Precarity, urbanisation and humanitarian resilience

城市化和大规模移民的加速进程对全球健康、可持续发展和人权保护提出了深刻的挑战。为了应对这一新出现的疾病风险和社会脆弱性，联合国各机构重新调整了政策重点，将弱势人口融入城市，而不是建造营地（难民署，2014年）。流离失所人口管理的这一范式转变对人道主义组织的作用和影响范围产生了重大影响，这些组织现在被迫在有时限的紧急情况的迫切要求之外开展行动，并应对城市非正规性引发的复杂危机。如何提供关键的医疗援助和保护“城市幸存者”的人权，提出了一系列跨越人道主义、紧急研究、发展、城市规划和职业健康等传统领域的问题。该项目由无国界医生组织英国分部（MSF-UK）的曼森社会科学团队负责，以无国界医生组织在孟加拉国达卡的贫民窟居民中发起城市医疗保健计划的创新努力为基础。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无管制的制革厂、塑料厂、服装厂和金属厂工作的可怕条件。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，到疲惫、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首次在达卡为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。这个博士项目利用多元化的社会科学工具包，探讨了三条相互关联的调查线，这些调查线来自无国界医生组织在达卡的工作，并反过来寻求深化和告知无国界医生组织的工作：1）与“工作健康”相关的日常谈判是什么，以及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”的地理分布是什么？工人到哪里去获得“快速解决”，以及无国界医生的服务如何在这些正式和非正式的护理回路中定位？3)无国界医生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？除了为无国界医生改善这些社区医疗服务的策略提供信息外，这项研究还将揭示一个新兴的人道主义干预前沿--一个专注于社区复原力、城市环境健康和生活质量的前沿，而不是严格意义上的急诊医学。

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.