Margaret Bourdeaux: Why civilians suffer more once a war is over
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster. Full bio
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what it would be like
there are no rules
and there are no laws.
about what this is like,
a medical student in 1999,
in the Balkans during the Kosovo War.
from my medical school
that I had befriended in the camp
life in this postwar setting.
was a very interesting place
the war didn't break out again.
it was actually a lawless place,
both public and private,
of these situations and settings,
before you run into a situation
how incredibly vulnerable you are.
when I had to cross the first checkpoint,
through this checkpoint
right then and there,
was absolutely nothing
of the families that I got to know
where there are no social institutions
"What are we going to eat tonight?"
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
had to sort through questions like,
What am I going to do?"
is bleeding. What should I do?
where are the nurses?
In what currency will I pay them?"
where will I find them?
are they actually counterfeits?"
the dominant feature of life,
that people have to manage
is incredibly difficult to explain
who are living outside of it.
I became a physician,
health policy researcher.
Division of Global Health.
on this problem right away.
the crushing vulnerability
of fragile settings?
we can start to think about
that are critical to survival,
I had amazing colleagues.
question for them.
"Oh, if you work in war,
you work on refugee camps,
mass atrocities?" --
very, very important.
why I was so passionate about this issue,
the public health consequences of war
and disability from war
living in a conflict-affected state
has been achieved.
but of course it's not,
by robbing them of their clinics,
they're on the run.
and yet more deadly is the destruction
and their finances.
surprising at all to me.
and somewhat dismaying,
about human suffering and war.
country of Liberia.
about this group, Doctors Without Borders,
and calling for aid and assistance.
answered the question:
even in Liberia?
is an amazing organization,
emergency care in war zones.
before Ebola even struck.
in the entire country
醫生不到 50 名。
a functioning health system,
aid was phenomenal.
two percent of that funding
Haitian public institutions,
from the earthquake even today.
in the northern autonomous region of Iraq,
that in the last nine months,
from four million people
have experienced incredible trauma.
16-hour days without pay.
每天無薪的工作 16 小時。
by 25 percent;
並沒有增加 25 ％，
and to short-term relief efforts.
of the five million people in his region
whether they should flee
this is a frustrating topic for me,
and security systems?
in these settings are corrupt
in these situations.
is absolutely true
to Haiti, to Liberia --
for their country,
to save their health institutions.
who wants to help
Afghani health sector leaders.
have pulled off an incredible feat
access to health care
the health status
of Health does things
we just don't have the money.
that the current situation
we could possibly conceive of.
is that when governments like the US --
and disaster relief worldwide.
that's just disaster relief.
goes to international relief agencies,
into these areas,
of temporary health system, let's say,
when they run out of money.
community policy experts,
in how to monitor
of health systems
and wave our arms.
they don't need us to tell them that.
need to take their cue
health sector leaders like these.
with some support.
and make new partnerships.
with NATO and other security policy makers
to protect health system institutions
and other critical social institutions
we need to engage is you,
and indeed, the world public.
the value of social institutions,
in these fragile settings,
doctors are on the run in country X.
to, let's say, detect influenza."
That's what I'd tell you.
institution defenders and builders.
the Marshall Plan
institutions after World War II.
really serves as the foundation
human rights organizations.
in terms of creating institutions,
country was threatened,
to protect human security,
should do the same.
Reviewed by Winston Szeto
ABOUT THE SPEAKERMargaret 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.
Margaret Bourdeaux | Speaker | TED.com