Is aid failing?

[Music] The Swiss Connection Science podcast is back with brand new stories. They're all connected by one overarching theme, the climate challenges we face today, and the smart solutions that can help us tackle them. This season we're diving into the depths of Swiss lakes, where invasive muscles are threatening the delicate indigenous ecosystem. We'll also travel to the Arctic to discover how ancient ice can reveal the vital clues of pioneering climate research. And we'll explore the critical world of the semi-conductor industry, looking at its global importance and Switzerland's potential role within it. All this and more is coming soon in the new season of the Swiss Connection Science podcast. [Music] Swiss Info Podcasts [Music] This is Inside Geneva. I'm your host, Imogen folks, and this is a production from Swiss Info, the International Public Media Company of Switzerland. [Music] In today's program. The shock dismantling of the US Agency for International Development is reverberating around the world. The coup, COVID, and cuts. Myanmar is already a nation and turmoil. The slashing of the UK's foreign aid budget has come at the worst possible moment. It is a catastrophe. It is not an opportunity, but now we have an obligation to transform the system. There's no other way the U.M. and system can survive this crisis without any changes. There's suspension of funding by major donors, not only the US, but also the UK, Germany, and other donors. As a result, there are going to be excess debts, millions of people that are going to die. The Schuylen have died because of these funding cuts. An outbreak of Ebola in the Democratic Republic of Congo has been declared as a public health emergency of international concern by the World Health Organization. Every process in society follows a gendered pattern, so 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 death and preparing them for the burying ceremony. With US Secretary of State Marco Rubio stating the World Health Organization was a little late in identifying it. The World Health Organization has, unfortunately, not done well around the world. I think they failed miserably during COVID. They covered for China, and that's how we're getting out of it. If the United States had not withdrawn from the World Health Organization, we would have been part of the WHO's response, which means that on May 5th, when WHO learned about this, the United States government would have learned about this. Instead, Rubio is saying that he didn't find out about this until 10 days later. Well, maybe we shouldn't have pulled out of the WHO and we would have found out about this earlier. Hello and welcome again to Inside Geneva. I'm Imogen Fox. Now, everyone working in or with the United Nations in aid and development on humanitarian projects knows the whole sector is facing huge challenges. Savage funding cuts, more conflicts and crises, and a growing sense among seasoned aid workers that the system needs to change. And I want to stress here, change not as a need or reaction to having less money, but after a long experience of what works and doesn't, radical root and branch change to make the system better. So in today's programme, we've got a series of in-depth interviews that reflect clearly and concernedly where humanitarian work is in mid-2026. We'll talk to a team from the prestigious medical journal The Lancet, whose new reports as the aid system is failing those most in need. At University of Geneva, the director of the Geneva Centre of U-Made and Studies, and the co-chair of the Laws and Commission on Has Conflict and for Displacement. My name is Esperanza Martinez. I am a medical doctor and humanitarian worker. I currently work as a professor at the Australian National University, but my previous work was with the International Committee of the Red Cross in Geneva. And we'll talk to a gender specialist who fears many traditional donor countries are putting conditions on their aid that could be damaging to women. My name is Hannah Reine. I'm a project manager at the International Gender Champions Secretariat. And for an even closer look at what's happening with the traditionally biggest donor of all, we'll talk to a man who had a front row seat as Elon Musk and his doge team dismantled the United States Government's aid and development arm USAID. And it all took place when, as again now, an Ebola outbreak had just begun. My name is Nicholas Enrich. I was the acting assistant administrator for global health at the US Agency for International Development, USAID, in January 25 as the agency was dismantled by the Trump Administration. So a lot to look forward to in today's episode. And because we're now seeing one of the most serious Ebola outbreaks in years, we will spend some time looking specifically at that. Is the aid sector fit to cope? And how might the shift in funding and in ideology around aid affect how this outbreak is handled? We'll begin with that new report from the Lancet. In it, Professor Karl Longché and Esperanza Martinis conclude that the humanitarian system is failing millions of people, but work on their report began long before the US, as well as Europe and the United Kingdom, decided to make such big cuts in overseas aid funding. So my first question to Karl Blanche was, has the report missed its moment? This is exactly the right moment to publish this report. We started two years ago and we were about to finish in a year from now. We started to accelerate everything because we could see that there were so many changes happening in the world. Gaza, Sudan, end of Syria, and then the new regime reconstruction. Yemen, the war, starting, a lot of publicist emergencies. And now we publish that exactly at the heart of the anti-Until virus outbreak and Ebola outbreak in Uganda and the RC. This is exactly the right time. Why? Because we think that a lot of governments, a lot of donors, a lot of policymakers and new agencies are making important decisions now. And we do think that they need to be well informed on the status of the system and on some key recommendations that need to take into account for the decisions. So do you see the current funding cuts, which are repeatedly described to me as a catastrophe or crisis, a disaster? Do you see that as an opportunity or somebody put it to me at a trap? It is a catastrophe. It is not an opportunity. But now we have an obligation to transform the system. There's no other way the Uyumat and system can survive this crisis without any changes. So this obligation does mean that all the right minds need to be around the table, to reshape and revisit how the system is organized and structured. That's going to be a huge challenge because it's clear. But we do think that we can have a few changes in the next three years and we do hope our work, our report and two years of work is going to help everybody to shape new ideas. The report makes really stresses the idea that the money that goes into humanitarian aid needs to be better spent and it's better spent by the local people who know what their needs are, who know their community. But I'm just wondering how you sell that to traditional donor countries where people are saying, "We're struggling ourselves. We don't want to give any money at all." And if we do, we want to see exactly how it's spent. Yes, but absolutely, maybe not because a lot of donors is very keen to actually bring the localization agenda at the heart of the funding. They just want to know how, how do we do it? And when we bring in this report, this notion of performance of the response and a accountability to affected populations, if we put that at the heart of the response, a lot of donors are going to follow. It does mean that a lot of local organizations, NGOs, and so on, will have to be better performed, be more transparent on how they spend their money, and deliver with being a accountability to populations. But at trust, local actors, to be who come from the community, to actually respect more the needs and the voices coming from communities. A couple of examples. One comes from Sudan where we have the emergency response rooms since 2023. And they have realized that the international response was not responding to the communities needs and were actually very partial because people stayed in a government state and instead of going to the other side. side of the front line. So they decided to get organized to call all the doctors and all the nurses and midwives. And let's get organized. It's very much a community-led organization. And now they received money from the European Union. They were nominated for the Nobel Prize prize. And they are highly recognized. We have seen that with the White helmets in Syria as well. So the United Nations at the moment is kind of fighting for its life. I mean, there's a whole school of thought. Again, we look to America. We just don't need it. People just think maybe the US would actually leave. I mean, where do you sit with that? You're not talking about getting rid of the of the UN. But you just think reorganization. The example of the Ebola outbreak, this is where you need the BHO on the front line, guiding everybody, coordinating everybody. We absolutely need the BHO. We do think that doing conflict response. We need UN agencies to be better aligned or to have not that many agencies being involved. There's a lot of fragmentation among the UN system. They take a lot of money as well from the international funding. We do think it's not really fair. And this money could be reallocated to national actors. That's very clear to us. But we do think that the UN agencies, including the BHO, for example, play a key role at guiding all the actors in terms of clinical guidelines, treatment guidelines and guidance so that everybody's going to work with the same standards of quality. That is essential. But they will need to be reformed. We do think they will need to shrink a little bit. There are too many UN agencies. And for the local systems and local actors, they have no clue who is doing what in the system. So this has to change. So Carmel and Shay advocates big changes in how we deal with aid, more local, more streamlined, less duplication. Some listeners like me may know that those ideas have been around and have come from aid workers themselves even for many years. Blanche's partner Esperanza Martinez agrees that changes longer. Verdeed, we know what's wrong and we have known it for a long, long time. For many years, that the structure was too heavy, that we have duplications in the humanitarian system, that the localization that was agreed and the evolution of power that was agreed in Istanbul in the world humanitarian summit hasn't materialized. And so this report actually confirms that we haven't made the programs that was required. At the same time, it identifies concrete ways in which we could advance. For example, if we talk about inverting the power, it's not just localization in the sense of talking about it. It's actually giving the resources and the autonomy and seeding power and decision making and authority to the communities and to the local actors. What the end of the day are the first responders. So there are concrete actions in the report that point out of ways where we can use this transformative period, challenging and critical period on the humanitarian sector to actually move the needle because we are in a place where we are not meeting the needs of people. I'm going to ask you to focus a little bit on this latest crisis, which is Ebola outbreak, a very serious one, much more serious than once we've seen in the last few years. How do you kind of square in your head? You want lots of change in the way humanitarian aid is delivered. Right now, we have a crisis where the funding that's available isn't just not possibly meeting the needs. Now, I know you say that the local people are already trying to meet the needs, but this is an area that's had conflict for decades. The national health system is in a very, very difficult situation. There is suspension of funding or the ceasing of funding by major donors, not only the U.S., but also the UK, Germany and other donors. Happened in a very critical period in the humanitarian sector. And as a result, there are going to be excess debts, millions of people that are going to die that shouldn't have died because of these funding cuts. Now, when you look at the humanitarian sector and the dependency on a few donors, you say, well, actually, this was a crisis in the making, but no one expected this to be so sudden and so abrupt. However, in situations like the ERC, communities are not waiting for the international actors to arrive. They're healthcare workers, their community workers, the communities themselves. They are acting and they are responding. And I think that's where we actually need to identify who is acting, who is legitimate in the eyes of the community and actually direct the funding directly there. How do you see, though, the current shift towards, I mean, you talk about taking geopolitics out of aid, but in fact, it seems to be going in the other direction. And there are many donor countries. The United States is clearly the the one that is in the headlines now, which is determining deciding how it will spend its money based on ideology. I mean, we see particularly the removal of programs that target gender or specifically promote women or reproductive health. Crisis like Ebola, you absolutely need to involve the women and probably approach them separately. The fact that those donors are also driving agenda that are against women, against gender inclusion, against certain specific diseases, who are focused on one disease and not on the other, that also was a malaise of the system. That was something that was not working. So we have a calls from middle powers to actually have the right conversations. And this is a conversation that is not only about money, it's about principles. I mean, women, people of diverse gender, children, elderly, they also have rights. They have the same right than other communities to help to protection institutions of armed conflict. And those conversations, we need them to be louder and we need to be more associated with accountability and with compliance. Moving forward, we need to say, okay, who is actually violating the rights of civilians, who is actually attacking hospitals and health facilities, and where is the accountability and the responsibility for that? And that is not necessarily related to funding. That is related to leadership and principle leadership. Unfortunately, many listeners may indulge in a cynical smile hearing, Martin is a peel for political leadership. A lot of people I talk to think that leadership is pretty thin on the ground nowadays. The UN and other humanitarian actors have been plunged into a cash crisis and into soul searching about how to go forward, some are even fighting to survive. Coming up in the second half of the program, is Washington's new ideology driven approach to foreign aid harming women and what does the end of USAID mean for crises like enable outbreak? But before that, a quick heads up. Our next inside Geneva podcast will be asking, what's the point of foreign aid at all? It's out on June 9th, but we're recording it with an audience at Geneva Graduate Institute this Thursday, May 28th. It starts at 2pm and we've got a great line up. Chris Locke here, outgoing secretary general of Medsasal Frontier, Dyka Potsil, EU ambassador to the UN in Geneva, Professor Jules Carbignet, longtime vice president of the International Committee of the Red Cross, and Jacqueline Lee, a master student in international development. If you're in Geneva this week, do come along. Meanwhile back to today's podcast, 2026 has seen a new conflict in Iran. The closure of the Strait of Hormuz is pushing some regions of Africa closer to famine. There's no real peace for Gaza, nor a cease-fire in Ukraine, and now we're seeing one of the most dangerous Ebola outbreaks in years. Our third interview today is with Hannah Reinal, project manager at Geneva-based international gender champions. She had an important point to make about Ebola. If we look at the current outbreak, there's a lack of funding for even for just basic hygiene and sanitation services, that is the first piece of it. The other one is that we need to understand that every process in society follows a gender pattern. So 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 death and are preparing them for the burying ceremony. So who is more at risk of contracting Ebola? It's the women. And this is just one small example that I'm afraid we will see play out in the myriad of different ways. So why does Reinal fear that? Well, we know the US has cut aid savagely, and more of that shortly when we talk to a former USAID official who witnessed those cutbacks firsthand. But we also know that more recently, Washington has offered some new money to specific hand-picked crisis zones. It's not nearly as much as before and Rhinal told me. It's all framed under a rather curious acronym, PHFFA, introduced by President Trump early this year. Yeah, so it sounds like another and really acronym from the UN world. It stands for promoting human flourishing and foreign assistance. So that sounds quite promising. It does. And that's part of the trick, I believe. So it sounds unobjectionable, right? Why wouldn't we want to promote human flourishing? I believe that this is by design already to even have a name that tricks you into thinking that this is something positive when actually the changes that proposes are quite radical and really threaten the gender architecture that we worked so hard to build here in Geneva. Well, give me some examples then. What is it that's raising the alarm bells with Geneva gender champions with you? Well, I think it's helpful to zoom out and first understand what it's actually made of because it's an umbrella term that unites three different component rules. And so these rules are called combating gender ideology, protecting life and foreign assistance, and combating the discriminatory equity ideology. So this is what the EI now means for the US administration. The policy entered into effect at the end of February this year. It's, as I said, quite radical and what it proposes, both in its reach and in its scope. And it's something that I think we need to take really seriously as a community of practitioners. Let's try and on pick that a little bit. If an aid agency or an NGO is found to be in violation, what would be a violation? Funding a women's clinic which provided reproductive health advice? With that, be one. The problem with this policy is the ambiguity that's really built into the design of it. I spent a lot of time reading through the policies, reading through the quite detailed FAQ, and some of these answers are really not clear. And that, in my opinion, underlines this risk of organizations for lack of clarity, preferring to rather not touch something at all. Currently, based on my interpretation and also what I hear from other entities, interpretation of the policy, yes, everything that's relating to sexual and reproductive health seems a bit more off-limits. There are certain topics that are generally considered more appropriate in context with US donation conversations. So, for example, anything related to maternal mortality is apparently a more palatable topic. But looking at abortion, for example, looking at sexual violence survivors, what I'm afraid this policy could really mean on the ground is, let's say, we have a post-conflict setting, a girl becomes the victim of sexual violence, and then does not even have a menu of options being laid out to her in terms of what the follow-up procedures could be, because even mentioning, for example, abortion as a method of treatment of family planning would be considered prohibited under the policy. The same goes, for instance, for the distribution of post-rape kids and conflict settings. Is this something that organizations just don't dare to venture into anymore, because they are too afraid that it might come with financial repercussions for them? I see parallels with the media actually here in this chilling effect that once you get political pressure about a particular subject, we can think of plenty of them in the middle least, is the big one at the moment, that you start thinking, well, maybe we'll just leave that topic alone, because we know we're just going to get in hot water for it. And you fear the same could be happening now with programs that directly target women's health or reproductive health. Exactly. And that is one of the huge concerns around this new policy. So if we start with what it applies to actually, and that's a big step and qualitatively from what we've seen in previous years, does promoting human flourishing and foreign assistance policy, with all its sweeping prohibitions that it introduces, applies to foreign NGOs, to international multilateral organizations, to recipient governments, so governments that receive aid directly from the US, and as well to US-based organizations, it overall is estimated to apply to an amount of close to 40 billion in humanitarian aid and foreign assistance of the US across 160 countries. That's huge, right? So this is a really sweeping change that is being introduced. And I believe where the danger of the policy lies is in one part, certainly in its implementation, but even more so in the fear of what non-compliance might mean for organizations. Because what this policy spreads out is that if you don't act and compliance with the various prohibitions that it introduces, the US will either not give your entity or your recipient state any money or it even is entitled to remove money that has already been distributed. The other key shift that this policy introduces is that this doesn't only apply to US funding, but actually it means that if you have funding coming from other sources, so let's say you're funded by the Swedish government or the German government. The US prohibitions or violations of those can also apply then, and that means even if you have a completely separate program that has nothing to do with US funding, you can still be penalized as an entity if you're viewed to be non-compliant. Now what does that mean in concrete terms? I think it means that organizations first of all have to carry huge burdens in terms of the compliance, so there's very detailed provisions spelling out for organizations. What they have to do in order to be recipients of US 4 and 8. I believe that it means that organizations are likely to become more careful on how they use other donors' money and that there will be a leap towards trying to avoid that financial risk at all cost by rather not touching the topic at all. What Hannah Rinal is outlining their sounds a very long way from humanitarian aid's fundamental principles of impartiality and neutrality based on need. What will that mean for a crisis like Ebola? Our final interview today takes us behind the scenes in Washington in early 2025 when Elon Musk and his Department of Government Efficiency or Doge were dismantling USAID. Nicholas Enrich has written a whole book about that called Into the Woodchipper and will be discussing that at length with him in our inside Geneva books to make you think episode out on June 23rd. For now, let's hear from him what it was like in early 2025 to work in global health at USAID while the Department was being dismantled and in Ebola outbreak was taking place then too. It was absolutely terrifying. First of all, I should say that I was totally unqualified to be in charge of dealing with this. I was promoted to be the head of global health only when Doge had illegitimately pushed my boss and the 60 other most senior leaders at USAID onto administrative leave. All of our programs were frozen. We weren't allowed to communicate with anyone. Our leadership had been decapitated. The new political leadership did not care. It had no interest in dealing with this. This was the situation I was finding myself in dealing with my first Ebola outbreak from a position of responsibility. There's no other way to describe it than just fear and terror from my side of knowing that we were failing to respond. I knew we wouldn't be able to put the robust response in place that USAID is usually able to muster. But we even tried to get them to do things like screening at airports for passengers who were traveling on international flights to make sure they didn't have symptoms of Ebola before getting on airplanes. We couldn't even get the political appointees to sign off on that. There's one which I was a jaw on the floor moment. The Doge team, when you said there is this outbreak, we have actually committed to sending PPE protective equipment. I think it was in Kenya, Nairobi. They said, yeah, if you want it to get there, you can fly over there and hire a truck and take it yourself. This is astonishing. Yeah. It just kind of goes to show the disdain that Doge and the political leadership had for our processes and systems. We had an outbreak response team that knew exactly how to respond to an Ebola outbreak because they've done it before. All of those systems broke down. It came to angry people who didn't understand what was happening, just kind of slamming the table and wondering how they could do things differently. The problem was they didn't want us to access the PPE that the US government had already paid for because it was being stored in a warehouse that was operated by the World Health Organization, which they were in the process of withdrawing from. Rather than engage briefly with the WHO to get that PPE into the outbreak zone within hours, they decided that they would not do that. Weeks later, when news stories started coming about, the PPE sitting in a warehouse while an outbreak was going on, Pete Morocco, again, the head of the agency at the time, ordered me to go and get it myself without talking to WHO, which I didn't understand what he meant. that turns out what he was actually talking about was me hopping on a plane going. going to Nairobi, getting to the warehouse with a truck, getting the PPE somehow across the border into Uganda. And, you know, I tried to explain that that was not feasible or legal. And the response that I got was simply that he emailed my boss and told me that if I didn't move that PPE within 12 hours, that I should be fired. Do you think, I mean, perhaps this is a stretch, but we've got a big, very dangerous actually now Ebola outbreak in DRC, which has been circulating for quite some time. And I hear on a daily basis from the agency's large and small, they are saying we are cash strapped. Do you think the cuts to USAID are in any way linked? I mean, this is an outbreak that's been circulating for at least two months, apparently. Absolutely. I do think that the cuts to USAID are relevant and are slowing the response substantially. I mean, from initial detection all the way through where we are today, USAID had a playbook in place of how we would bring in disaster assistance response team that would have been in the country within 2448 hours to help coordination the USAID partners on the ground who no longer are exists because of the cuts to USAID. You know, we would have been able to pre-position PPE in and we would have been able to have partners working to conduct contact tracing and support with risk communication and safe federal procedures, etc. But instead, we had that playbook and now instead the State Department is trying to respond to this, something they've never done before without the expertise, without the structures, without the know-how. And even to the extent that they are trying to respond, the speed that we're losing is the difference between decisions that are made in hours and decisions that are made in days or even weeks. And so, yeah, I do think that if USAID still existed, the American government response would have been much more swift and substantial. What do you think about Secretary Rubio saying the WHO was late? Yeah, I mean, to me, the first thing I thought about that was if the United States had not withdrawn from the World Health Organization, you know, we would have been part of the WHO's response, which means that when on May 5th, when WHO learned about this, the United States government would have learned about this. And that's, you know, one of the many, many, many reasons that we need to engage with the World Health Organization and other multilateral institutions if we're looking for effective global health response. And instead of being the first on the scene, the US government turns out to be the last ones to find out. And then once we do, we're struggling to figure out what to do about it. And again, it just stands in stark contrast to the way that we would do outbreak response just a year ago. Clearly you are, or I imagine I assume from your answer there, you're not a big fan of the move to leave the World Health Organization. Can I ask you, though, overall about reform maybe of humanitarian work because there is an ongoing soul searching debate here in Geneva that reform is needed. It should be less top down. I mean, frankly, that's something I've heard for 20 years. So it's not really new. Some people say that the cuts, not just from the US, they're coming from Europe to our golden opportunity to reform. And others are saying this is a trap. The cuts are too savage. You're not going to have thought out clever reform and a climate like this. I just wonder how you see it. I think those are both true, right? That reform is and was overdue. And unfortunately, I actually think that the resistance to reform over the last several years as you put it may have made it easier for the US to have made the decision to withdraw from the WHO. On the other hand, they probably would have done it anyway. I'm not sure that they were like looking very specifically at the reform efforts. But I do think that that did leave the WHO and other UN agencies vulnerable to these retaliatory actions by the United States. However, I do think that there is opportunity. I do think that the Bull Outbreak is just one example of how we're going to, it's going to become very, very clear over the next couple of years how important it is for the United States to reengage and re, like if global health remains a priority, which I believe that it will, we're going to need to reengage. But that engagement does not need to look the same. And it hopefully this is an opportunity to implement some much need reforms. And I mean for that, both in terms of, you know, at the WHO or multilateral level, and also within whatever the US government, international development and foreign assistance portfolio looks like, I think that we all get caught up in the way things were and bureaucracy builds upon itself. And the one silver lining of what the Trump administration has done is they've really torn down that bureaucracy and given us an opportunity for a fresh start when we move forward. I don't think it's, it's a good thing that we've gotten here, but we do need to take advantage of the opportunities that are there. And that brings us to the end of this edition of Inside Geneva. My thanks to Karl Blanche, Esperanza, Martin Eze, Hannah Reinal, and Nicholas Enrich for their time. A reminder will be putting foreign aid back in the spotlight on our next edition of Inside Geneva, asking what the point of it is and unpicking the options for change and improvement. You can hear that on June 9th or join us in person for the live recording at Geneva Graduate Institute on May 28th. And don't forget, you can hear more from Nicholas Enrich in our June 23rd books to make you think episode where he'll be telling us all about his book into the woodshipper, the Inside Story of the Disruption of USAID. For now, that's it for me, Imagine Folks. Thanks for listening and catch you next time on Inside Geneva. For your podcasts, check out our previous episodes, how the international red cross unites prisoners of war with their families or why survivors of human rights violations turn to the UN in Geneva for justice. I'm Imogen Folks. Thanks again for listening.