Aid that fails, aid that discriminates…and aid that’s gone

Anyone who has spent any time in Geneva recently knows that the humanitarian agencies, big and small, are struggling with major financial cutbacks, even as the crises they are supposed to alleviate – Gaza, Sudan, Ukraine, Afghanistan, Somalia – get worse and more numerous.

This week on Inside Geneva we offer four in-depth interviews on the current situation for humanitarian aid, from specialists with very different experiences, who all agree that the system needs radical reform, but who all warn that the current trajectory of funding cuts and political pressure is absolutely the wrong approach.

Please listen to this week’s episode:

Aid that fails

We start by talking to Professors Karl Blanchet of the University of Geneva, and Esperanza Martinez of the Australian National University. They are co-authors of a report from the prestigious medical journal, the Lancet, whose headline reads “The humanitarian system is failing 239 million people.”

The report, they explain, calls for “urgent transformation.” Among the changes they demand are an inversion of the power structures around aid, so that “affected communities, not donors or geopolitics, are in charge of decisions and resources.”

But these proposals have been circulating in the United Nations and other aid agencies for at least two decades – when I first arrived in Geneva one of the most common conversations was about ending “top down” aid delivery and focussing on “localisation”.

Martinez agrees the debate is not new; at the World Humanitarian Summit ten years ago key promises of reform were made, and not fulfilled. “We know what’s wrong and we have known it for a long time, for many years…this report actually confirms that we haven’t made the progress that was required.”

But is now, amid all the financial cutbacks, really the best time to release such a report? Aid agencies are struggling to survive, let alone introduce radical reform. Blanchet thinks it’s now or never. The aid cuts “are a catastrophe, not an opportunity,” he tells Inside Geneva. But, “there’s no other way the humanitarian system can survive this crisis without any changes.”

As well as advocating for a more local, community centred strategy for humanitarian aid, the report highlights other challenges it would like to see governments – both traditional donors and those in countries where conflict or crisis is taking place – address.

Violence against, or obstruction of, healthcare, the report reminds us, reached record levels in 2024. Blanchet and Martinez urge states to end impunity for such acts. They also warn that humanitarian funding is increasingly shaped by politics, adding “the system has become selective, unreliable, and deeply politicised.”

Aid that discriminates

That politicisation brings us to our next interview this week. Hannah Reinl is project manager at the Geneva based International Gender Champions, and she’s been taking a close look at a new directive on aid delivery that has emerged from the United States.

It’s called PHFFA, or “Promoting Human Flourishing in Foreign Assistance.” It sounds, I suggest, quite promising, particularly from an administration that only recently shut down its entire foreign aid department, USAID, with the loss of thousands of jobs, and millions of dollars in humanitarian funding.

But Reinl is cautious. The directive, she fears, has a clear ideological slant, aimed, like other US policies, at removing any gender based focus. PHFFA, she explains, contains three different “rules…combating gender ideology, protecting life and foreign assistance, and combating discriminatory equity ideology.”

What might that mean in practice? No US funding for programmes that support women’s reproductive health, Reinl suggests, with the grim consequence that victims of sexual violence may not be offered the help – including the option to terminate a pregnancy – they need. Also worrying, she says, is a possible “chill factor”. The compliance regulations to receive any US funding are so complex, she fears many aid agencies will decide themselves not to undertake a particular project, because they worry it will fall foul of US rules.

And just to take a hypothetical scenario, Reinl and I discussed the current serious Ebola outbreak in the Democratic Republic of Congo. Women the world over are most often the first carers of the sick, so aid programmes are often designed to reach women specifically.

‘‘Every process in society follows a gendered pattern,” Reinl points out. “It’s often going to be the women who are the caretakers of the sick people. It’s going to be the women who are washing the bodies of the dead and are preparing them for the burial ceremony.”

And since we know the traditional washing of bodies has been a key factor in the spread of Ebola, a targeted programme to communicate safe burial practices to local women would, you would imagine, be ideal. But not, apparently, if it is gender focussed. It’s just a hypothetical example – but one that worries aid agencies studying Washington’s PHFFA rules.

Aid that’s gone

We stay in Washington for our third and final interview, with Nicholas Enrich, who until last year worked in USAID’s global health department, but, like so many others, lost his job during Elon Musk’s dismantling of the agency. Enrich has now written a book called Into the Wood Chipper with a firsthand account of what that was like, which he talks about in detail in our June 23 “Books to make you think” episode of Inside Geneva.

This week, we hear from him specifically about Ebola, because in early 2025 there was an Ebola outbreaking taking place too, just as Musk and his ‘Department of Government Efficiency’ or Doge, staff were entering USAID’s offices and firing people, including nearly all of Enrich’s colleagues.

“It was absolutely terrifying ,” Enrich remembers. “All of our programs were frozen.

I knew we wouldn’t be able to put the robust response in place that USA is usually able to muster.”

Normally, Enrich told Inside Geneva, the US would have sprung into action in hours, putting its experts, its logistic skills, and its cash, in support of getting the outbreak under control. None of that happened. When he suggested airport screenings on international flight passengers – a minimum intervention in major disease outbreaks – he was ignored.

The most jaw dropping moment the revelation that millions of dollars of protective medical equipment – masks, gloves etc – bought months ago by the US for just such an outbreak, were still sitting in a warehouse in Nairobi. Doge was not interested in releasing them, in part, Enrich suggests, because the warehouse was supervised by the World Health Organisation, and no one wanted to contact an organisation President Trump had decided to leave.

Enrich was even told, by a Trump appointee supervising the dismantling of USAID, that if he was really so keen to deliver the PPE he should get on a plane to Nairobi, hire a truck, and drive the vital equipment to DRC himself.

Enrich’s book (and a reminder you can hear much more detail on Inside on June 23) highlights exactly the perfect storm of aid that is politicised, centralised, cash strapped, and as a result fails to deliver at all. Everything the Lancet report from Blanchet and Martinez say should be abandoned in favour of a localised, more streamlined, but well funded approach. Perhaps we could start with a return to the most fundamental principles of aid delivery: humanity, impartiality, neutrality, and independence, to ensure effective, safe, and unbiased assistance?

These interviews are truly thought provoking, so do listen in full. And, if you’re in Geneva this week and want to see us recording our next episode, we’ll be at the Graduate Institute on May 28, 14:00, with a panel including diplomats, aid workers and academics to ask “What’s the point of foreign aid at all?” For all our non Geneva based listeners, that episode is out on June 9.

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