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譯者: David Hsu
審譯者: Winston Szeto
00:12
So have you ever wondered
what it would be like
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請問你有曾想過,
生活在一個不受管制的地方
是怎樣感覺嗎?
00:15
to live in a place with no rules?
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00:19
That sounds pretty cool.
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聽來是蠻酷的。
00:20
(Laughter)
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(笑聲)
00:21
You wake up one morning, however,
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可是,大早醒來後,
00:23
and you discover that the reason
there are no rules
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你發現沒有管制的原因
卻是因為已沒有政府了,
而且也沒有任何法律了,
00:26
is because there's no government,
and there are no laws.
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00:29
In fact, all social institutions
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,
00:39
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,
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我倒是知道這是什麼的感覺。
00:47
because when I was
a medical student in 1999,
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因為在 1999 年,
我為醫學院學生時,
00:50
I worked in a refugee camp
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。
00:56
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
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難以置信,
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
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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。
01:08
and understand how they navigated
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。
01:16
Postwar Kosovo
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,
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.
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目的是為了確保戰爭
不會再度爆發。
01:26
But other than that,
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,
01:29
and almost every social institution,
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,
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,
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當你置身在這種情況和環境中,
01:43
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
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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。
01:53
where you realize
how incredibly vulnerable you are.
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01:59
For me, that moment came
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,
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
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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,
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如他想在此時此地把我射殺的話,
02:14
actually wouldn't be doing
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
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但當時我體會到的脆弱感,
是絲毫比不上
02:23
in comparison to the vulnerability
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
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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,
02:34
is riddled with danger and uncertainty,
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是充滿危險和不確定性的。
02:37
and simple questions like,
"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?」
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,
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至於安全問題,
當你沒有任何保安系統時,
02:50
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
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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
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會不會演變成暴力事件,
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?
02:59
Health concerns
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,
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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?"
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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?
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「我懷孕的姐姐正在出血,
我該怎麼辦?
03:15
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?
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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?"
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我該怎麼付錢?
我要用哪國貨幣支付?」
03:24
"If I need medications,
where will I find them?
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「如果我需要藥物,
我在哪裡可以找到?
03:28
If I take those medications,
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?」
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,
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生活的主要特徵,
03:41
is the incredible vulnerability
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
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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.
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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。
04:03
I came back to Boston,
I became a physician,
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我回到了波士頓,我成了一名醫生,
04:06
I became a global public
health policy researcher.
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我成了一名
環球公共衞生政策研究員。
04:10
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.
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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,
04:16
really wanted to get started
on this problem right away.
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真的很想立即就研究這問題。
04:19
I was like, "How do we reduce
the crushing vulnerability
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我在想:
「對生活在這種匱乏環境的人,
04:23
of people living in these types
of fragile settings?
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我們如何能減少
這令人窒息的脆弱感?
04:26
Is there any way
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,
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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.
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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.
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對他們來說,
這是一種不尋常的問題。
04:44
They were kind of like,
"Oh, if you work in war,
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他們的反應是:
「哦,你在戰場中工作,
04:47
doesn't that mean
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?" --
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在記錄戰爭暴行?」
04:51
which is, by the way, very,
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,
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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,
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
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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.
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研究人員作出一個
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
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就是絕大多數因戰爭
死亡和殘疾的事情
05:21
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
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所以活在受衝突影響的國家中
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.
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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,
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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,
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因為戰爭之所以殺人,
是因為它摧毀了診所,
05:45
of their hospitals,
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摧毀了醫院,
05:46
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.
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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
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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.
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06:00
So this is really not
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,
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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。
06:12
in terms of how we think
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。
06:18
Last year, you may remember,
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你可能會記得去年
06:20
Ebola hit the West African
country of Liberia.
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伊波拉病毒侵襲西非國家賴比瑞亞。
06:25
There was a lot of reporting
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,
06:29
sounding the alarm
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:
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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?
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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,
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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.
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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.
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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
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在全國 450 萬人口之中,
醫生不到 50 名。
06:59
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,
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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,
在 11 年後仍沒有。
07:08
11 years later.
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07:09
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.
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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
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但你知不知道國際社會
捐款中只有 2%
07:20
went to rebuild
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.
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海地人民可謂到了今天
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。
07:35
He's the Minister of Health
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,
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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
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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。
07:52
Thousands of these new arrivals
have experienced incredible trauma.
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這些數以千計的新移民
經歷了難言的創傷。
07:56
His doctors are working
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。
08:02
His budget has not increased
by 25 percent;
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可是他的財政預算
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.
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因為撥款已調去應付保安問題
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——
08:17
how do you think that's going to influence
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你覺得這會怎樣影響
08:19
the decision making
of the five million people in his region
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當地 500 萬居民的決定呢?
08:22
as they think about
whether they should flee
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他們正在考量是否應該逃跑,
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,
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所以你可以看到,
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?
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本土的衞生和保安系統呢?
08:41
I usually tier two concerns,
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:
08:46
and the concern that people
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
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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.
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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
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但我也可告訴你,
相反的也是絕對有的,
09:01
in every case I have worked on,
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2030
在我有參與的每一個案件中都有——
09:03
from Afghanistan to Libya, to Kosovo,
to Haiti, to Liberia --
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從阿富汗到利比亞、到科索沃、
到海地、到賴比瑞亞——
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,
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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.
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冒著一切風險來
挽救他們的衞生體制。
09:15
The trick for the outsider
who wants to help
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3348
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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2308
並建立渠道讓他們走上領導位置。
09:23
That is exactly what happened
in Afghanistan.
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3184
這也正是在阿富汗能做到的。
09:27
One of the unsung and untold
success stories
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3329
我們在阿富汗國家建設上付出的努力
09:30
of our nation-building effort
in Afghanistan
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2918
其中一個無聲無聞的成功故事,
09:33
involved the World Bank in 2002
investing heavily
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3496
就是世界銀行在 2002 年
投放大量資金
09:37
in identifying, training and promoting
Afghani health sector leaders.
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5135
去發掘、培訓和提拔
阿富汗的衞生部門領袖。
09:43
These health sector leaders
have pulled off an incredible feat
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3853
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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1372
09:49
They have aggressively increased
access to health care
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589142
3947
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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593113
2016
09:55
They are rapidly improving
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,
189
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1271
09:58
which used to be the worst in the world.
190
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1986
而它曾經是世界上最糟糕的。
10:01
In fact, the Afghan Ministry
of Health does things
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2822
事實上,阿富汗衞生部所做的事
10:04
that I wish we would do in America.
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1696
是我希望我們也能在美國做到的。
10:06
They use things like data to make policy.
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2372
他們用數據資料來製定政策。
10:08
It's incredible.
194
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1185
簡直不可思議。
10:09
(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.
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2602
「我們負擔不起,我們真的沒錢。
10:16
It's just unsustainable."
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1355
這是不可能持續的。」
10:19
I would submit to you
that the current situation
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2733
但讓我告訴你:我們現有的情況
10:21
and the current system we have
200
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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.
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4038
是我們可以想像
最昂貴、效率最低的制度。
10:27
The current situation
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
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2064
或者說組成歐盟委員會的
10:33
that make up the European Commission --
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633307
1874
一眾成員國政府——
10:35
every year, they spend 15 billion dollars
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2649
每年就要花費 150 億美元
10:37
on just humanitarian and emergency
and disaster relief worldwide.
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4006
在全球的人道、緊急和災難救援上。
10:41
That's nothing about foreign aid,
that's just disaster relief.
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3321
這數字不包括外援,只是賑災而已。
10:45
Ninety-five percent of it
goes to international relief agencies,
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645895
5045
這費用 95% 給了國際救援機構,
10:50
that then have to import resources
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,
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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.
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3569
錢用光後就要把它瓦解,
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,
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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
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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
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2447
11:21
in threatened situations.
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2567
各個強項和弱項。
11:24
And that's when we see doctors fleeing,
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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 --
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2435
當我們看到體制崩潰時,
11:30
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.
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3110
這就是我們需要發出警報
並揮手求救之時。
11:35
OK?
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695656
1394
行嗎?
11:37
Not now.
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697074
1151
還等什麼?
11:38
Everyone can see that's an emergency,
they don't need us to tell them that.
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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。
11:42
Number two:
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702942
1939
第二點:
11:44
places like where I work at Harvard
need to take their cue
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704905
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,
11:48
from the World Bank experience
in Afghanistan,
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2198
11:50
and we need to -- and we will --
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1657
我們需要並將會
11:52
build robust platforms to support
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。
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.
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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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724245
1154
第三點:
12:05
we need to reach out
and make new partnerships.
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725423
2578
我們需要積極溝通,
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,
12:09
we have launched a new initiative
with NATO and other security policy makers
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729923
4012
我們與北約和其它安全決策者
發起了一個新舉措,
12:13
to explore with them what they can do
to protect health system institutions
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733959
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.
237
739349
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
239
742652
4700
維護當地衞生系統和
其它關鍵社會體制
12:27
is an integral part of their mission.
240
747376
2443
是他們任務的重要一環。
12:29
It's not just about avoiding
collateral damage;
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749843
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
753004
1805
12:36
But the most important partner
we need to engage is you,
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756545
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.
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3432
美國大眾,以至世界大眾。
12:43
Because unless you understand
the value of social institutions,
245
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5696
除非你們能明白
社會體制的寶貴價值,
12:49
like health systems
in these fragile settings,
246
769328
2511
就像政局不穩環境下的衞生體制,
12:52
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
248
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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.
249
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4966
它在談論,「嘿,所有這些醫生
正從某國逃命。
13:02
I wonder what that means.
250
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2417
我想知道這意味什麼:
13:05
I wonder what that means
251
785011
1852
究竟該國衞生系統
13:06
for that health system's ability
to, let's say, detect influenza."
252
786887
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.
253
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3377
「嗯,情況應該好不了那裡。」
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.
255
796778
6280
是我最喜歡的三位捍衞和建設
社會體制的美國人。
13:23
Over here is George C. Marshall,
256
803666
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
257
806575
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.
258
809428
4191
來拯救第二次世界大戰後
所有在歐洲的經濟制度。
13:34
And this Eleanor Roosevelt.
259
814119
2353
這是愛蓮娜·羅斯福。
13:36
Her work on human rights
really serves as the foundation
260
816496
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.
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819666
3028
13:43
Then my big favorite is Ben Franklin,
262
823150
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,
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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
832402
1724
我可以這麼說,
13:54
that these are folks who, when our
country was threatened,
266
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3753
這些人在我們國家受到威脅之時,
13:57
or our world was threatened,
267
837927
2007
或是我們世界受到威脅之時,
13:59
they didn't retreat.
268
839958
1303
並沒有退縮。
14:01
They didn't talk about building walls.
269
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2341
他們並沒有談論建圍牆,
14:03
They talked about building institutions
to protect human security,
270
843650
5381
他們談論的是建設制度
來保障人類安全,
14:09
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.
272
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2798
所以我們這一代也應該
做同樣的事情。
14:16
Thank you.
273
856503
1160
謝謝。
14:17
(Applause)
274
857687
2229
(掌聲)
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