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.