Precarity, urbanisation and humanitarian resilience

城市化和大规模移徙进程的加速对全球卫生、可持续发展和保护人权提出了深刻的挑战。为了应对这种疾病风险和社会脆弱性的新形势，联合国各机构重新调整了政策重点，将弱势群体融入城市，而不是建设难民营（难民署，2014年）。这种流离失所人口管理模式的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，现在人道主义组织被迫在有时间限制的紧急情况的紧急需求之外开展工作，并应对城市非正式性引发的复杂危机。如何提供关键的医疗援助并保护这一日益增多的“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。该项目隶属于无国界医生组织曼森分会（英国）社会科学小组，以无国界医生组织在孟加拉国达卡贫民窟居民中发起城市保健方案的创新努力为基础。除了与过度拥挤和不合标准的住房有关的传统健康问题外，这些社区还面临着在不受管制的制革厂、塑料厂、制衣厂和金属厂工作的恶劣条件。这种“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，到疲劳、接触有毒物质、自我药疗和人体工程学限制对健康的累积影响。无国界医生有史以来第一次开始向达卡的工人提供基本职业健康服务。如何最好地满足极度脆弱人口的健康需求，需要努力解决迫使他们进入这种危险职业环境的经济不稳定状况。利用多样化的社会科学工具包，这个博士项目考察了三个相互关联的调查线，这些调查线来自于无国界医生在达卡的工作，并反过来寻求深化和告知：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”的地域是什么？工人们去哪里获得“快速治疗”？无国界医生的服务在这些正式和非正式的护理循环中是如何定位的？3)无国界医生如何在处理地方性职业危险的同时促进健康决策？除了告知无国界医生改善这些社区医疗服务的策略外，这项研究还将揭示人道主义干预的新兴前沿——一个关注社区恢复力、城市环境卫生和生活质量的前沿，而不是严格的急救医学。

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.