Why civilians suffer more once a war is over | Margaret Bourdeaux

Translator: Noelia Bernárdez Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

So have you ever wondered what it would be like

Algunha vez vos preguntastes como sería

to live in a place with no rules?

vivir nun lugar sen normas?

That sounds pretty cool.

Soa ben, non si?

(Laughter)

You wake up one morning, however,

(Risas)

Mais unha mañá espertas

and you discover that the reason there are no rules

e descobres que a razón pola que non hai normas

é que non hai goberno e tampouco hai leis.

is because there's no government, and there are no laws.

In fact, all social institutions have disappeared.

De feito, todas as institucións sociais desapareceron,

So there's no schools,

polo que non hai escolas,

there's no hospitals,

non hai hospitais,

there's no police,

non hai policía,

there's no banks,

non hai bancos,

there's no athletic clubs,

non hai clubs deportivos,

there's no utilities.

non hai servizos.

Well, I know a little bit about what this is like,

Pois ben, eu teño unha idea do que é iso

because when I was a medical student in 1999,

porque, cando era estudante de medicina no 1999,

I worked in a refugee camp in the Balkans during the Kosovo War.

traballei nun campo de refuxiados nos Balcáns durante a guerra de Kosovo.

When the war was over,

Cando rematou a guerra,

I got permission -- unbelievably -- from my medical school

incriblemente obtiven un permiso da facultade

to take some time off

para coller uns días

and follow some of the families that I had befriended in the camp

e acompañar a algunhas das familias coas que trabara amizade no campo

back to their village in Kosovo,

na viaxe de volta ás súas vilas en Kosovo,

and understand how they navigated life in this postwar setting.

para comprender como afrontaban a vida nun contexto de posguerra.

Postwar Kosovo was a very interesting place

O Kosovo da posguerra era un lugar moi interesante

because NATO troops were there,

porque alí estaban as tropas da OTAN,

mostly to make sure the war didn't break out again.

máis que nada para garantir que non volvese estalar a guerra,

But other than that, it was actually a lawless place,

mais, á parte diso, o certo é que era unha zona sen lei

and almost every social institution, both public and private,

e case todas as institucións sociais, tanto públicas coma privadas,

had been destroyed.

foran destruídas.

So I can tell you

Teño que dicir

that when you go into one of these situations and settings,

que cando te atopas nun escenario ou nunha situación coma esa

it is absolutely thrilling ...

é a cousa máis emocionante do mundo...

for about 30 minutes,

durante uns 30 minutos,

because that's about how long it takes before you run into a situation

porque iso é, máis ou menos, o que tardas en bater cunha situación

where you realize how incredibly vulnerable you are.

na que te decatas do incriblemente vulnerábel que es.

For me, that moment came when I had to cross the first checkpoint,

No meu caso, ese momento chegou ao ter que cruzar o primeiro control

and I realized as I drove up

e reparar, mentres me achegaba,

that I would be negotiating passage through this checkpoint

en que ía ter que negociar o paso por este control

with a heavily armed individual

cun individuo armado ata as orellas que,

who, if he decided to shoot me right then and there,

se decidía pegarme un tiro alí mesmo,

actually wouldn't be doing anything illegal.

en realidade non estaría a facer nada ilegal.

But the sense of vulnerability that I had was absolutely nothing

Porén, a sensación de vulnerabilidade que eu sentín non era absolutamente nada

in comparison to the vulnerability of the families that I got to know

comparada coa vulnerabilidade das familias que coñecín

over that year.

ao longo daquel ano.

You see, life in a society where there are no social institutions

A vida nunha sociedade sen institucións sociais

is riddled with danger and uncertainty,

está chea de perigo e incerteza.

and simple questions like, "What are we going to eat tonight?"

Preguntas tan sinxelas como “que imos cear hoxe?”

are very complicated to answer.

vólvense moi difíciles de responder.

Questions about security, when you don't have any security systems,

As cuestións sobre seguridade cando non hai sistema de seguridade ningún

are terrifying.

son terroríficas.

Is that altercation I had with the neighbor down the block

Tornará aquel altercado que tiven co veciño de abaixo

going to turn into a violent episode that will end my life

nun episodio violento que acabe coa miña vida

or my family's life?

ou coa da miña familia?

Health concerns when there is no health system

Os problemas de saúde cando non hai sistema de saúde

are also terrifying.

tamén son terroríficos.

I listened as many families had to sort through questions like,

Escoitei a moitas familias facerse preguntas como

"My infant has a fever. What am I going to do?"

“O meu neno ten febre. Que podo facer?”

"My sister, who is pregnant, is bleeding. What should I do?

“A miña irmá, que está preñada, está a sangrar. Que fago?

Who should I turn to?"

A quen acudo?”

"Where are the doctors, where are the nurses?

“Onde andan os doutores? U-los enfermeiros?

If I could find one, are they trustworthy?

Se atopo algún, será de fiar?

How will I pay them? In what currency will I pay them?"

Como lles hei pagar? En que moeda lles pago?”

"If I need medications, where will I find them?

“Se preciso medicamentos, onde os atopo?

If I take those medications, are they actually counterfeits?"

E se tomo eses medicamentos, non serán falsificacións?”

And on and on.

E así unha detrás da outra.

So for life in these settings,

Nestas circunstancias vitais,

the dominant theme, the dominant feature of life,

o tema predominante, o aspecto dominante da vida,

is the incredible vulnerability that people have to manage

é a incrible vulnerabilidade coa que teñen que lidar as persoas

day in and day out,

un día si e outro tamén

because of the lack of social systems.

por mor da falta de sistemas sociais.

And it actually turns out

E resulta

that this feature of life is incredibly difficult to explain

que este aspecto da vida é incriblemente difícil de explicar

and be understood by people who are living outside of it.

e facérllelo entender ás persoas que viven alleas a el.

I discovered this when I left Kosovo.

Isto descubrino cando marchei de Kosovo.

I came back to Boston, I became a physician,

Volvín a Boston, fíxenme doutora,

I became a global public health policy researcher.

logo investigadora de políticas de saúde pública mundiais.

I joined the Harvard Medical School

Uninme á Escola de Medicina de Harvard

and Brigham and Women's Hospital Division of Global Health.

e á División de Saúde Mundial do hospital Birgham and Women.

And I, as a researcher,

Eu, como investigadora,

really wanted to get started on this problem right away.

devecía por pórme a traballar neste problema de contado.

I was like, "How do we reduce the crushing vulnerability

Eu dicía: “Como diminuímos a vulnerabilidade devastadora

of people living in these types of fragile settings?

á que se enfrontan as persoas que viven neste tipo de situacións tan fráxiles?

Is there any way we can start to think about

Hai algún xeito no que podamos comezar a pensar

how to protect and quickly recover

en como protexer e recuperar axiña

the institutions that are critical to survival,

as institucións fundamentais para a supervivencia,

like the health system?"

como o sistema de saúde?”

And I have to say, I had amazing colleagues.

Debo dicir que tiña uns colegas marabillosos e,

But one interesting thing about it was,

no entanto, un detalle interesante

this was sort of an unusual question for them.

era que, para eles, esa pregunta era algo estraña.

They were kind of like, "Oh, if you work in war,

Dicíanme cousas como: “Iso de traballar na guerra

doesn't that mean you work on refugee camps,

non significa traballar en campos de refuxiados

and you work on documenting mass atrocities?" --

e documentar atrocidades masivas?”,

which is, by the way, very, very, very important.

cousa que é moi moi importante, por certo.

So it took me a while to explain why I was so passionate about this issue,

Levoume un anaco explicarlles por que me apaixonaba tanto este asunto,

until about six years ago.

ata haberá uns seis anos.

That's when this landmark study

Daquela publicouse un estudo sen precedentes

that looked at and described the public health consequences of war

que analizaba e describía as consecuencias da guerra

was published.

na saúde pública.

They came to an incredible, provocative conclusion.

Chegaron a unha conclusión incrible e provocadora:

These researchers concluded

os investigadores concluíron

that the vast majority of death and disability from war

que a maior parte das mortes e discapacidades provocadas pola guerra

happens after the cessation of conflict.

ocorren cando xa rematou o conflito.

So the most dangerous time to be a person living in a conflict-affected state

O período máis perigoso para as persoas que viven nun estado en conflito

is after the cessation of hostilities;

é tras a fin das hostilidades,

it's after the peace deal has been signed.

despois de asinar o acordo de paz,

It's when that political solution has been achieved.

cando xa se acadou unha solución política.

That seems so puzzling, but of course it's not,

Semella desconcertante, mais abofé que non o é,

because war kills people by robbing them of their clinics,

porque as guerras matan as persoas roubándolles as súas clínicas,

of their hospitals,

os seus hospitais,

of their supply chains.

as súas cadeas de subministración.

Their doctors are targeted, are killed; they're on the run.

Os médicos tórnanse en obxectivos e asasínanos. Teñen que fuxir.

And more invisible and yet more deadly is the destruction

E máis invisíbel e, con todo, aínda máis letal é a destrución

of the health governance institutions and their finances.

das institucións de goberno sanitarias e os seus medios financeiros.

So this is really not surprising at all to me.

Así que a min isto non me resulta nada sorprendente

But what is surprising and somewhat dismaying,

O que si é sorprendente e, dalgún xeito, desalentador

is how little impact this insight has had,

é o escaso impacto que esta percepción tivo

in terms of how we think about human suffering and war.

na nosa maneira de pensar no sufrimento humano e a guerra.

Let me give you a couple examples.

Vouvos poñer un par de exemplos.

Last year, you may remember,

Se cadra lembrades que o ano pasado

Ebola hit the West African country of Liberia.

o ébola azoutou Liberia, o país de África occidental.

There was a lot of reporting about this group, Doctors Without Borders,

Daquela déuselle moita cobertura a un grupo, Médicos Sen Fronteiras,

sounding the alarm and calling for aid and assistance.

que estaba a dar a alarma e a pedir axuda e medios.

But not a lot of that reporting answered the question:

Non obstante, poucas desas reportaxes respondían á seguinte cuestión:

Why is Doctors Without Borders even in Liberia?

Que fan en Liberia os de Médicos Sen Fronteiras?

Doctors Without Borders is an amazing organization,

Médicos Sen Fronteiras é unha organización magnífica

dedicated and designed to provide emergency care in war zones.

que se dedica a prestar coidados de emerxencia en zonas de guerra.

Liberia's civil war had ended in 2003 --

A guerra civil de Liberia rematou no 2003,

that was 11 years before Ebola even struck.

11 anos antes de que chegase sequera o ébola.

When Ebola struck Liberia,

Cando o ébola atacou Liberia,

there were less than 50 doctors in the entire country

había menos de 50 médicos para todo un país

of 4.5 million people.

de 4,5 millóns de persoas.

Doctors Without Borders is in Liberia

Médicos Sen Fronteiras está en Liberia

because Liberia still doesn't really have a functioning health system,

porque Liberia aínda non conta cun sistema de saúde operativo

11 years later.

11 anos despois.

When the earthquake hit Haiti in 2010,

Cando o terremoto sacudiu Haití no 2010,

the outpouring of international aid was phenomenal.

o fluxo de axuda internacional foi fantástico,

But did you know that only two percent of that funding

mais sabiades que só un 2 por cento deses fondos

went to rebuild Haitian public institutions,

se usaron para restaurar as institucións públicas haitianas,

including its health sector?

incluído o sector sanitario?

From that perspective,

Dende esa perspectiva,

Haitians continue to die from the earthquake even today.

mesmo hoxe os haitianos seguen a morrer a causa do terremoto.

I recently met this gentleman.

Hai pouco coñecín a este cabaleiro.

This is Dr. Nezar Ismet.

É o doutor Nezar Ismet.

He's the Minister of Health in the northern autonomous region of Iraq,

É o ministro de Saúde da rexión autónoma do norte de Iraq,

in Kurdistan.

Kurdistán.

Here he is announcing that in the last nine months,

Aquí está a anunciar que nos últimos nove meses

his country, his region, has increased from four million people

a poboación do seu país, da súa rexión, aumentou de catro

to five million people.

a cinco millóns de persoas,

That's a 25 percent increase.

un aumento do 25 por cento.

Thousands of these new arrivals have experienced incredible trauma.

Milleiros destas persoas que chegaron experimentaron traumas incribles.

His doctors are working 16-hour days without pay.

Os seus médicos traballan xornadas de 16 horas sen cobrar.

His budget has not increased by 25 percent;

Os seu presuposto non aumentou un 25 por cento,

it has decreased by 20 percent,

senón que diminuíu un 20 por cento,

as funding has flowed to security concerns and to short-term relief efforts.

xa que os fondos destináronse a seguridade e medidas de auxilio a curto prazo.

When his health sector fails --

Cando o seu sector sanitario caia

and if history is any guide, it will --

—e se algo nos di a historia é que caerá—

how do you think that's going to influence

como pensades que vai afectar iso

the decision making of the five million people in his region

ás decisións dos cinco millóns de persoas da súa rexión

as they think about whether they should flee

cando consideren se deberían fuxir

that type of vulnerable living situation?

dese tipo de situación vital vulnerable?

So as you can see, this is a frustrating topic for me,

Como vedes, este é un tema frustrante para min.

and I really try to understand:

e xuro que intento comprender

Why the reluctance to protect and support

por que somos tan remisos a protexer e apoiar

indigenous health systems and security systems?

os sistemas de saúde e de seguridade autóctonos.

I usually tier two concerns, two arguments.

Normalmente escoito dúas preocupacións, dous argumentos.

The first concern is about corruption,

O primeiro ten que ver coa corrupción.

and the concern that people in these settings are corrupt

coa preocupación de que a xente que está nestas situacións

and they are untrustworthy.

é corrupta e pouco de fiar.

And I will admit that I have met unsavory characters

Hei de admitir que teño batido con varios personaxes indesexables

working in health sectors in these situations.

traballando no sector sanitario nestas situacións,

But I will tell you that the opposite is absolutely true

pero podo dicirvos que o contrario tamén é completamente certo

in every case I have worked on,

en todos os casos nos que traballei.

from Afghanistan to Libya, to Kosovo, to Haiti, to Liberia --

Dende Afganistán até Libia, pasando por Kosovo, Haití, Liberia...

I have met inspiring people,

teño coñecido xente inspiradora,

who, when the chips were down for their country,

que, cando o seu país se viu nunha encrucillada,

they risked everything to save their health institutions.

o arriscaron todo para salvar as súas institucións sanitarias.

The trick for the outsider who wants to help

O truco para as persoas alleas que queiran axudar

is identifying who those individuals are,

está en identificar eses individuos

and building a pathway for them to lead.

e marcarlles o camiño no que farán de guías.

That is exactly what happened in Afghanistan.

Iso mesmo foi o que aconteceu en Afganistán.

One of the unsung and untold success stories

Un dos casos de éxito esquecidos e descoñecidos

of our nation-building effort in Afghanistan

das nosas iniciativas de consolidación nacional en Afganistán

involved the World Bank in 2002 investing heavily

foi o grande investimento que realizou o Banco Mundial no 2002

in identifying, training and promoting Afghani health sector leaders.

para identificar, instruír e ascender os líderes do sector sanitario afgáns.

These health sector leaders have pulled off an incredible feat

Estes líderes do sector sanitario conseguiron toda unha fazaña

in Afghanistan.

en Afganistán.

They have aggressively increased access to health care

Aumentaron de xeito impresionante o acceso aos servizos sanitarios

for the majority of the population.

para a maior parte da poboación.

They are rapidly improving the health status

Están a mellorar rápido a situación sanitaria

of the Afghan population,

da poboación afgá,

which used to be the worst in the world.

que antes era a peor do mundo.

In fact, the Afghan Ministry of Health does things

De feito, o Ministerio de Saúde afgán fai cousas

that I wish we would do in America.

que oxalá fixeramos nos EE.UU.

They use things like data to make policy.

Usan datos para deseñar medidas políticas.

It's incredible.

Abraiante.

(Laughter)

(Risas)

The other concern I hear a lot about is:

A outra preocupación que oio moito é:

"We just can't afford it, we just don't have the money.

“Non nolo podemos permitir, non hai cartos para iso.

It's just unsustainable."

É insostíbel.”

I would submit to you that the current situation

Gustaríame apuntar que a situación actual,

and the current system we have

o sistema que temos actualmente,

is the most expensive, inefficient system we could possibly conceive of.

é o sistema máis caro e ineficiente que poderiamos concibir.

The current situation is that when governments like the US --

Na actualidade, os gobernos, como o dos EE.UU.,

or, let's say, the collection of governments

ou, por exemplo, o conxunto de gobernos

that make up the European Commission --

que forman a Comisión Europea,

every year, they spend 15 billion dollars

gastan 15 mil millóns de dólares todos os anos

on just humanitarian and emergency and disaster relief worldwide.

só en axuda humanitaria, de emerxencia e para catástrofes en todo o mundo.

That's nothing about foreign aid, that's just disaster relief.

Iso non inclúe a axuda exterior, só a axuda para catástrofes.

Ninety-five percent of it goes to international relief agencies,

O 95 por cento deses cartos van ás axencias de axuda internacional,

that then have to import resources into these areas,

que logo teñen que importar recursos a esas zonas

and knit together some type of temporary health system, let's say,

e montar unha especie de sistema sanitario temporal

which they then dismantle and send away when they run out of money.

que logo desmantelan e mandan fóra cando se esgotan os cartos.

So our job, it turns out, is very clear.

A nosa misión, polo tanto, é moi clara.

We, as the global health community policy experts,

Como expertos en políticas da comunidade sanitaria mundial,

our first job is to become experts in how to monitor

a nosa primeira misión é facernos expertos en observar

the strengths and vulnerabilities of health systems

os puntos fortes e débiles dos sistemas sanitarios

in threatened situations.

en situacións de ameaza.

And that's when we see doctors fleeing,

E esta dáse cando os médicos foxen,

when we see health resources drying up,

cando se esgotan os recursos sanitarios,

when we see institutions crumbling --

cando se veñen abaixo as institucións.

that's the emergency.

Esa é a emerxencia.

That's when we need to sound the alarm and wave our arms.

É aí cando temos que dar a alarma e sacudir os brazos.

OK?

Estamos?

Not now.

Non agora.

Everyone can see that's an emergency, they don't need us to tell them that.

Calquera ve que iso é unha emerxencia, non precisan que llelo digamos nós.

Number two:

Segundo:

places like where I work at Harvard need to take their cue

os lugares como no que eu traballo en Harvard deben seguir o exemplo

from the World Bank experience in Afghanistan,

da experiencia do Banco Mundial en Afganistán,

and we need to -- and we will --

e precisamos —e farémolo—

build robust platforms to support health sector leaders like these.

establecer plataformas sólidas para apoiar estes líderes do sector sanitario.

These people risk their lives.

Esta xente xoga a súa vida.

I think we can match their courage with some support.

Coido que podemos corresponder ao seu valor con algo de apoio.

Number three:

Terceiro:

we need to reach out and make new partnerships.

temos que comunicarnos e formar novas alianzas.

At our global health center,

No noso centro sobre saúde mundial,

we have launched a new initiative with NATO and other security policy makers

sacamos unha nova iniciativa coa OTAN e máis creadores de política de seguridade

to explore with them what they can do to protect health system institutions

para estudar con eles o que poden facer para protexer as institucións sanitarias

during deployments.

durante os despregamentos.

We want them to see

Queremos que se decaten

that protecting health systems and other critical social institutions

de que protexer os sistemas sanitarios e outras institucións sociais fundamentais

is an integral part of their mission.

é unha parte indispensábel da súa misión.

It's not just about avoiding collateral damage;

Non todo é evitar danos colaterais;

it's about winning the peace.

hai que gañar a paz.

But the most important partner we need to engage is you,

Agora ben, o socio máis importante ao que cómpre que impliquemos sodes vós,

the American public, and indeed, the world public.

os cidadáns estadounidenses e, por suposto, os de todo o mundo,

Because unless you understand the value of social institutions,

porque, a non ser que entendades o valor das institucións sociais,

like health systems in these fragile settings,

como o sistema sanitario, nestas situacións fráxiles,

you won't support efforts to save them.

non apoiaredes as iniciativas para salvalos.

You won't click on that article

Non ides picar nese artigo

that talks about "Hey, all those doctors are on the run in country X.

que di “Ei, todos os médicos do país X están fuxindo.

I wonder what that means.

Que significará?

I wonder what that means

Pregúntome como vai afectar iso

for that health system's ability to, let's say, detect influenza."

á capacidade dese sistema sanitario para, por exemplo, detectar a influenza”.

"Hmm, it's probably not good." That's what I'd tell you.

“Mmm, non ha de ser boa cousa”. Iso é o que vos diría eu.

Up on the screen,

Na pantalla,

I've put up my three favorite American institution defenders and builders.

están tres dos meus defensores e creadores de institucións estadounidenses favoritos.

Over here is George C. Marshall,

Por aquí está George C. Marshall,

he was the guy that proposed the Marshall Plan

o tipo que propuxo o Plan Marshall,

to save all of Europe's economic institutions after World War II.

que salvou as institucións económicas de Europa tras a Segunda Guerra Mundial.

And this Eleanor Roosevelt.

Logo temos a Eleanor Roosevelt.

Her work on human rights really serves as the foundation

O seu traballo a prol dos dereitos humanos é a base

for all of our international human rights organizations.

das nosas organizacións internacionais de dereitos humanos.

Then my big favorite is Ben Franklin,

E logo está o meu favorito, Ben Franklin,

who did many things in terms of creating institutions,

que fixo moitas cousas no que se refire a crear institucións,

but was the midwife of our constitution.

mais foi o pai da nosa constitución.

And I would say to you

E vouvos dicir

that these are folks who, when our country was threatened,

que estes foron os tipos que, cando o noso país estaba ameazado,

or our world was threatened,

cando o noso mundo estaba ameazado,

they didn't retreat.

non se renderon.

They didn't talk about building walls.

Non falaron de construír muros;

They talked about building institutions to protect human security,

falaron de construír institucións para garantir a seguridade humana,

for their generation and also for ours.

para a súa xeración e tamén para a nosa,

And I think our generation should do the same.

e eu coido que a nosa xeración debería facer o mesmo.

Thank you.

Grazas.

(Applause)

(Aplausos)