Precarity, urbanisation and humanitarian resilience

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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.