When a natural disaster and humanitarian crisis hits the headlines, many of us (including me) reach straight for our wallets. Emergencies have an easier time getting our attention (and emotional investment) than the chronic health problems that plague the developing world every day. But to hear the Disease Control Priorities report tell it, emergency aid is one of the worst uses of donations, despite being one of the most emotionally compelling.
The full discussion is on pages 1147-1161 of the report. A couple highlights:
The immediate lifesaving response time is much shorter than humanitarian organizations recognize. In a matter of weeks, if not days, the concerns of both the population and authorities shift from search and rescue and trauma care to the rehabilitation of infrastructure (temporary restoration of basic services and reconstruction). In Banda Aceh, Indonesia, after the December 2004 tsunami, victims were eager to return to normalcy while external medical relief workers were still arriving in large numbers.
Even if a donation is made minutes after a disaster, it might not be used in any meaningful way until it’s too late for emergency relief. Another reason to favor organizations with staff already on the ground.
Several specific emergency interventions are criticized for high costs and low or negative effects, including mobile hospitals:
The limited lifesaving usefulness of foreign field hospitals has been discussed. Again, the lessons learned from the Bam earthquake are clear. The international community spent an estimated US$10.5 million to dispatch approximately 10 mobile hospitals, which arrived from two to five days after the impact, long after the last casualty had been evacuated to other Iranian provinces.
And search-and-rescue operations (particularly those not carried out by locals):
Few developing countries have established the technical capacity to search for and attend to victims
trapped in confined spaces in the event of the collapse of multistory buildings. Industrial nations routinely dispatch search
and rescue (SAR) teams. Costs are high and effectiveness is reduced by delayed arrival and quickly diminishing returns.
Following the 1988 earthquake in Armenia, in the former Soviet Union, the U.S. SAR team extracted alive only two victims at a cost of over US$500,000. In Turkey in 1999, 98 percent of the 50,000 people pulled alive from the rubble were salvaged by relatives and neighbors. In Bam in 2003, the absence of high-rise and reinforced concrete buildings ruled out the need for specialized teams. Nevertheless, according to UN statistics, at least US$2.8 million was spent on SAR teams. An alternative solution consists of investing these resources in building the capacity of local or regional SAR teams—the only ones able to be effective within hours—and training local hospitals to dispatch their emergency medical services to the disaster site.
The report is also harsh on in-kind donations, which it says are “not only are of limited use, but often cause serious logistic, economic, and political problems in the recipient country” due to warehousing issues.
The report’s bottom line is that “emergency relief is “one of the least cost-effective health activities,” and no substitute for (a) disaster preparedness (discussed on pgs 1158-9); (b) proven interventions to deal with chronic, everyday health problems.
I should note that this chapter is less thoroughly referenced than most others in the report, although this is likely because emergencies are a bad environment for meticulous study (and so evidence must be informal and observational instead). Having read it, I’m personally hesitant to give to disaster relief again. I’d rather up my donations to projects that aim to strengthen everyday health infrastructure for those in chronic need. I do feel an emotional pull to try to help when disaster strikes, and I feel this pull more strongly in the aftermath of the headline than contemplating it in the abstract – but I also agree with the DCP report’s emphasis on using limited funds as well as possible:
The willingness to spend hundreds of thousand of dollars per victim rescued from a collapsed building in a foreign coun-
try is a credit to the solidarity of the international community, but it also presents an ethical issue when, once the attention has
shifted away, modest funding is unavailable for the mid-term survival of tens of thousands of victims.
Comments
I agree with the conclusion that investing in disaster preparedness and the improved capacity of local systems likely mitigates the effect of a disaster more efficiently than donating after after the fact. But this analysis parses “emergency relief” far too finely and leaves out much that needs to be done in the wake of disaster, in which local NGOs or nonprofits often take an effective lead role.
Search and rescue – which in this analysis is conflated to mean “emergency relief” – is almost always led by government. Nonprofits generally provide what is known in U.S. FEMA parlance as “mass care” – food, shelter, health services, water, sanitation. The basics, once people have been helped to safety. I would suggest that donors implicitly understand this – after all, they’re not funding “rescue,” they’re funding “relief.”
Relief, as the report suggests, in most instances moves to “recovery” in a few days. Nonprofits and NGOs often play a critical role here as well. Survivors may be eager to return to normalcy, but critical infrastructure is often damaged and unusable. So whereas the medical workers might not be “saving” people who just came out of the rubble, they are providing all the health services that people can longer get because their local clinics or hospitals are demolished. I don’t know about the specific example of mobile hospitals in Bam, but I do know that several nonprofits that went shelter to shelter after Katrina, providing ongoing care for many people’s medical conditions – like diabetes, high blood pressure, etc – were instrumental in ensuring those people were able to maintain some semblance of health. (We get far too caught up in counting “deaths” or “effects” in the first days after an emergency, discounting entirely those that happen over the ensuing months that are directly related to the disaster as well.)
This occurs for many social services beyond health. Providing child care and education when schools are closed; helping get livelihoods back underway and housing in place; etc. My sense is that donors respond to a crisis not just with the idea of literally “saving” lives but to help those affected ensure that they have the opportunity to get back on their feet. In this respect, their money is well-placed (though, admittedly, because of the unstable nature of crisis situations, there is likely to be more “waste” of these dollars).
Immediate response is always inherently local. And as my report for the Aspen Institute on the local nonprofit response to Katrina showed (http://www.nonprofitresearch.org/newsletter1525/newsletter_show.htm?doc_id=377736), many local groups will get involved even if disaster response is not a part of their mission. So I agree that it’s best to try to funnel funds to those groups. For donors without previous experience in the affected areas, that can be a challenge, though in the U.S., community foundations, local giving circles, and other local fund vehicles provide an easy mechanism.
In my report I suggested that Congress mandate the Red Cross give 5% of their fund raising to such groups. But it may be time to develop a national fund rather than have the Red Cross dominate disaster fund raising, in order to provide local groups better access and distribute the money based on merit – the ARC and any other group would be on equal footing for getting funds. This fund might also become a type of private disaster insurance fund, funding preparedness in high-risk areas.
There are several postings on my blog http://www.hausercenter.org/iha related to disaster contributions that might interest you, including the concept of a joint appeal for international emergencies.
You can find some good ‘lessons learned’ documents on the website of the International Strategy for Disaster Reduction at http://www.unisdr.org/.
Part of what you are pointing out is that there aren’t enough (or perhaps good enough) links between relief, rehabilitation and development.
I haven’t read the report you reference as yet, but I do know that much of what happens in development is not locally-driven. Yet the case of the APOC – set up to control river blindness or onchocerciasis – shows that “community-directed” health care delivery can make a huge difference in health care delivery. And in fact, can help strengthen weak health care systems from the bottom up, rather than from the top down, as much of the current work attempts to do. See http://www.who.int/tdr/publications/tdrnews/news80/cdi.htm.
Rosemary
Interesting conversation going here. At
GlobalGiving our emphasis is on “community-led” solutions and organizations (while admittedly some of the projects are run by international NGOs). This worked out well for donors who used our platform in response to the Burma Cyclone and China Earthquake earlier this year. In both cases, we had already established relationships with organizations already authorized and working in these tough locations, and we were able to get funds to the ground very quickly. In the case of China, our project partner, Half the Sky Foundation,posted regular updates so that donors were kept aware of how their funds were being used in the short term (and longer term).
Highlighting this to say that all “impulsive” disaster giving isn’t necessarily a waste.
Cheers,
Donna @ GG
This was an interesting post, and some great comments. It is human nature that we don’t do enough to prepare for things. We usually don’t do something until it’s too late. The lessons learned will occasionally make people proactive, but in general, people don’t do enough before a disaster, and it hurts us. All we can do is learn from our past.
Those points you made are a concern of mine too. I have friends who lived and stayed in New Orleans bywater region where the flood level varied and they collected in higher ground houses or toughed it out alone; but most helped and there were relief places and centers in the 10 days before the military came through put up by the residents. They even knocked on doors and helped the shut ins, who were afraid of everything after the storms. When the military entered it became caotic, and the fire departments that broke into every house and the pets that were seized? My friends took care of every animal and cats were able to avoid capture and survived just fine. People did things like leave huge amounts of food out before evacuating. But when the animal rescue teams “stolled” the pets, a lot of people missed them. House muckers took valuables while residents were forbidden to re-enter their own neighborhood or held in camp like settings in far away states. And remember the volunteers who couldn’t enter New Orleans because they were stopped by authorities?
A proper and viable solution would be to set up local non-profit disaster relief organizations that stay and operate locally.
I am doing just that, look it up on the websites listed. We are going to operate ongoing, because Detroit is a disaster zone and offer the proper resources that exist but information is currently hard to find. We are spending our time this winter creating the resource database and fundraising to pay for the bus conversion; which we already own; and ofcourse spreading the word that this needs to happen if we are going to affect true change, not leaving out the ever growing population that is impoverished all across the nation.
We could use help, please contact me,
Thanks,
Jean
Wow I never thought about it that way but that makes a lot of sense. When you think about it most companies cant use revenue efficiently enough to turn the cash around in months, and there is so much legal red tape with charities you can add on a few more weeks.
I’ve noticed that people are linking to this post in the context of Haiti relief. I’d like to point out that emergency relief is for the survivors of the disaster – not for search and rescue. You’re right that the need for search and rescue is over in 24-48 hours after a disaster.
But people in Haiti need food, clean water, toilet facilities, and shelter right now if we’re going to prevent a massive outbreak of typhoid, dengue fever, and malaria.
Interesting points, and I do agree in principle that donations for disaster preparedness are more logical than emergency aid. However, there are some disasters of a magnitude that cannot be foreseen, for example Hurricane Katrina, the 2004 Indian Ocean tsunami, or the Haitian earthquake. Dollars are needed right at that moment, and thank goodness people care enough to respond.
I have worked in development for too long and am only grateful this discussion is being started now by reputable and respected sources referencing real analysis. While so much money is being genuinely donated by the global community, a lot of it will be wasted if not stolen. Yes corruption is rampant in emergency missions as prices skyrocket for basic supplies. In the weeks to come, as these stories begin to filter out of Haiti, it only makes people previously willing to contribute less likely to in the future impacting those organizations who are running effective missions, many of them local & grassroots who never receive enough funding.
When additional funds are needed to rebuild infrastructure (as discussed above), it will be harder to find because these are not classified as emergency funds.
But this discussion only opens a larger issue which is how donor funding is generally wasted on ridiculous overheads including expat salaries. Here in Kenya, the average salary for a UN director represents $340,000 USD/yr in salary and benefits. The average Kenyan earns less than $700 per year.
Alanna, the report this post discusses is about disaster relief in general, not just search-and-rescue. It specifically addresses disease outbreaks, stating “the imminent risk of large outbreaks in the aftermath ofnatural disasters is over-stated” (see page 1151).
We don’t at this point endorse the chapter’s conclusions. We haven’t looked into this area enough to do so, and we also note (as we state in the original post) that the chapter is thinly sourced. However, we do feel the chapter is worth noting since it comes from a generally high-quality source and seems to take an unusually critical position on the value of disaster relief. We’re very interested in your thoughts on it.
I hate these kinds of analysis, while true it’s so frustrating to read them. You know what I’m talking about, those contrarian, turn your world upside down ideas. Like if somebody said “recycling actually produces more trash”.
Anyway the fact of the matter is people are emotional creatures, they’re going to donate to an event, they’re not going to donate to an abstract concept like “donate to disaster prevention in Uganda so it doesn’t end up like Haiti”. It’s just the way it is. People are simply not smart enough to do these kinds of intellectual Uturns.
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