1994. Rwanda is in the throes of genocide. The humanitarian organizations on the scene were proliferating, providing food, shelter and medical care to the refugees. But aid workers and reporters there encountered an appalling phenomenon: Innocent victims were not the only ones seeking assistance from the humanitarian groups. The murderers were, too. The Hutu army and the tens of thousands of members of extremist militias who abetted the slaughter of the Tutsis were being helped by those organizations. Even worse: They were utilizing the resources being heaped on them to continue their killing spree with impunity, while the victims remained defenseless.

The result was that the victims who remained in Rwanda were totally abandoned to their fate. Because the media reports focused on the Goma refugee camp for Tutsis, in the Democratic Republic of Congo, the aid organizations’ help and financial donations were channeled there. Meanwhile, survivors in Rwanda barely received anything from the donor countries, despite the horrific conditions they faced. Decomposing bodies were strewn on the ground, water sources were polluted, crops rotted in the fields and infrastructures − fuel, electricity, communications − collapsed.

The case of Rwanda confronted the providers of humanitarian aid with a living, moral dilemma. On the one hand, they were incapable of standing aside as the vast disaster unfolded before Western eyes. However, it was becoming increasingly obvious that it was the aid itself that was allowing the massacre to continue and even intensifying it. The question that arises from this state of affairs is as clear as it is difficult to ask: In some cases, is it better not to provide aid to the victims of a humanitarian disaster?

One person who has allowed herself to pose the question − and offer a trenchant reply − is Linda Polman, a Dutch journalist who has been covering such disasters around the world for 20 years. Her most recent book is “The Crisis Caravan: What’s Wrong with Humanitarian Aid?” ‏(English, 2010, translated from the Dutch by Liz Waters; Hebrew edition, 2012‏). In it she argues that in many cases the intervention of aid organizations has done more harm than good to the victims, and nonintervention would have been the wiser course. This is a harrowing proposition, but the examples Polman cites are persuasive enough to show that it certainly warrants an examination.

A disturbing picture arises from the book. If we thought of such aid activists as a group of mission-driven people whose aim is to rescue as many victims as possible and ameliorate their suffering, then we have to think again. Polman describes a vast industry consisting of a range of organizations of different kinds that pursue donors’ money like locusts and, as in any free market, compete among themselves over the huge sums at stake: $120 billion a year. In Polman’s view, superficial media coverage, competition for donations and the fact that domestic political forces often exploit the help they receive to promote their own military and economic interests − all these collectively transform humanitarian aid from a neutral force aimed at doing good into a lethal weapon.

Is Polman right, or is she endangering or perhaps undermining activity which is, in the final analysis, positive? The answer to that turns out to be complex. Still, none of those engaged in humanitarian aid projects who were interviewed for the article − including those who were critical of some of what Polman says or questioned her conclusions − disputes the facts.

Where’s the money?

A basic tenet of humanitarian assistance is preservation of neutrality: The aid organizations are ostensibly out to save lives without political considerations. However, this aspiration also can play into the hands of local political and nationalist forces, which are able to make the organizations their tool. There are many ways in which humanitarian activity injects large amounts of money into the various locales where it operates − i.e., by paying for housing for aid workers, hiring bodyguards, underwriting taxes and other fees demanded by the government and the military, and covering expenditures of the aid workers themselves in terms of fuel, bars and restaurants − generally in devastated countries which have no other source of income.

As soon as aid groups appear on the scene, Polman writes, local political, military and business leaders suddenly start to drive expensive cars and build luxury residences. The prices in these “humanitarian territories” skyrocket; rent is the first to rise. When such workers arrived in Kabul, for example, the rent for places along the city’s bombed-out streets reached a level higher than in Manhattan, Polan notes in her book: The going price for a foreigner in a “tiny, abandoned hovel” was $5,000 a month. Most of the buildings belonged to Afghans who were abroad. According to real estate agents, the owners were mostly commanders from the Taliban and the Northern Alliance who lived in Pakistan and used the rent money to underwrite militias.

Polman also relates how local army officers collect tax from the aid NGOs for almost every ac activity − from vaccinating children to entering combat zones. She goes into detail about the ways in which militia leaders try to arrogate to themselves as large a percentage as possible of the value of the aid. Charles Taylor, the former Liberian president who was recently convicted of abetting war crimes by the International Court at The Hague and sentenced to 50 years in prison, demanded that the NGOs pay him 15 percent of the value of the aid they provided, in cash.

In Somalia, the fee that warlords collected from workers entering combat zones equaled 80 percent of the value of the aid commodities. In a telephone interview, Polman notes that even though this was a known fact, the aid groups continued to arrive. “They preferred to pay the 80 percent to warlords − who would buy more guns and create more victims − instead of realizing that they had crossed the limits, say no and take their aid elsewhere, to save more human lives,” she says.

Her book quotes the head of the United Nations delegation to southern Afghanistan, Talabek Masadykov, as saying that aid organizations in the province of Uruzgan were forced to pay the Taliban the equivalent of one-third of the value of their food aid and agricultural support. She also quotes estimates to the effect that after the 2004 tsunami in Aceh Province, in Indonesia, “soldiers walked off with at least 30 percent of tsunami relief,” and adds that “30 percent is also the annual slice of the Indonesian military regime’s state budget that ‘disappears’ annually.” The rival factions feed and arm themselves with the revenues that result from their negotiations with NGOs, and also use the money to buy support .
“Irrespective of the consequences for the length and ferocity of wars,” Polman writes, NGOs and others ‏(including journalists, she says‏), “are free to make agreements, pacts, contracts and deals at their own discretion with wannabe presidents, tribal chiefs, warlords, troublemakers, rebel leaders, headmen, insurgents, terrorist cells, child generals” and a host of others.

Susan Farnsworth, the executive director of Global Rights, an organization that protects the rights of marginalized populations in the Third World, and who was also formerly in charge of projects run by the international anti-poverty CARE group in the United States, agrees with Polman that aid funding is not always channeled to the right places.

“Part of that has to do with the pressure that donors put on organizations to spend the money and spend it fast,” she says in a phone call from Washington, D.C. “The donors apply pressure because they think that speed means efficiency and a correct use of the money. But there is no necessary correlation between the two. Many times it’s best to stop and think about who you are working with.”

A different approach is voiced from Paul O’Brien, a senior executive at the Oxfam America humanitarian organization. “It is impossible to monitor every dollar that goes into Pakistan or other places, and every dollar can do good or bad − or both together,” he says by phone.

“Polman is right to insist that the organizations display great caution, but wrong in that her analysis stops the moment she identifies a few cases in which the money was harmful. One’s role as an aid worker is to understand the unintended damage, but at the same time to evaluate the overall impact of the aid. It’s a matter of proportion, knowledge, asking questions and grasping the complexity of work in a difficult environment.”

“It’s true that the work is more complex than we thought at the outset,” O’Brien admits. “We started with the idea that is identified with the medical professions: not to cause harm of any kind. But what many of us understood along the way is that when you bring resources to regions in which there are no resources, the impact is tremendous. Part of it is negative, and we hope that part of it is also positive. Your responsibility as an aid worker is to keep your eyes open to all those possibilities and try to ensure that in the final analysis your impact will do more good than harm. If you want to ensure that every dollar is being used immaculately, go do humanitarian work in Finland.”

Food vs. guns

In fact, Polman’s allegations go farther: The cases of Goma, Somalia, Liberia and Indonesia are only examples of a systemic ailment in the humanitarian realm, she says, in which aid organizations enter certain regions knowing that the money is reaching the wrong side, because that is where the government money is being channeled. She explains: “The aid organizations will not choose to leave even if they know that the money is being used to buy arms, or that the aid food is being traded for guns, because that is their basic choice: not to go where aid will save as many people as possible, but to go where the donors decide. That is one of the consequences of the organizations’ choosing to please their donors instead of relieving human suffering.”

The workers themselves refer to this as “the humanitarian dilemma,” Polman explains: “Aid organizations want to help people, but at the same time they have to help themselves. They must make a priority of their own survival. They have to make sure that they − and not a competing organization − get the donor money. The consequence is that you choose to go where donors want you to go, leave when the donors tell you to leave and you do not undertake certain projects because the donors are not interested in them.”

That sounds like an innate problem. Is there a solution?

Polman: “This is definitely not an easy situation to change, but in my view − and I am sure in the view of many of the donors − the aid organizations should make people’s suffering their priority. If people knew how the system works, I’m sure there would be a lot more pressure on the organizations to make themselves more independent of donors. There are organizations that ensure that less than 50 percent of their money comes from donors, because that gives them a certain freedom of movement; they don’t have to follow every whim of a donor. But in most of the big aid organizations more than 50 percent of their income depends on governments. That is their choice, and they stick to it because donor governments possess the largest budgets.”

For her part, Gal Lusky, who heads Israeli Flying Aid − which, according to its website, “provides life-saving aid to people affected by natural and man-made disasters in developing countries worldwide” − agrees with Polman that the humanitarian organizations give the donors too much leeway for intervention. This, in fact, along with other faults in the entire aid system, was one of the reasons that Lusky founded an independent organization. She offers an example of the possibilities that arise when dependence on donors is no longer a factor.

“I fed 80,000 people in Indonesia within two weeks and had $5,000 left over,” she says. “In the affected area I saw the oldest mosque in western Sumatra. The worshipers, about 1,200 people, closed the road and gathered there, exposed to the elements. As I do not report to my donors what I do with the money, I was free to be attentive to the situation on the ground and to use the funding to build huge lean-tos to protect them, and a temporary mosque.”

Polman notes in the interview that part of the overall humanitarian aid problem is related to the dependence of the organizations on local authorities. “We may have the impression that aid groups go to places like Sudan, and then decide how the money will be spent. But that is not true. They sometimes have to beg to be allowed in and negotiate to get access to the victims there. You have to pay before the local authorities give you permission to work in their territory, and the payment can run into crazy amounts.”

Lusky’s take on the groups’ obedience to the dictates of local authorities almost has a comic side to it, if the story were not so sad. In Sri Lanka, for example, the local government, instead of sending aid workers to the victims of the tsunami, sent them to a hotel where they were asked to rest before joining a tour of an elephant orphanage.

“They feel a need to host you when children outside are dying,” Lusky says, still shaken by the incident. Other aid providers accepted the invitation, she adds.

The vodka gambit

There is another aspect to the aid organizations’ dependence on the local authorities: the growing tendency by those authorities to block workers’ access to disaster areas. “Is the ‘humanitarian space’ shrinking?” Marie-Pierre Allie, the president of the French organization Doctors Without Borders, asked in the introduction to a book published by that group last year.

Nothing shows more graphically, or harrowingly, the helplessness of humanitarian organizations in the face of an entry ban than the current case of Syria. A knowledgeable source tells about bodies of pregnant women lying in the streets, their stomachs split open, and bodies of infants whose fingernails were ripped out − all strewn about in public spaces as a warning to the inhabitants.

“International law does not allow aid to be forced upon Syria,” the source explains, “and the NGOs are afraid to enter illegally.” The result, he says, is that the whole world is standing aside silently while atrocities continue to be perpetrated.

Gal Lusky recalls an argument she had on this subject with former French Foreign Minister Bernard Kouchner, a cofounder of Doctors Without Borders. “That organization started out in an attempt to be different, but today it is like all the others,” she says. “They do not enter places where they are not allowed in. The same thing happened to me with the ambassador of China, who told me, ‘My colleagues call you angels, but really you are criminals.’ I don’t understand why the armies of the West were able to topple Saddam Hussein but cannot force aid on countries that prohibit it.”

Lusky emphasizes another point: Regimes divert aid to their supporters but deny it to the opposition. “The opposition is always deprived of aid in disaster areas. This always complicates the activity − the understanding that you come to a place where you will have to evade the army and enter prohibited areas − because the army imposes closures and prevents people from getting aid. The UN Security Council’s definition of crimes against humanity does not include the prevention of aid, but that is the worst form of murder there is.”

In contrast to other activists, who are aware of the phenomenon but are unwilling to talk about it, Lusky is ready to name names. “It happens in Zimbabwe, for example,” she says.

“President Mugabe blocks aid to the opposition. I had to smuggle drugs against cholera from Mozambique. The opposition lives close to the borders, because they are afraid to be near the main roads in the capital. Everyone who is there knows, but no one talks about it.

“The ban on bringing in aid − in the form of antibiotics − to Burma killed more people than the cyclone there [in 2008],” she continues. “The aid people are locked into a hotel and obey the sovereign government. The government [in Niger] says that no one is allowed to go to the Delta, so no one goes there. Millions of dollars given by donors were lost there in waiting. But who do the organizations work for? For their donors? For the country they come from and its agenda? Or for the victims, damn it? That is why we established an organization. Our slogan is: ‘No one asks for permission to kill, we do not ask permission to save lives.’”

Lusky’s organization, IFA, operates secretly in countries which do not have diplomatic relations with Israel. In a conversation, she talks about activity in the demilitarized zone between Georgia and Russia, to which access was forbidden during the period of the war in South Ossetia [in 2008]. Lusky and IFA volunteers operated in the area clandestinely, ignoring the Russians’ orders. The other organizations, who obeyed them, asked her to try to persuade the general in charge to allow aid into the region.

“At night, the Georgians would come down and massacre Russian soldiers, so I knew I must not stay there after dark,” she says. “I went to the general that afternoon, shaking with fear, and passed on the organizations’ request. The general said he would take it under consideration and invited me to have a glass of vodka with him. The procedure was that I had to match him glass for glass, when he weighed about 200 kilos and I’m 50 kilos. At the sixth glass, when I was half-unconscious and darkness was falling, I asked him for an answer. It was negative.”

Lusky and the IFA continued their covert activity in the demilitarized zone. They inserted into the aid packages a leaflet of the organization with a few words of encouragement. A few days later, representatives of the World Food Program asked Lusky to approach the Russian general again. This time he was furious. He was holding an IFA leaflet.

“I understand that Madame did not listen to my warnings and entered the occupied area,” he said. She replied, “I understand that if you are holding my leaflet, your soldiers looted the refugees.” The general fell silent, she says. “I looked him in the eyes, and finally he said, ‘As an officer in the Russian army I condemn what you did, but if a citizen could salute, I would salute you now.”

One way to bypass the local authorities’ control of aid distribution, Slusky says, is to buy local goods instead of bringing in items manufactured in the donor state. “The customs authorities force you into the hands of the local government,” she explains. “The opposition never appears in the distribution data, so the aid organization effectively becomes a vote canvasser for the regime.”

According to Lusky, aid is never lacking in the affected country , and bringing in funding from abroad serves the donor country more than it does those in need.

“The Americans have an aid law which requires them to supply aid in the amount of .07 percent of their GNP,” she says. “They also want to show that they are giving, so they buy the rice for Haiti from their own farmers and thereby leave the dollars in the United States. A kilo of rice costs $6 by the time it lands in Haiti, whereas with $6 I can buy 10 kilos. It’s not that rice is in short supply there. All this deception kills me. I am tired of it by now, and it bugs me that no one is even close to understanding the manipulation.”

Paul O’Brien believes that the situation is even more complex than Lusky makes out. “In the end,” he says, “the only way to solve problems long term is to accord the local government responsibility for its inhabitants. If access to a certain area is blocked for legitimate reasons − if, say, the government is trying to deal with the situation by itself − it is our responsibility to heed that. But if the reasons for the blockage are not legitimate, then it is certainly our responsibility to demand access forcefully. At the same time, in many cases we need to take into account that the damage that can be caused by illegal activity − you might be caught and expelled − is more serious than delaying access while attempting to obtain legal entry.”

The food weapon

Linda Polman’s book also deals extensively with another major realm in which humanitarian aid becomes a weapon in the hands of local forces: the supply of food.

For instance, in 1992, contrary to the picture provided by the media, there was no famine in northeastern Somalia. Nevertheless, when the World Food Program offered local leaders food they did not reject it, because hostile tribes, which were not starving, also received donations of food, which they sold and used the proceeds to acquire arms. The result, Polman writes, was an arms race which engulfed the locals.

Selling food provided by aid groups and using the profit to buy weapons is one way in which such aid is abused. But the food gambit and the claims of hunger are bargaining chips in the hands of the military, corrupt governments and militia commanders in other ways: According to Polman, in most cases the hunger itself is the result of deliberate human activity, and not only caused by the caprices of nature.

For example, the drought that ravaged Ethiopia in the 1980s was only one reason for the large-scale starvation in the country. A more substantial cause, the journalist claims, was the internecine strife between government forces and rebels in the northern regions of Eritrea and Tigray. The rebels held out with the help of supporters in villages who supplied them with food, water, shelter and new recruits. In response, the Stalinist regime of Mengistu Haile Mariam launched a campaign to expel the villagers in the north and push them southward, into government-held areas. By this means the regime cut off the rebels from their backers and also used the uprooted villagers as cheap labor on large-scale, government-owned agricultural projects. Polman writes: “Government forces sealed off the northern region and went to work. They shot men and boys dead. They raped and mutilated women and girls. They flung infants onto fires. They set schools and clinics ablaze, slaughtered livestock, burned grain stores, and poisoned water sources with human corpses and dead animals.”

Once the famine became a fact and refugee masses began to wander about, the regime invited the international media to document the horrors, citing the drought as the official reason for the disaster. Government spokesmen explained that “reception camps” needed to be built for the survivors, who had to be moved from the north to the south. For this they needed money.

The extensive media coverage generated one of the most magnificent donation campaigns ever: the Live Aid concerts, organized by singer-activist Bob Geldof, which raised more than $104 million. According to Polman, the thousands of Western aid workers and journalists who flocked to Ethiopia were forced to convert their money into local currency “at rates favorable to the regime, and this alone helped to keep the Ethiopian war machine running.” Food provided by aid groups served as bait to lure starving villagers into the camps. The forced treks to the south lasted an average of five days: Of the 600,000 people who embarked on them, about 100,000 died on the way. The food itself was distributed not according to need but according to loyalty. In 1985, some 6,000 children died of starvation in one of the camps, even though food for them was available.

The French organization Doctors Without Borders, unable to bear the situation, left the country; other aid groups turned a blind eye and stayed. Polman adds that Oxfam’s analysis of the events made do with raising questions about the “haste, scale and timing” of the migration program. Live Aid and other campaigns “doubled Oxfam’s turnover inside a year,” to more than $35 million.

“No one knows for certain how many lives were ultimately lost during the ‘rescue operation’ for the people of northern Ethiopia,” Polman writes. “Estimates vary from as many as a million to as ‘few’ as 300,000.”

‘Genetic flaw’

In many cases, then, according to Polman, humanitarian aid − whether in the form of cash, goods or food − does not assist the victims and ultimately perpetuates conflicts. The neutral facade of the organizations is problematic and misleading, she says in the phone conversation: “The organizations give the appearance of being apolitical, neutral and geared only to saving lives, so it is not their responsibility if politicians abuse their good intentions. I think that is a very naive, dangerous and irresponsible attitude. Yes, fundamentally aid organizations should be neutral, but if nobody around you respects that neutrality and everybody uses you as an instrument of war or as a political instrument, then the neutrality becomes ridiculous and irresponsible.”

Humanitarian crises are almost always political in character, Polman writes, or crises which can be solved only by political means. “When donors, militias, and armies ... play politics with humanitarian aid, NGOs cannot afford to be apolitical.”

Susan Farnsworth agrees: “My conclusion is that aid is not apolitical, but it’s difficult for the organizations to accept this. You want to remain neutral, that is why people offer aid: because they believe in the basic right of every person to receive aid.”

The problem Polman is actually pointing to is the lack of external oversight of humanitarian activity. “’Humanitarian territories’ in war zones are free markets where anyone can set out his aid stall, as long as he can agree to terms with local power brokers,” she writes, adding, “There are no rules, no limits, and no requirement to have any understanding of the local balance of power, or to coordinate with other parties involved, humanitarian agencies included.”

“One of the chronic ills of the aid system,” she explains in the interview, “is that the organizations and donors all want their freedom, they all want to be the boss of the budgets that are entrusted to them. There is nobody who can force an aid organization or donor to spend their money in a particular way. So there is a basic flaw in the system, a genetic flaw.”

A good example of the chaos that results from the lack of external control is the upsetting case of Murray Town Camp, in Sierra Leone, where amputees of the country’s civil war were concentrated. About 200,000 people, most of them civilians, were killed in the war, which raged for a decade beginning in 1991. People whose limbs were amputated by rebels or soldiers, and were unable to return to their villages, because they were under rebel control, gathered at the Murray Town site. In the wake of the extensive media coverage, some 300 NGOs descended on the camp.

According to Polman, even those who did not come to assist the amputees used photographs of them to raise funds: “The amputees were the icons of Sierra Leone’s civil war.” In Polman's book, Max Chevalier, a Dutch physiotherapist and acting head of a French NGO called Handicap International, described an endless procession of people trying to extract benefit from the publicity value of the amputees and arriving in the camp with excessive assistance and goods, generating confusion and causing damage. Doctors Without Borders, from France, which was in charge of the camp in practice, arranged prosthetic limbs for each of the amputees. However, the latter, understanding the power of their plight, preferred to hobble about without the artificial limbs. In fact, camera crews paid them to do just that.

Doctors Without Borders soon gave up, because neither the aid workers nor the government officials were willing to accept its authority. More and more organizations continued to bring prosthetic limbs to the camp, until there were at least two for each resident. Some unidentified groups distributed medicine without medical supervision. One of Chevalier’s patients died of an overdose. Chevalier told a film crew that arrived to do a documentary on the camp that they should make a film based on the fact that 303 of every 1,000 children in Sierra Leone die before reaching the age of five, from malaria, diarrhea and anemia. The filmmakers declined.

A subsequent marketing stratagem in the camp − and, according to Chevalier, the most disturbing − was to drop the idea of bringing aid to the amputees, and instead take the amputees to the aid, in the United States. Polman quotes Chevalier: “Almost all my child patients have already been taken out of the camp by aid groups no one’s ever heard of.”

Chevalier explained to Polman that children with artificial limbs need medical follow-up every six months, in order to make adjustments for their growth. The adjustments could not be made for those who received high-tech prostheses in the United States, as the know-how does not exist in Sierra Leone. In at least some of the cases, Chevalier related, no one bothered to ask for the children’s medical records; most of them suffered from many other problems, and the amputated limb was actually the least of them. Everything was done in secret, Chevalier said, and some of the children were taken for adoption even though they still had parents in Sierra Leone.

Catering disaster

Linda Polman’s journalistic interest in humanitarian activity began by chance. She relates that it all started with a phone call she got in 1993 from a friend, a British freelance photographer in Holland. “He called me one night when I was in Amsterdam, and said ‘Linda, I’m calling you to say good-bye, I can no longer live as a freelance photographer here, there’s no money. I accepted a job in Somalia, working for a catering company.’”

Polman wished him a safe journey. Only after hanging up did it occur to her that the combination of a hunger-stricken region and a catering company might make a good news story. Not long afterward she traveled to Somalia, completely unprepared for what she encountered there.

“I found myself in the middle of this huge UN peace-keeping operation,” she recalls, “and I got totally caught up with it. I stayed there for weeks and weeks, thinking this would be my story. From that time on I followed peacekeepers in several parts of the world as a reporter: in Haiti, in Rwanda, in Sierra Leone.”

In time, Polman says, her focus shifted from the events themselves to what was happening around them. “I wanted to find out why I was reading in the paper that help had arrived somewhere, while at the same time I could see that help − those big caravans − making a lot of noise but not helping very much,” she says.

She went on visiting war- and disaster-stricken countries, including Liberia, Congo and Afghanistan, and acquainting herself with the history of the aid organizations. “I wrote the book to start a discussion,” she says. “I think people should know that there is a very dark side to the aid organizations.”

What were the reactions to the book?

Polman: “The initial reaction was and is anger. Aid organizations feel attacked by the book and they feel they don’t deserve that. But then they start responding to the allegations. Sometimes they defend themselves and say it’s not their problem, and that even if all the organizations together save one child’s life it’s worth it.

“But that’s fine, as long as they react, as long as they can’t get away with pretending that there is no problem. I am very happy to say that an organization like Doctors Without Borders, in France, is doing a study on their own way of operating. But other than that, to my great disappointment − though I am not surprised − this very important study was met with total silence. There was no reaction from the other aid organizations. But the study is there, and books like mine are out there, the facts are there, and the pressure on aid organizations is more apparent.”

The phone interview with Polman took place on the eve of her trip to another disaster zone, this time in Haiti. She already spent a good deal of time there in the 1990s, as a radio reporter in Holland. She returned to the island after the earthquake in January 2010, which killed more than 220,000 people and left several million homeless. Since then she has been back three times. “It’s a wonderful country,” she says, adding that the situation there is very sad.

On May 14, the Center for Global Development, a Washington, D.C.-based nonprofit think tank that focuses on “practical ideas for global prosperity,” published a policy paper titled “Haiti: Where Has All the Money Gone?” According to the report ‏(available online at www.cgdev.org‏), in the 28 months since the earthquake, official donors have disbursed nearly $6 billion in aid to Haiti, an amount equivalent to $600 per person in the country of 10 million, where the average annual income is $670.

“The short answer” to the question of where the money went, the report’s co-authors write in one of the center’s blogs, “is that the vast majority of the money so far disbursed has been paid to international nongovernmental organizations ‏(NGOs‏) and private contractors. And while many of these organizations do excellent work, there is shockingly little information on how they used the funds.”

Polar tents to Sri Lanka

The cases of Haiti, Sierra Leone and Rwanda illustrate the chaotic situation that ensues when a humanitarian disaster gets wide media coverage and draws in numberless organizations both large and small, without proper supervision and control. In some cases, a public relations war breaks out, with the logos of the various agencies flaunted on flags, T-shirts, caps and cars. Polman refers to this state of affairs as “a supermarket of aid agencies.”

According to Susan Farnsworth, “What appears on television draws attention and brings a great many smaller organizations, which in some cases have never worked in that particular country before and don’t always send people who know the region. You get a tremendous flood of people, who step on each other’s toes.”

The result is the arrival of workers and volunteers who are not familiar with the terrain, the local culture or the practical needs of the inhabitants. Thus, equipment arrives that is not suited for the climate or the local customs.

A senior source in an Israeli aid organization, who did not want his name used, describes an event in 2005 to which he was a witness. British organizations asked for money to buy equipment for preparing food in Sri Lanka, and brought in cookers. But these were so complicated to operate that the local residents quickly gave up on them.

“I myself didn’t understand how to use them,” the source says. “The locals dug a deep pit, threw the cookers into it and covered it up.”

“Tsunami victims were further bemused by the arrival of crates of winter coats, polar tents, stiletto-heeled shoes, G strings for women and packets of Viagra,” Polman writes.

Residents of Bosnia received Prozac whose sell-by date had passed, though some welcomed them. As amusing as all this sounds, according to the International Committee of the Red Cross, “well-intended but unwanted gifts that clog up airports and logistical hubs are among the most significant problems faced by anyone providing emergency relief,” Polman notes.

IFA’s Gal Lusky mentions additional examples. “The Italians sent pasta to Sri Lanka, for example. The Sri Lankans do not eat that kind of food. The British sent them tents suited for 20 below zero, when the temperature outside was 40 degrees [Celsius] with 90 percent humidity. On the first day they enthusiastically pitched the tents, on the second day they cut windows in them and on the third day all that remained was the roof, which they hung from a coconut tree. Oxfam sent coats to Kashmir which local tradition forbade the local people to wear.”

Even worse, Lusky adds, are the frequent cases in which aid organizations send male physicians into conflict areas where rape is widespread. “Why not make the service you want to provide accessible?” she asks. “It’s better to stay home and remain indifferent to the suffering.”

On the other hand, prolonged crisis situations which pass under the media radar do not get aid at all. Farnsworth notes, for example, the current plight of starvation which is emerging in the Sahel region of West Africa.

“It’s not reported in the papers here, even though it affects millions of people,” she says. “But what can you do to make people take notice? It is not swift and headlong murder, there are no dramatic images; the region suffers from periodic drought. When you work in an aid organization you see these things and try to raise money for them. The problem is that you must not cry wolf too much, because if you make a mistake once you will no longer be believed. So everyone is careful and things move slowly, but in the meantime people are suffering and dying.”

“Only 25 percent of all the international aid goes to the poorest countries,” Polman says, “while 75 percent is being spent in countries where donors have an interest. We could change that. We could say that we have to save lives only where our money gets the best value, don’t go to where it’s most popular. The aid world will not change itself. So we, the public − and it is our money they are spending − have to pressure them. We have to help change the aid organizations.”