ABOUT THE SPEAKER
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.

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.

More profile about the speaker
Margaret Bourdeaux | Speaker | TED.com
TEDxBeaconStreet

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

Filmed:
979,657 views

战争不仅仅带走人的生命,还摧毁维持社会运转的公共机构,比如:公共基础设施,银行和医院等。全球健康政策分析师Margaret Bourdeaux医生提出了关于建立一个用于保护弱势群体的强大弹性健康体系进行战后恢复的大胆想法。
- 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

Double-click the English transcript below to play the video.

00:12
So have you ever wondered想知道
what it would be like
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大家有没有想过生活在一个
00:16
to live生活 in a place地点 with no rules规则?
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没有约束管制的世界
将会是怎么样一种情形?
00:19
That sounds声音 pretty漂亮 cool.
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这听起来很酷。
00:21
(Laughter笑声)
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(笑声)
00:22
You wake唤醒 up one morning早上, however然而,
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当有一天你一觉醒来,
发现没任何约束的原因,
00:23
and you discover发现 that the reason原因
there are no rules规则
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是因为没有政府也没有法律。
00:26
is because there's no government政府,
and there are no laws法律.
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00:29
In fact事实, all social社会 institutions机构
have disappeared消失.
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事实上,整个社会体系都消失了。
00:34
So there's no schools学校,
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所以没有了学校,
00:36
there's no hospitals医院,
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没有医院,
00:37
there's no police警察,
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没有警察,
00:38
there's no banks银行,
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没有银行,
00:40
there's no athletic竞技 clubs会所,
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没有体育俱乐部,
00:42
there's no utilities公用事业.
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没有公共设施。
00:44
Well, I know a little bit
about what this is like,
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其实我对这种状况有一些了解,
00:48
because when I was
a medical student学生 in 1999,
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因为在1999年科索沃战争期间,
00:50
I worked工作 in a refugee难民 camp
in the Balkans巴尔干 during the Kosovo科索沃 War战争.
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我曾作为一个医科学生
在巴尔干半岛的一个难民营工作过。
00:57
When the war战争 was over,
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战争结束时,
00:58
I got permission允许 -- unbelievably令人难以置信 --
from my medical school学校
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没想到学校竟然批准了
01:01
to take some time off
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我请假的请求,
01:02
and follow跟随 some of the families家庭
that I had befriended结识 in the camp
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允许我跟随难民营家庭的一些朋友
01:06
back to their village in Kosovo科索沃,
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返回他们在科索沃的家乡,
01:09
and understand理解 how they navigated导航
life in this postwar战后 setting设置.
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我因此目睹了他们
如何在战后环境中生活。
01:16
Postwar战后 Kosovo科索沃
was a very interesting有趣 place地点
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战后的科索沃是个很有意思的地方,
01:19
because NATO北约 troops军队 were there,
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一方面北约军队在这里
01:22
mostly大多 to make sure
the war战争 didn't break打破 out again.
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最大程度地保证这里
不再重燃战火。
01:26
But other than that,
it was actually其实 a lawless不法 place地点,
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但另一方面,
其实它是一个无法无天的地方,
01:30
and almost几乎 every一切 social社会 institution机构,
both public上市 and private私人的,
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几乎所有的公共的和
私有的社会机构
01:33
had been destroyed销毁.
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都被摧毁了。
01:35
So I can tell you
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所以可以这样说:
01:39
that when you go into one
of these situations情况 and settings设置,
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当刚步入这种处境的时候,
01:44
it is absolutely绝对 thrilling惊险 ...
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毫无疑问是,
你会感到毛骨悚然,
01:47
for about 30 minutes分钟,
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这种感觉会持续大约半个小时,
01:49
because that's about how long it takes
before you run into a situation情况
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因为这是适应一个新环境
所需要的时间,
01:53
where you realize实现
how incredibly令人难以置信 vulnerable弱势 you are.
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这个环境会使你意识到自己是
多么难以置信的脆弱。
01:59
For me, that moment时刻 came来了
when I had to cross交叉 the first checkpoint检查站,
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而当我通过第一个哨卡的时候
就体会到了这种感觉,
02:03
and I realized实现 as I drove开车 up
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当我逐渐开近这个哨卡,
02:05
that I would be negotiating谈判 passage通道
through通过 this checkpoint检查站
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我突然意识到一会儿要与
02:09
with a heavily严重 armed武装 individual个人
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哨卡里有全副武装的哨兵交涉,
02:11
who, if he decided决定 to shoot射击 me
right then and there,
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如果他此时此刻要射杀我的话,
02:15
actually其实 wouldn't不会 be doing
anything illegal非法.
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我确定那根本
算不上什么违法的事情。
02:18
But the sense of vulnerability漏洞 that I had
was absolutely绝对 nothing
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然而我感受到的这种脆弱
丝毫比不上
02:23
in comparison对照 to the vulnerability漏洞
of the families家庭 that I got to know
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我在那年认识的那些家庭所承受的
02:27
over that year.
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脆弱感。
02:29
You see, life in a society社会
where there are no social社会 institutions机构
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大家知道,一个没有社会机构的环境
会让你的生活
02:34
is riddled百病 with danger危险 and uncertainty不确定,
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充满危险和未知,
02:38
and simple简单 questions问题 like,
"What are we going to eat tonight今晚?"
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像一些很简单的问题,
譬如:今晚我们吃什么,
02:42
are very complicated复杂 to answer回答.
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都会变得很难回答。
02:46
Questions问题 about security安全,
when you don't have any security安全 systems系统,
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而如果没有了安保系统,
02:51
are terrifying可怕的.
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安保问题同样是件很恐怖的事情。
02:52
Is that altercation争吵 I had
with the neighbor邻居 down the block
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我和楼下邻居的几句口角
02:55
going to turn into a violent暴力 episode插曲
that will end结束 my life
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会演变成使我或我的家人丧命
02:58
or my family's家庭的 life?
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的暴力事件吗?
03:00
Health健康 concerns关注
when there is no health健康 system系统
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当没有了健康体系,
关于健康问题的担忧
03:02
are also terrifying可怕的.
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也同样令人惊恐。
03:05
I listened听了 as many许多 families家庭
had to sort分类 through通过 questions问题 like,
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我听到过很多家庭的各种问题,
不得不把它们进行分类,
03:08
"My infant婴儿 has a fever发热.
What am I going to do?"
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譬如:我的孩子发烧了,
我该怎么办?
03:12
"My sister妹妹, who is pregnant,
is bleeding流血的. What should I do?
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我怀孕的姐姐大出血了,
我该怎么办?
03:16
Who should I turn to?"
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我该找谁帮忙?
03:17
"Where are the doctors医生,
where are the nurses护士?
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哪儿有医生,哪儿有护士?
03:19
If I could find one, are they trustworthy可靠?
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如果我找到了医生,
他们值得信任吗?
03:22
How will I pay工资 them?
In what currency货币 will I pay工资 them?"
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我该付给他们多少钱,
付哪种货币?
03:25
"If I need medications药物治疗,
where will I find them?
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如果我需要用药,
我该去哪儿买?
03:28
If I take those medications药物治疗,
are they actually其实 counterfeits假冒?"
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如果我买到了药,
它们会不会是假的?
03:31
And on and on.
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很多这样或那样的问题。
03:34
So for life in these settings设置,
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在这样环境下的生活
03:37
the dominant优势 theme主题,
the dominant优势 feature特征 of life,
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生活的主题
03:41
is the incredible难以置信 vulnerability漏洞
that people have to manage管理
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就是人们每天都要去面对的
03:45
day in and day out,
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难以置信的脆弱感,
03:47
because of the lack缺乏 of social社会 systems系统.
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而这正是因为社会体系的缺失。
03:50
And it actually其实 turns out
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事实证明,
03:51
that this feature特征 of life
is incredibly令人难以置信 difficult to explain说明
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这种生活方式非常难以描述,
03:55
and be understood了解 by people
who are living活的 outside of it.
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局外人也无法理解。
03:59
I discovered发现 this when I left Kosovo科索沃.
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在我离开科索沃的时候
得出了以上这些结论。
04:03
I came来了 back to Boston波士顿,
I became成为 a physician医师,
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后来我回到了波士顿,
成为了一名医生。
04:07
I became成为 a global全球 public上市
health健康 policy政策 researcher研究员.
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同时也成为了一名
全球公共卫生政策研究员。
04:11
I joined加盟 the Harvard哈佛 Medical School学校
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我加入了哈佛医学院
04:12
and Brigham布里格姆 and Women's女士的 Hospital醫院
Division of Global全球 Health健康.
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和布莱根妇女医院的全球卫生部。
04:15
And I, as a researcher研究员,
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而我作为一个研究员,
04:17
really wanted to get started开始
on this problem问题 right away.
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非常想马上开始解决这个问题。
我在想:“我们要如何改善
04:19
I was like, "How do we reduce减少
the crushing破碎 vulnerability漏洞
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生活在如此匮乏环境下
人们的脆弱感?
04:23
of people living活的 in these types类型
of fragile脆弱 settings设置?
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04:27
Is there any way
we can start开始 to think about
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有没有什么方法能让我们开始考虑
04:29
how to protect保护 and quickly很快 recover恢复
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去保护和快速重建
04:32
the institutions机构
that are critical危急 to survival生存,
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那些对于生存至关重要的体系,
04:35
like the health健康 system系统?"
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譬如说卫生系统?”
04:36
And I have to say,
I had amazing惊人 colleagues同事.
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我不得不说,
我有一群特别棒的同事。
04:40
But one interesting有趣 thing about it was,
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但有意思的是,
04:42
this was sort分类 of an unusual异常
question for them.
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在他们看来
这竟然是个非常规问题。
04:45
They were kind of like,
"Oh, if you work in war战争,
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他们是这样认为的:
如果你在战争中工作,
04:47
doesn't that mean
you work on refugee难民 camps营地,
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那不意味着你应该为难民营工作,
04:49
and you work on documenting文档化
mass atrocities暴行?" --
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去记录那些战争暴行吗?
04:52
which哪一个 is, by the way, very,
very, very important重要.
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这些是非常非常重要的事情。
04:55
So it took me a while to explain说明
why I was so passionate多情 about this issue问题,
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所以我总是需要花费一些时间去解释
为什么我对这件事情如此关心,
05:00
until直到 about six years年份 ago.
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直到六年前。
05:02
That's when this landmark里程碑 study研究
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当时,
这一具里程碑意义的研究被发表,
05:04
that looked看着 at and described描述
the public上市 health健康 consequences后果 of war战争
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内容探讨了战争对于
05:08
was published发表.
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公共卫生的影响。
05:09
They came来了 to an incredible难以置信,
provocative挑衅 conclusion结论.
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他们的得出了一个不可思议的,
爆炸性的结论。
05:15
These researchers研究人员 concluded总结
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这些研究者推断
05:18
that the vast广大 majority多数 of death死亡
and disability失能 from war战争
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大部分的死亡和残疾
05:22
happens发生 after the cessation戒烟 of conflict冲突.
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产生于冲突结束之后。
05:24
So the most dangerous危险 time to be a person
living活的 in a conflict-affected受冲突影响 state
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所以对于一个处在战乱国家的人来说,
最危险的时段
05:29
is after the cessation戒烟 of hostilities敌对行动;
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是在停战之后;
05:31
it's after the peace和平 deal合同 has been signed.
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在和平协议签订之后。
05:33
It's when that political政治 solution
has been achieved实现.
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在政治解决方案已被各方所接受之后。
05:36
That seems似乎 so puzzling令人费解,
but of course课程 it's not,
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这看起来很莫名其妙,但其实不然,
05:39
because war战争 kills杀死 people
by robbing劫财 them of their clinics诊所,
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因为战争会使人们失去他们的诊所、
05:45
of their hospitals医院,
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医院和
05:47
of their supply供应 chains.
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相关的供应链体系,
从而造成人的死亡。
05:48
Their doctors医生 are targeted针对, are killed杀害;
they're on the run.
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医生们成为了被屠杀的靶子;
他们在不停的逃亡。
05:52
And more invisible无形
and yet然而 more deadly致命 is the destruction毁坏
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难以察觉然而却更致命的是
05:56
of the health健康 governance治理 institutions机构
and their finances财政.
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对卫生管理机构及其
财政体系的破坏。
06:01
So this is really not
surprising奇怪 at all to me.
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所以这个结论对于我来说
并没什么吃惊的。
06:05
But what is surprising奇怪
and somewhat有些 dismaying令人沮丧,
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但令人惊讶甚至沮丧的是
06:08
is how little impact碰撞 this insight眼光 has had,
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这种深刻的见解
06:12
in terms条款 of how we think
about human人的 suffering痛苦 and war战争.
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对我们对人类苦难和战争的认知,
并没什么影响。
06:16
Let me give you a couple一对 examples例子.
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我来举几个例子,
06:19
Last year, you may可能 remember记得,
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大家可能还记得去年
06:21
Ebola埃博拉病毒 hit击中 the West西 African非洲人
country国家 of Liberia利比里亚.
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埃博拉病毒席卷了
西非国家利比里亚。
06:26
There was a lot of reporting报告
about this group, Doctors医生 Without没有 Borders国界,
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有很多新闻报道
关于无国界医生
06:30
sounding听起来 the alarm报警
and calling调用 for aid援助 and assistance帮助.
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得到消息后响应号召去参加援助。
06:33
But not a lot of that reporting报告
answered回答 the question:
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但是很少有报道解释这个问题:
06:37
Why is Doctors医生 Without没有 Borders国界
even in Liberia利比里亚?
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为什么是无国界医生
在利比里亚做这些事?
06:39
Doctors医生 Without没有 Borders国界
is an amazing惊人 organization组织,
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无国界医生是个不可思议的组织,
06:42
dedicated专用 and designed设计 to provide提供
emergency care关心 in war战争 zones.
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它致力于提供战区急救。
06:47
Liberia's利比里亚 civil国内 war战争 had ended结束 in 2003 --
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利比里亚内战
早在2003年就结束了,
06:50
that was 11 years年份
before Ebola埃博拉病毒 even struck来袭.
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那是埃博拉病毒来袭的11年前。
06:54
When Ebola埃博拉病毒 struck来袭 Liberia利比里亚,
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然而当埃博拉病毒席卷
整个利比里亚的时候,
06:56
there were less than 50 doctors医生
in the entire整个 country国家
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这个有着450万人口的国家却
07:00
of 4.5 million百万 people.
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仅仅只有不到50名医生。
07:02
Doctors医生 Without没有 Borders国界 is in Liberia利比里亚
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无国界医生在来到利比里亚
07:04
because Liberia利比里亚 still doesn't really have
a functioning功能 health健康 system系统,
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是因为这个国家在战争结束11年后
仍然没有一个
07:08
11 years年份 later后来.
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能够正常运转的卫生体系。
07:10
When the earthquake地震 hit击中 Haiti海地 in 2010,
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当2010年海地发生地震的时候,
07:13
the outpouring流露 of international国际
aid援助 was phenomenal非凡的.
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国际援助发挥的作用是惊人的。
07:16
But did you know that only
two percent百分 of that funding资金
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但是大家知道吗,仅有2%的救援资金
07:20
went to rebuild重建
Haitian海地 public上市 institutions机构,
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被用作重建包含卫生部门在内的
07:23
including包含 its health健康 sector扇形?
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所有公共机构。
07:25
From that perspective透视,
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正因如此,
07:27
Haitians海地人 continue继续 to die
from the earthquake地震 even today今天.
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至今仍不断地有海地人
因为那次地震而死亡。
07:31
I recently最近 met会见 this gentleman绅士.
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最近我有幸结识了
07:33
This is Dr博士. Nezar内扎尔 Ismet伊斯梅特.
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Nezar Ismet博士。
07:36
He's the Minister部长 of Health健康
in the northern北方 autonomous自主性 region地区 of Iraq伊拉克,
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他是伊拉克北部
克库尔德斯坦自治区域
07:39
in Kurdistan库尔德斯坦.
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的卫生部长。
07:41
Here he is announcing宣布
that in the last nine months个月,
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他表示在过去的九个月内,
07:45
his country国家, his region地区, has increased增加
from four million百万 people
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他所在的区域人口从400万
07:49
to five million百万 people.
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飙升到了500万。
07:50
That's a 25 percent百分 increase增加.
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增长率高达25%。
07:52
Thousands成千上万 of these new arrivals到达
have experienced有经验的 incredible难以置信 trauma外伤.
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数以千计的新移民
经历了令人无法想象的创伤。
07:57
His doctors医生 are working加工
16-hour-小时 days without pay工资.
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那里的医生每天工作16个小时,
而且还没有任何酬劳。
08:03
His budget预算 has not increased增加
by 25 percent百分;
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而他们的财政预算
不仅没有按照25%的比例进行增长
08:05
it has decreased下降 by 20 percent百分,
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反而削减了20%,
08:08
as funding资金 has flowed流入 to security安全 concerns关注
and to short-term短期 relief浮雕 efforts努力.
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因为资金都被用来维持安保
以及提供短期救助了。
08:13
When his health健康 sector扇形 fails失败 --
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一旦他们的卫生系统崩塌——
08:15
and if history历史 is any guide指南, it will --
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历史证明必将如此——
08:17
how do you think that's going to influence影响
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大家认为这将对
08:19
the decision决定 making制造
of the five million百万 people in his region地区
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这里的500万人
08:23
as they think about
whether是否 they should flee逃跑
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考虑是否逃离
08:25
that type类型 of vulnerable弱势 living活的 situation情况?
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这个脆弱的环境时产生什么样的影响。
08:29
So as you can see,
this is a frustrating泄气 topic话题 for me,
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如你所见,
对我来说这是个令人沮丧的话题,
08:32
and I really try to understand理解:
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我尽全力去寻求原因:
08:34
Why the reluctance不情愿 to protect保护 and support支持
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为什么人们不愿意去保护和支持
08:37
indigenous土著 health健康 systems系统
and security安全 systems系统?
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本地的卫生和安全体系?
08:41
I usually平时 tier一线 two concerns关注,
two arguments参数.
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我通常有两个论点,
08:44
The first concern关心 is about corruption腐败,
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第一个是腐败,
08:47
and the concern关心 that people
in these settings设置 are corrupt腐败
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人们担心在这系统中工作的人
都是腐败且
08:49
and they are untrustworthy靠不住.
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不值得信任。
08:52
And I will admit承认 that I have met会见
unsavory难吃的 characters人物
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我承认在那种环境中的卫生部门中
遇到过
08:55
working加工 in health健康 sectors行业
in these situations情况.
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一些令人讨厌的人。
08:57
But I will tell you that the opposite对面
is absolutely绝对 true真正
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但我可以肯定的告诉大家,
相反的例子绝对存在,
09:01
in every一切 case案件 I have worked工作 on,
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而且在我参与过的案件中都发生过。
09:03
from Afghanistan阿富汗 to Libya利比亚, to Kosovo科索沃,
to Haiti海地, to Liberia利比里亚 --
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无论是阿富汗、利比亚、科索沃、
还是海地、利比里亚。
09:07
I have met会见 inspiring鼓舞人心 people,
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我遇到很多鼓舞人心的人,
09:09
who, when the chips芯片 were down
for their country国家,
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他们在国家危难之际,
09:11
they risked冒险 everything
to save保存 their health健康 institutions机构.
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他们不顾一切地去拯救卫生机构。
09:15
The trick for the outsider局外人
who wants to help
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对于外界力量来讲,
如果想支持这种行为,
09:18
is identifying识别 who those individuals个人 are,
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一个方法就是要辨别出这样的人,
09:21
and building建造 a pathway for them to lead.
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并且帮他们铺就一条
通向领导岗位的道路。
09:23
That is exactly究竟 what happened发生
in Afghanistan阿富汗.
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这种情况确实在阿富汗发生过。
09:27
One of the unsung幕后 and untold数不清
success成功 stories故事
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我们在为阿富汗的国家建设所作的努力中
09:31
of our nation-building国家建筑 effort功夫
in Afghanistan阿富汗
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就有这样一个不为人知的成功案例,
09:34
involved参与 the World世界 Bank银行 in 2002
investing投资 heavily严重
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涉及世界银行在2002年投巨资
识别、培训并推举
09:37
in identifying识别, training训练 and promoting促进
Afghani阿富汗 health健康 sector扇形 leaders领导者.
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人们成为阿富汗卫生部门领导。
09:44
These health健康 sector扇形 leaders领导者
have pulled off an incredible难以置信 feat功绩
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这些卫生部门的领导人在阿富汗取得了
09:47
in Afghanistan阿富汗.
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令人叹为观止的成就。
09:49
They have aggressively积极 increased增加
access访问 to health健康 care关心
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他们积极为大多数人增加
09:53
for the majority多数 of the population人口.
187
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获得医疗保健的权益。
09:55
They are rapidly急速 improving提高
the health健康 status状态
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他们使阿富汗人民的健康状况
09:57
of the Afghan阿富汗 population人口,
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得到了快速的改善,
09:58
which哪一个 used to be the worst最差 in the world世界.
190
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那里的健康状况曾经是
全世界最差的。
10:01
In fact事实, the Afghan阿富汗 Ministry
of Health健康 does things
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事实上,阿富汗卫生部长做了
10:04
that I wish希望 we would do in America美国.
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我希望在美国也可以实施的事情。
10:06
They use things like data数据 to make policy政策.
193
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他们根据数据去制定相关政策。
10:08
It's incredible难以置信.
194
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太不可思议了。
10:10
(Laughter笑声)
195
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(笑声)
10:12
The other concern关心 I hear a lot about is:
196
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关于另外一个担忧,
我听到过很多的就是:
10:14
"We just can't afford给予 it,
we just don't have the money.
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我们负担不起,
我们没有足够的钱。
10:17
It's just unsustainable不可持续的."
198
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1355
这根本持续不下去。
10:19
I would submit提交 to you
that the current当前 situation情况
199
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在这里我不得不指出,
我们现有的状况和体系
10:22
and the current当前 system系统 we have
200
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1735
10:23
is the most expensive昂贵, inefficient低效 system系统
we could possibly或者 conceive构想 of.
201
611935
4038
是我们所能想到的最昂贵,
也是最低效的。
10:27
The current当前 situation情况
is that when governments政府 like the US --
202
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3378
现在的情况是,像美国
10:31
or, let's say, the collection采集
of governments政府
203
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2064
或者是欧盟
10:33
that make up the European欧洲的 Commission佣金 --
204
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1874
这样的政府团体
10:35
every一切 year, they spend 15 billion十亿 dollars美元
205
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2649
他们每年仅在
10:38
on just humanitarian人道主义 and emergency
and disaster灾害 relief浮雕 worldwide全世界.
206
626058
4006
人道援助、应急救援和全球赈灾上
就花费了150亿美元。
10:42
That's nothing about foreign国外 aid援助,
that's just disaster灾害 relief浮雕.
207
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这还不是所有的援外资金,
仅仅是赈灾资金。
10:46
Ninety-five九十五 percent百分 of it
goes to international国际 relief浮雕 agencies机构,
208
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5045
95%的赈灾资金
流向了国际救援组织,
10:51
that then have to import进口 resources资源
into these areas,
209
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4337
然后他们必须得这些区域运送物资,
10:55
and knit针织 together一起 some type类型
of temporary临时 health健康 system系统, let's say,
210
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4389
并且组建起一些临时的卫生系统,
10:59
which哪一个 they then dismantle拆除 and send发送 away
when they run out of money.
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当钱用完以后,
这些卫生系统人员会被解散遣返。
11:04
So our job工作, it turns out, is very clear明确.
212
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所以,讲到这里,
我们要做的工作就很清晰了。
11:09
We, as the global全球 health健康
community社区 policy政策 experts专家,
213
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4775
我们作为全球公共健康政策专家,
11:13
our first job工作 is to become成为 experts专家
in how to monitor监控
214
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5545
首要的目标是专注监控
11:19
the strengths优势 and vulnerabilities漏洞
of health健康 systems系统
215
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2447
受到严重威胁下的卫生系统的
各项强度和漏洞。
11:22
in threatened受威胁 situations情况.
216
670020
2567
11:24
And that's when we see doctors医生 fleeing逃离,
217
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当我们看到医护人员纷纷逃离,
11:26
when we see health健康 resources资源 drying烘干 up,
218
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1937
卫生保障资源枯竭,
11:28
when we see institutions机构 crumbling摇摇欲坠 --
219
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2435
卫生机构摇摇欲坠 ,
11:31
that's the emergency.
220
679065
1613
这就是危机到来的时刻。
11:32
That's when we need to sound声音 the alarm报警
and wave our arms武器.
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3110
那就是我们就应该拉响警钟,
开始行动的时刻了。
11:35
OK?
222
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1394
对吧?
11:37
Not now.
223
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1151
并不是这个时候。
11:38
Everyone大家 can see that's an emergency,
they don't need us to tell them that.
224
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3912
谁都能看出来这是个危机,
不需要我们来告知他们。
11:43
Number two:
225
691122
1939
第二点:
11:45
places地方 like where I work at Harvard哈佛
need to take their cue球杆
226
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3337
类似我工作过的哈佛这样的机构,
11:48
from the World世界 Bank银行 experience经验
in Afghanistan阿富汗,
227
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2198
应该从世界银行在阿富汗的经验中
得到一些提示。
11:50
and we need to -- and we will --
228
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1657
我们现在需要,将来也一定会
11:52
build建立 robust强大的 platforms平台 to support支持
health健康 sector扇形 leaders领导者 like these.
229
700349
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需要建立强大的平台
去扶植那些卫生部门的领导人。
11:58
These people risk风险 their lives生活.
230
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这些人冒着生命危险去做这些事情。
12:00
I think we can match比赛 their courage勇气
with some support支持.
231
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3712
我认为我们要用我们的支持来
回应他们的勇气。
12:04
Number three:
232
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1154
第三点:
12:05
we need to reach达到 out
and make new partnerships伙伴关系.
233
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2578
我们应该着手去建立新型的伙伴关系。
12:08
At our global全球 health健康 center中央,
234
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1874
在我们的全球卫生中心,
12:10
we have launched推出 a new initiative倡议
with NATO北约 and other security安全 policy政策 makers制造商
235
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4012
我们同北约和其他安保政策制定机构
发起了一项新的倡议,
12:14
to explore探索 with them what they can do
to protect保护 health健康 system系统 institutions机构
236
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5366
去与他们探究在进行安保部署时,
能为保护卫生系统的机构
12:19
during deployments部署.
237
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1715
做些什么。
12:21
We want them to see
238
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1540
我们希望他们能够明白
12:22
that protecting保护 health健康 systems系统
and other critical危急 social社会 institutions机构
239
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4700
保护卫生系统及其他关键的社会机构
12:27
is an integral积分 part部分 of their mission任务.
240
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2443
也是他们使命中不可分割的一部分。
12:30
It's not just about avoiding避免
collateral抵押 damage损伤;
241
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3137
这不仅仅是为了避免受到牵连的损害,
12:33
it's about winning胜利 the peace和平.
242
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1805
而是为了赢得最终的和平。
12:36
But the most important重要 partner伙伴
we need to engage从事 is you,
243
744725
3583
但我们最需要团结的伙伴是你们,
12:40
the American美国 public上市,
and indeed确实, the world世界 public上市.
244
748332
3432
是全体美国人民,
事实上也是全世界人民。
12:43
Because unless除非 you understand理解
the value of social社会 institutions机构,
245
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因为只有你明白了社会机构,
12:49
like health健康 systems系统
in these fragile脆弱 settings设置,
246
757508
2511
比如说卫生系统,
它们在脆弱环境中的价值,
12:53
you won't惯于 support支持 efforts努力 to save保存 them.
247
761066
2248
你才会去付出努力去支持拯救它们。
12:55
You won't惯于 click点击 on that article文章
248
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2398
只有这样,你才能不去理会
12:57
that talks会谈 about "Hey, all those
doctors医生 are on the run in country国家 X.
249
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4966
《X国所有医生都在逃命》这样的文章。
13:02
I wonder奇迹 what that means手段.
250
770750
2417
文章说,“我想知道这意味着什么?
13:05
I wonder奇迹 what that means手段
251
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1852
我想知道
13:07
for that health健康 system's系统 ability能力
to, let's say, detect检测 influenza流感."
252
775067
3952
X国的卫生系统是否可以检测
比如说流感这样的疾病?”
13:11
"Hmm, it's probably大概 not good."
That's what I'd tell you.
253
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3377
要我说,“嗯,情况不那么乐观。“
13:15
Up on the screen屏幕,
254
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1164
在屏幕上,
13:16
I've put up my three favorite喜爱 American美国
institution机构 defenders捍卫者 and builders建设者.
255
784958
6280
我已经放上了我最喜欢的三个
美国的机构创建者及捍卫者。
13:23
Over here is George乔治 C. Marshall马歇尔,
256
791846
2885
这个是乔治·卡特莱特·马歇尔,
13:26
he was the guy that proposed建议
the Marshall马歇尔 Plan计划
257
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2829
他是马歇尔计划的提出者,
13:29
to save保存 all of Europe's欧洲 economic经济
institutions机构 after World世界 War战争 IIII.
258
797608
4191
在二战后拯救了
所有欧洲的经济体系。
13:34
And this Eleanor埃莉诺 Roosevelt罗斯福.
259
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2353
这个是埃莉诺·罗斯福。
13:36
Her work on human人的 rights权利
really serves供应 as the foundation基础
260
804676
3146
她在人权方面所做的工作是
我们所有国际人权组织的基石。
13:39
for all of our international国际
human人的 rights权利 organizations组织.
261
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3028
13:43
Then my big favorite喜爱 is Ben Franklin富兰克林,
262
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2040
接下来这个是我最喜欢的
本杰明·富兰克林
13:45
who did many许多 things
in terms条款 of creating创建 institutions机构,
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3208
他在机构创建上面做了很多工作,
13:48
but was the midwife助产士 of our constitution宪法.
264
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同时也是我们宪法的起草者。
13:52
And I would say to you
265
820582
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我想告诉大家的是
13:54
that these are folks乡亲 who, when our
country国家 was threatened受威胁,
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这些就是当我们的国家,
13:58
or our world世界 was threatened受威胁,
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我们的世界受到威胁时
14:00
they didn't retreat撤退.
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永不退缩的人。
14:01
They didn't talk about building建造 walls墙壁.
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他们不讨论筑城墙。
14:03
They talked about building建造 institutions机构
to protect保护 human人的 security安全,
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而是通过建立机构去保护人们的安全,
14:10
for their generation and also for ours我们的.
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功在当代,利在千秋。
14:13
And I think our generation
should do the same相同.
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我们应当以他们为楷模。
14:16
Thank you.
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谢谢。
14:17
(Applause掌声)
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(掌声)
Translated by frank chow
Reviewed by Jiawei Ni

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ABOUT THE SPEAKER
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.

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.

More profile about the speaker
Margaret Bourdeaux | Speaker | TED.com