我想知道這意味什麼：
13:02
I wonder what that means.
250
770750
2417
13:05
I wonder what that means
251
773191
1852
究竟該國衞生系統
13:07
for that health system's ability
to, let's say, detect influenza."
to, let's say, detect influenza."
252
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3952
有沒有能力檢測流行性感冒爆發？」
13:11
"Hmm, it's probably not good."
That's what I'd tell you.
That's what I'd tell you.
253
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3377
「嗯，情況應該好不了那裡。」
我會這樣回答你。
我會這樣回答你。
13:15
Up on the screen,
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1164
在螢幕上，
13:16
I've put up my three favorite American
institution defenders and builders.
institution defenders and builders.
255
784958
6280
是我最喜歡的三位捍衞和建設
社會體制的美國人。
社會體制的美國人。
13:23
Over here is George C. Marshall,
256
791846
2885
在這邊是喬治·卡特萊特·馬歇爾，
13:26
he was the guy that proposed
the Marshall Plan
the Marshall Plan
257
794755
2829
他就是提出馬歇爾計劃的人，
13:29
to save all of Europe's economic
institutions after World War II.
institutions after World War II.
258
797608
4191
來拯救第二次世界大戰後
所有在歐洲的經濟制度。
所有在歐洲的經濟制度。
13:34
And this Eleanor Roosevelt.
259
802299
2353
這是愛蓮娜·羅斯福。
13:36
Her work on human rights
really serves as the foundation
really serves as the foundation
260
804676
3146
她的人權工作真正為
我們所有國際人權組織奠定基礎。
13:39
for all of our international
human rights organizations.
human rights organizations.
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3028
13:43
Then my big favorite is Ben Franklin,
262
811330
2040
這是我最喜歡的班傑明·富蘭克林，
13:45
who did many things
in terms of creating institutions,
in terms of creating institutions,
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3208
他在創造制度方面做了很多貢獻，
13:48
but was the midwife of our constitution.
264
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2767
也是我們憲法得以誕生的助產士。
13:52
And I would say to you
265
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1724
我可以這麼說，
13:54
that these are folks who, when our
country was threatened,
country was threatened,
266
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3753
這些人在我們國家受到威脅之時，
13:58
or our world was threatened,
267
826107
2007
或是我們世界受到威脅之時，
14:00
they didn't retreat.
268
828138
1303
並沒有退縮。
14:01
They didn't talk about building walls.
269
829465
2341
他們並沒有談論建圍牆，
14:03
They talked about building institutions
to protect human security,
to protect human security,
270
831830
5381
他們談論的是建設制度
來保障人類安全，
來保障人類安全，
14:10
for their generation and also for ours.
271
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2614
裨益他們那一代以至我們這一代。
14:13
And I think our generation
should do the same.
should do the same.
272
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2798
所以我們這一代也應該
做同樣的事情。
做同樣的事情。
謝謝。
14:16
Thank you.
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（掌聲）
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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