On a significant occasion marking the launch of the John Hopkins Center for Humanitarian Health and a new Lancet Commission report, David Miliband, CEO and President of the International Rescue Committee (IRC), delivered a powerful address underscoring the severe challenges plaguing global humanitarian health. His speech painted a stark picture of how intertwined health outcomes are with conflict, displacement, and fragile states, emphasizing that the divide between war-torn nations and the rest of the world represents the greatest inequality of our time. ### Conflict's Devastating Toll on Public Health Miliband pointed to ongoing crises, such as the renewed Ebola outbreak in eastern Democratic Republic of Congo and Uganda, as a grim reminder of how instability directly jeopardizes public health. In conflict zones, the very foundations of healthy communities crumble. Food production systems are shattered, markets collapse, and livelihoods disappear, leading to widespread food insecurity and malnutrition—a silent killer, particularly among displaced children. Basic healthcare services, including vital vaccination campaigns, suffer severe disruptions, making populations vulnerable to preventable diseases like measles, polio, and diphtheria. Maternal and child health programs, crucial for reducing preventable illness and death, are undermined, while disease surveillance and preparedness mechanisms weaken, leaving communities defenseless against outbreaks. ### The Alarming Decline in Global Health Funding Compounding these challenges is a global "aid recession" that has seen a dramatic decrease in financial support. Global health funding, which stood at approximately $80 billion in 2021, has plummeted to an alarming 15-year low of about $40 billion today. Official Development Assistance (ODA) has also been cut by nearly a quarter. This reduction occurs precisely when humanitarian needs are escalating, from Sudan to Gaza. Low-income countries, especially those affected by conflict, receive only a fraction of the funding required for pandemic preparedness, leaving them critically exposed to future health crises. Humanitarian appeals consistently remain underfunded, forcing already strained health systems in these regions to attempt the impossible: do more with significantly less. ### Urgent Need for Systemic Change The current humanitarian health architecture, Miliband argued, is at an inflection point. With roughly 60 ongoing wars, chronic displacement, a deepening climate crisis, and increasing impunity for attacks on civilians and aid workers, the world faces a new, dangerous normal. This isn't a stable situation, but rather one that risks accelerating and spreading instability if not urgently addressed. While humanitarian aid can alleviate immediate suffering and prevent deaths, the ultimate solution lies in political action to resolve conflicts and address their root causes. The report strongly criticizes the widespread impunity in war zones, advocating for a robust international response to protect civilians and aid workers. ### Rethinking Humanitarian Approaches Miliband highlighted the counterproductive nature of "false choices" often debated within the humanitarian sector—such as global standards versus local adaptation, or humanitarian aid versus development aid. These binary distinctions often neglect the unique and varied contexts faced by affected populations. He stressed the importance of differentiating between acute crises with no government support, protracted crises with weak governance, and settings where displaced populations can be integrated into new local and national systems. Recognizing these distinct scenarios is crucial for tailoring effective responses and ensuring accountability flows directly to the people who need help most, not just to national leadership. ### Innovative Solutions for a New Era The speech outlined several innovative approaches crucial for improving humanitarian health. These include advocating for pooled funds, which can increase efficiency and coordination, and promoting cash-based assistance, which empowers affected individuals and supports local economies. Innovative financing instruments are also critical for attracting private and concessional funding, especially in more stable environments. Miliband emphasized the need for aligned outcomes across all actors, shared metrics, transparent reporting, and clear accountability for who delivers aid and at what cost. Prioritizing anticipatory action over reactive responses is also key, rewarding efforts to prevent crises rather than just responding after they occur. This means supporting evidence-based interventions at scale, creating incentives for efficiency and innovation, and channeling resources to programs that deliver the best outcomes for every dollar spent. ### Concentrating Resources Where They Are Most Needed A critical point raised was the severe imbalance in resource allocation. Over half of the world's extreme poor reside in fragile and conflict-affected settings, where life expectancy is seven years shorter and infant mortality more than double that of other developing countries. These regions also host roughly half of the world's "zero-dose" and under-immunized children. Yet, they receive a mere quarter of global ODA funding, a significant drop from nearly half a decade ago. The IRC advocates for increasing this figure to at least 60 percent, reflecting the disproportionate needs in these vulnerable areas. ### IRC's Practical Examples of Innovation The International Rescue Committee (IRC) is actively demonstrating how to embody a more effective future for humanitarian health. Through its REACH vaccination program, launched in 2022 across Chad, Ethiopia, Somalia, Nigeria, Sudan, and South Sudan, the IRC successfully immunized 30 million children. Even in communities previously deemed inaccessible to humanitarian actors (16% of the target), they achieved 100% coverage by employing a combination of humanitarian negotiations and portable vaccine carriers. This initiative also drove remarkable efficiency, reducing the average cost per dose from $3.75 to under $1 by 2025, far below UNICEF's benchmark. The program further leverages technical innovations like satellite and route mapping to extend its reach at lower costs. Another example is the IRC's anticipatory action against climate impacts. Recognizing that over a third of health facilities lack basic water, three-quarters lack basic sanitation, and over half lack basic hygiene, the IRC integrates climate forecasting, disease surveillance, and operational data. This allows teams to pre-emptively rehabilitate water systems, pre-position hygiene supplies, and expand community outreach *before* drought or flood-related outbreaks escalate, making more effective use of scarce resources and improving outcomes. Finally, the IRC is field-testing an AI-powered diagnostic tool for Mpox, a disease that has affected over 100,000 people and presents diagnostic challenges due to symptoms easily confused with other illnesses. This tool enables frontline health workers to rapidly diagnose Mpox simply from a photo of a lesion, eliminating the need for patients to travel long distances to see a doctor. These examples highlight the power of collaboration between local and global actors, leveraging technology and data to deliver better solutions and outcomes, supported by donors focused on learning and impact. ### The Imperative for Swift Action Miliband concluded by acknowledging the difficulty of translating good ideas into practical, systemic change, especially when involving multiple actors. While change is often gradual, he stressed that the populations served by humanitarian organizations cannot afford slow progress. Despite facing significant funding cuts, the IRC remains committed to impact evaluation, innovation, and cost-effectiveness, doubling down on these principles to achieve meaningful outcomes for the people they serve. This commitment, Miliband asserted, is the path to overcoming both the false dichotomies within the aid sector and the cruelty and neglect endured by millions in conflict-affected regions.