As US budget cuts leave millions without aid, an academic commission is making the case for affected communities and local actors to be placed at the centre of humanitarian response. We spoke with its co-chair Karl Blanchet, director of the Centre for Humanitarian Studies in Geneva.
It is an invisible catastrophe with a potentially devastating human toll. Cuts to humanitarian aid – led above all by the United States, historically the most generous donor – could cause up to 14 million avoidable deaths by 2030 as care is rationed for infectious diseases, maternal health and malnutrition, according to a study published in The Lancet in September 2025.
Before Donald Trump’s return to the White House, the medical journal and Johns Hopkins University in Baltimore had launched a commission to reform a humanitarian sector already under severe strain. Presented this Wednesday in Geneva, before heading to Washington, Dakar, Nairobi, Amman, Dhaka and Bogotá, the report makes for an alarming read.
The number of war victims across the world has not been this high in 20 years. In 2026, 239 million people rely on humanitarian aid. Yet the UN is compelled to focus on just 87 million. “This is not solely a funding problem – it is a political and moral failure,” the commission writes. Karl Blanchet, who co-chairs it and directs the Centre for Humanitarian Studies in Geneva, has just returned from a mission in Yemen for the World Health Organization.
Le Temps: Did what you saw in Yemen confirm your diagnosis of the failures of the humanitarian system?
Karl Blanchet: Yes. Yemen is no longer among the countries receiving US assistance. The health system is now sustained by families who are forced to pay for treatment and medicines for their loved ones. There is no more inequitable arrangement than that. The good news is that other international donors have not withdrawn. European countries and Gulf states want to rebuild the health system starting in the south, as we have no access to the areas controlled by the Houthis in northern Yemen.
How do you rebuild a health system like Yemen’s when funding is no longer enough?
There has indeed been a reduction in funding, but we should bear in mind that humanitarian spending worldwide grew continuously throughout the last decade – which precluded any serious reassessment. The trend reversed in 2024, when European countries realised the war in Ukraine was not going to end and that they needed to invest in their own defence. That trend accelerated with the election of Donald Trump, who slashed foreign aid massively and abruptly.
This across-the-board withdrawal is happening at a time when conflicts are multiplying and proving devastating, from Ukraine to Gaza to Sudan. In this dire context, we are calling for a rethink of priorities. A great deal of money is channelled into humanitarian aid and emergency response, to the detriment of investment in health systems that countries could rely on sustainably.
How do you intend to convince donors to change their approach?
Priorities should not be set by funders alone. Affected populations must also have a say. We need to start from the needs on the ground before determining what investment is required.
And yet, as the saying goes: “He who pays the piper calls the tune”. Governments like the Trump administration choose which countries are worthy of assistance based on criteria that have nothing to do with actual needs.
It is true that the US is operating in a transactional mode. But other major donor countries – even those that have also shrunk their contributions (only Spain and Denmark meet the target of allocating 0.7 per cent of their gross national income to international aid) – have not followed Washington’s unilateralism. In Afghanistan and Yemen, the two countries I know best, donors meet regularly and pull in the same direction with the aim of maximising their impact for the population.
I also believe in local pressure and the role of civil society as drivers of change. In Tanzania, for instance, it took just one journalist publishing a map showing which regions had not received their stocks of HIV medication or malaria-prevention bed nets for local elected officials to take notice and put pressure on the ministry. In the same vein, local aid organisations must receive a larger share of the funding. UN agencies still capture 50 per cent of funding, compared with just two per cent for local actors.
Do you not believe in new funding sources as a way of reviving the humanitarian system?
We must face reality: the withdrawal of the US, on which we had come to rely, has not been offset – not by European countries, not by China, not by the Gulf states. I have no faith in the private sector, as companies seek a return on investment rather than disinterested assistance. Philanthropy remains an option, but the Gates Foundation – which carries enormous weight and whose achievements in global health are remarkable – has not inspired a wave of imitators.
You are launching your report in Geneva, the world’s humanitarian capital, which benefits greatly from this international sector. Is your proposal of rebalancing aid in favour of local actors likely to find a receptive audience here?
We believe international organisations will still play a crucial role in the future, but less through direct field operations and more in a normative capacity – setting guidelines and quality standards. What is needed is a single UN agency responsible for humanitarian affairs. At present, the World Health Organisation (WHO), UNICEF, and the United Nations Population Fund (UNFPA) are competing for funding, resulting in duplication. Humanitarian work is also a sector where the notion of performance has been given little weight. Affected communities must be heard on this point too, and must have access to quality care.
Why do you believe local organisations are more effective than UN agencies?
International organisations are finding it increasingly difficult to access conflict zones – like in Sudan, where the most serious humanitarian crisis is unfolding. It has simply become too dangerous and too complicated. Local organisations are embedded in field networks and are more readily accepted. They are sometimes criticised for being activist in outlook, or for serving only their own community – but are European organisations truly more neutral and independent? We believe the minimum criterion for intervention should be “do no harm”, in keeping with medical ethics, whilst upholding the principles of humanity and impartiality.
Attacks on humanitarian workers have never been so frequent. How can impunity be brought to an end when international justice is itself under siege?
Humanitarian actors should work more closely with human rights organisations such as Amnesty International and Human Rights Watch. We collect data on attacks against hospitals, ambulances and first responders, but we do nothing with that information. These violations of the Geneva Conventions could be documented more systematically and even used in legal proceedings. We must also reaffirm that such attacks are unacceptable under any circumstances.
The use of aid as a tool of war has been evident in Gaza. Should humanitarian organisations accept Israel’s conditions in order to assist the civilian population?
These dilemmas are not new. In the 1980s, Médecins Sans Frontières withdrew from Ethiopia in protest at the instrumentalisation of famine by the authorities. The following decade, the NGO left the refugee camps in Goma, in the Democratic Republic of Congo, which were harbouring perpetrators of the Rwandan genocide.
Today, the aid entering Gaza is insufficient and manipulated. Humanitarian workers should refuse to hand over information about their patients or staff that could be used against them. Such a capitulation runs counter to every humanitarian and medical principle. The problem is that each organisation is responding to Israeli demands separately. What is needed instead is for them to collectively put their foot down and demand unhindered access – access that does not endanger the people of Gaza.
This article was originally published in French in Le Temps. It has been adapted and translated into English by Geneva Solutions. Articles from third-party websites are not licensed under Creative Commons and cannot be republished without the media’s consent.