Precarity, urbanisation and humanitarian resilience

城市化和大规模移徙进程的加快对全球卫生、可持续发展和人权保护提出了深刻挑战。为了应对这一新出现的疾病风险和社会脆弱性问题，联合国机构已将政策的重点重新放在弱势人口融入城市，而不是建造难民营(难民署，2014年)。流离失所人口管理的这种范式转变对人道主义组织的作用和影响范围具有相当大的影响，这些组织现在被迫超越有时间限制的紧急情况的紧急需求，并与城市非正规性引发的复杂危机作斗争。如何提供关键的医疗援助，并保护日益增多的城市幸存者的人权，引发了一系列跨越人道主义、应急研究、发展、城市规划和职业健康等传统领域的问题。该项目嵌入了无国界医生组织曼森分部(MSF-UK)的社会科学团队，建立在无国界医生组织在孟加拉国达卡贫民窟居民中发起城市卫生保健计划的创新努力的基础上。除了与过度拥挤和不合标准的住房相关的传统健康问题外，这些社区还面临着在不受监管的制革厂、塑料厂、服装厂和金属厂工作的恶劣条件。这场“人为灾难”的危害是极端的，从工作场所伤害和虐待造成的残疾、退化、创伤和死亡，到疲惫、接触有毒物质、自我用药和人体工程学限制对健康的累积影响。无国界医生组织在其历史上第一次开始向达卡的工人提供基本的职业健康服务(BOHS)。如何最好地满足极度脆弱人口的健康需求，需要努力应对迫使他们陷入如此危险的职业环境的经济早衰状况。利用多样化的社会科学工具包，这个博士项目研究了三个相互关联的问题，这三个问题产生于无国界医生组织在达卡的工作，并进而寻求深化和提供信息：1)与“工作健康”相关的日常谈判是什么，这些做法可能带来哪些额外的个人和公共健康风险(例如假药、抗菌素耐药性)？2)“工作健康”的地理位置是什么？无国界医生组织的工作人员到哪里去获得“快速解决办法”？无国界医生组织的服务如何在这些正式和非正式的护理流程中定位？3)无国界医生组织的工作人员如何在解决地方性职业危险的同时促进健康决策？除了向无国界医生组织提供改善这些社区卫生服务的战略外，这项研究还将揭示人道主义干预的一个新兴前沿--专注于社区复原力、城市环境健康和生活质量，而不是严格意义上的急救医学。

The accelerating process of urbanisation and massmigration present profound challenges to global health, sustainable development and the protection of human rights. To address this emerging landscape of disease risk and social vulnerability, United Nation agencies have refocused policy on the integration of vulnerable populations into cities rather than the construction of camps (UNHCR, 2014). This paradigm shift in displaced population management has considerable implications for the role and reach of humanitarian organisations, now forced to operate beyond the exigent demands of timebound emergencies and contend with the complex crises provoked by urban informality. How to provide critical medical aid and protect the human rights of this rising tide of 'urban survivors' raises a host of questions that cut across conventional domains of humanitarianism, emergency research, development, urban planning and occupational health. This project, embedded within the social-science team at The Manson Unit of Médecins Sans Frontières (MSF-UK), builds upon MSF's innovative efforts to initiate an urban health care programme among slum-dwellers in Dhaka, Bangladesh. In addition to the conventional health problems associated with overcrowded and substandard housing, these communities face appalling conditions working in unregulated tannery, plastics, garment and metal factories. The hazards of this 'man-made disaster' are extreme, ranging from disability, degradation, trauma and death caused by work-place injury and abuse to the cumulative health impacts of exhaustion, toxic exposure, self-medication and ergonomic constraints. For the first time in its history, MSF began to provide basic occupational health services (BOHS) to workers in Dhaka. How to best meet health needs of a deeply vulnerable population requires grappling with the conditions of economic precarity that force them into such hazardous occupational circumstances. Drawing upon a diverse social-science toolkit, this doctoral project examines three interlinked-lines of inquiry that emerge from and, in turn, seek to deepen and inform MSF's work in Dhaka: 1)What are the everyday negotiations associated with 'working health' and what additional individual and public health risks (e.g. counterfeit medicines, antimicrobial resistance) might these practices entail? 2)What are the geographies of 'working health'? Where do workers go to get a 'quick fix' and how are MSF services situated within these formal and informal circuits of care? 3)How do MSF workers facilitate health-decision making while addressing endemic occupational danger? In addition to informing MSF strategies to improve health access in these communities, this research will shed light on an emerging frontier of humanitarian intervention-one focused on community resilience, urban environmental health and quality of life rather than strictly emergency medicine.