The Hyperprioritized Humanitarian System: When Saving Lives Today Means Sacrificing Tomorrow

Executive Summary

• The new Global Humanitarian Overview admits we're now doing triage, not humanitarian assistance - choosing who lives today over who gets a future
• With education at 2% of funding and prevention programs eliminated, we're literally sacrificing children's futures to keep them alive today
• If we're making these impossible moral choices, then NOTHING should be off the table for reform - including the sacred cows of agency mandates and coordination structures
• The $230 million we saved through deduplication in Ukraine alone could have funded entire country responses - yet we resist system-wide implementation
• When field teams must decide which children get food and which don't, headquarters can handle some organizational disruption

I've tracked humanitarian funding crises for years. I've documented the US aid freeze that triggered this collapse. I've watched the dominoes fall exactly as predicted - from the January freeze to the global contraction to this moment of reckoning.

But even I underestimated how quickly we'd reach the breaking point. The UN itself now faces a $1.1 billion cash deficit by year-end, with The Economist reporting it may be unable to pay salaries by September. A 17% cut to the core budget is already planned. The entire system isn't just stressed - it's collapsing.

And nothing prepared me for what I read in the new "Hyperprioritized" Global Humanitarian Overview. Let's be honest about what this document represents: the humanitarian system's admission that we're no longer doing humanitarian assistance. We're doing triage.

Tom Fletcher, the Emergency Relief Coordinator, calls it "the cruel math of doing less with less." But here's what that math actually means: We're now systematically choosing between saving lives today and giving people any chance at a future tomorrow.

And if that's where we are - if we're literally calculating which 73 million people to abandon - then we need to have a very different conversation about humanitarian reform.

The New Reality: Humanitarian Triage

The numbers tell the story. From $47 billion to reach 190 million people, we've cut to $27.5 billion for 117 million. But look closer at where those cuts fall:

• Food Security: 42% - but only for IPC 5, those facing famine
• Health: 18% - limited to trauma care and epidemic response
• Education: 2% - basically abandoned
• Protection: 8% - life-saving interventions only, prevention eliminated

We're not preventing the next crisis. We're not building resilience. We're not even trying to break cycles of violence and displacement. We're just trying to keep people breathing.

In Afghanistan, 1.5 million children won't receive education support. In DRC, protection services will reach only 800,000 of 3.2 million survivors of gender-based violence. In Sudan, we're leaving 12 million people to face hunger alone because they're "only" at emergency levels, not catastrophic.

In Bangladesh, one million Rohingya refugees - people who've already lost everything - will see their food rations halved. These aren't abstract numbers. As the GHO states with brutal clarity: "Every dollar below the original $47 billion requirement means more lives lost, more suffering endured, and more crises deepening beyond repair."

In Colombia, over 46,000 children in Catatumbo face forced recruitment by armed groups, but community violence prevention programs are being shut down. In Haiti, where gangs control 80% of Port-au-Prince, we're cutting the very programs showing promise in reducing recruitment.

And the domino effect continues beyond the GHO. The Global Fund is cutting billions from existing grants globally, with South Africa alone facing a $1.4 billion reduction - a 16% cut to that country's allocation from existing grants for AIDS, TB, and malaria. These aren't new programs being denied funding. These are existing, life-saving interventions being terminated mid-stream.

The institutional self-harm runs even deeper. We're now seeing agencies like UNAIDS forced to raid their own emergency reserves - not for programmatic responses, but to fund their own restructuring and staff terminations. The system isn't just cutting fat; it's eating its own muscle to survive.

A Moral Failure: What This Means for Humanitarian Principles

For decades, we've operated under the fiction that humanitarian action could be neutral, impartial, and comprehensive. That we could reach everyone in need. That we wouldn't have to choose.

That fiction is dead.

When you allocate 2% to education while spending 42% on food, you're making a choice. When you cut protection programs to fund trauma surgery, you're choosing to treat rape survivors but not prevent rape.

These aren't technical decisions. They're moral ones. And we need to stop pretending otherwise. The GHO itself acknowledges this horrific trade-off: "Food assistance has been prioritized for those facing famine and catastrophic food insecurity (IPC 5), while millions facing emergency levels (IPC 4) may go without support." Translation: we wait until people are literally dying before we help them. We've institutionalized neglect.

And the consequences cascade through generations. Those 1.5 million Afghan children denied education? They're not just missing school - they're being condemned to illiteracy, poverty, and vulnerability to extremism. The 2.4 million children at risk of dying from malnutrition who won't receive treatment? The survivors will face lifelong cognitive impairment. We're not just failing to prevent tomorrow's crisis. We're actively creating it.

The Efficiency Imperative We Can No Longer Ignore

But here's where I get angry. Really angry.

If we're making these impossible choices - if we're literally sacrificing children's futures to keep them alive today - then every single inefficiency in our system is morally indefensible.

Let me be crystal clear about what I mean.

The 25% We're Leaving on the Table

I've documented extensively how cash assistance is approximately 25% more efficient than traditional aid. When you force cash through sectoral silos - making people collect separate vouchers for food, shelter, and medicine instead of giving them money to prioritize their own needs - you lose that efficiency.

In this hyperprioritized world, that 25% loss translates directly into dead children. It's the education programs we cut. It's the protection services we can't fund. It's the health clinics that close.

The evidence for cash's efficiency is overwhelming. The World Food Programme's 2015 Ethiopia study - the foundational research most cited in efficiency literature - demonstrated that cash assistance was 25-30% more cost-efficient than food aid.

The World Economic Forum's 2016 Principles on Public-Private Cooperation in Humanitarian Payments - endorsed by 18 major organizations including WFP, UNHCR, Mastercard, and Visa - recognized cash as "a faster and more effective form of humanitarian aid compared to in-kind assistance." As Stephen O'Brien, then UN Emergency Relief Coordinator, stated: these principles can "deliver humanitarian cash payments at scale with maximum efficiency and effectiveness."

The 2017 Campbell Systematic Review - the first comprehensive analysis of cash effectiveness in emergencies - examined studies across multiple countries and confirmed cash had the lowest cost per beneficiary of all humanitarian modalities.

Yet the resistance isn't technical - it's existential. Multi-Purpose Cash threatens the entire business model of agencies that have built empires on complexity. You don't need a dozen different organizations to deliver a single cash payment. You don't need separate assessments, separate databases, separate distribution systems. And that terrifies institutions whose survival depends on maintaining those separate systems.

Even WFP is now acknowledging this reality. During his Ethiopia visit last week, WFP Deputy Executive Director Carl Skau announced a shift away from in-kind food distribution: "Where markets are functioning, [cash-based modality] is a better approach because it allows beneficiaries to determine their most pressing needs. It also supports local markets." In 2024, WFP provided over $1.3 million in cash assistance in Ethiopia alone. Yet this represents a fraction of what's possible if we fully embraced cash's efficiency.

And I'm not alone in calling this out. Jan Egeland, Secretary General of the Norwegian Refugee Council, and Joyce Msuya, UN Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator - published their own damning assessment in December 2024. They explicitly called for eliminating "duplicative elements" in coordination and urged donors to discontinue "cumbersome and restrictive" conditions. When insiders at this level are publicly demanding the same reforms I've been documenting, you know the crisis has reached a breaking point.

The Cash Learning Partnership (CaLP) report goes further, highlighting how the lack of standardization and interoperability in cash programs directly undermines efficiency. The technical solutions exist. The resistance is purely political.

The evidence from the field is equally damning. A 2022 study in World Development found that cash transfers to Syrian refugees in Lebanon led to children transitioning from non-formal to formal schooling, reduced child labor, improved health outcomes, and lowered the likelihood of early marriage for girls. These are exactly the protection and development outcomes we're now sacrificing in the hyperprioritized GHO. We know what works. We're just refusing to implement it at scale.

The economic benefits extend beyond direct recipients. Systematic reviews show cash generates $2.00-$2.60 in local economic activity for every dollar provided, compared to $1.50 for vouchers. Studies from Kenya to Yemen consistently document this multiplier effect.

The $230 Million Question

In Ukraine, we proved that deduplication of cash assistance could save $230 million. Not through cutting services - through eliminating the waste of multiple agencies paying the same people for the same needs.

$230 million. That's more than the entire hyperprioritized appeals for Haiti AND Bangladesh combined. Think about that - the money we waste through duplication in ONE country could fund emergency food for 3.3 million Haitians facing gang violence AND support 2.9 million people in Bangladesh, including a million Rohingya refugees.

That $230 million could restore education services for every single one of those 1.5 million Afghan children we're abandoning. It could fund the entire protection response in DRC, reaching all 3.2 million GBV survivors, not just 800,000.

But have we implemented this system-wide? Of course not. Because it would require agencies to share data, integrate systems, and give up some control.

So instead, we keep those parallel systems while telling children in Afghanistan they can't go to school. We maintain our institutional boundaries while women in Yemen lose access to protection services.

The Perverse Incentives Killing People

Our current system incentivizes the exact opposite of what this crisis demands:

1. Agencies compete instead of collaborate because that's how they secure funding
2. Headquarters grow while field presence shrinks because overhead is easier to protect than programs. But instead of seizing this contraction to trim bloated coordination structures and reinvest in the field, the system defaults to cutting frontline and local actors first. It's a missed opportunity wrapped in a tragedy
3. Coordination multiplies instead of simplifies because everyone needs to lead something
4. Local actors get cut first despite being the most efficient, because they have the least political power

As the GHO notes, 47% of women-led organizations expect to shut down within six months. These are often the most efficient, most connected, most capable actors in a response. But they're being sacrificed to maintain international agency overheads.

The numbers are damning: National and local NGOs saw their share of funding drop from an already pathetic 8% to 7%, while UN agencies maintain 67% of the pie. We're watching the most efficient delivery channels collapse while bloated headquarters continue business as usual.

And here's the most infuriating part: the system operates a blatant double standard on risk. Lose a small percentage of cash assistance to fraud? Scandal. Congressional hearings. Program shutdown. But maintain massive duplication and inefficiency in traditional aid delivery? That's just "the cost of doing business."

We tolerate massive, routine waste in traditional aid while paralyzing innovation in our most efficient tool. Donors officially state cash is no riskier than in-kind aid, then operationally treat it like a ticking bomb. The hypocrisy would be laughable if lives weren't hanging in the balance.

If Everything's on the Table, Then Everything's on the Table

The humanitarian system is making the most brutal calculations imaginable. We're literally computing the minimum calories needed to prevent death, the bare medical services to stop epidemics, the absolute least education to prevent total societal collapse.

If we can put children's futures on the chopping block, then we can put agency mandates there too.

If we can tell rape survivors there's no funding for prevention programs, then we can tell UN agencies there's no justification for maintaining parallel systems.

If we can abandon the principle of reaching everyone in need, then we can abandon the sacred cow of institutional independence.

A Survival Plan for UN80 and Beyond

The UN80 reform process suddenly takes on existential importance. This isn't about bureaucratic reshuffling anymore. It's about survival - not of agencies, but of the people we claim to serve.

Here's what must happen:

1. Immediate Implementation of Proven Efficiencies

Every efficiency gain we've identified but not implemented is now unconscionable:

• Unified cash delivery systems (saving 25% minimum)
• Deduplication across all assistance (proven $230M savings in one country)
• Pooled procurement and logistics
• Integrated assessment and targeting systems

2. Radical Consolidation of Functions

The luxury of multiple agencies doing overlapping work is over:

• One cash delivery mechanism per response
• One assessment system per crisis
• One beneficiary database per country
• One coordination structure per sector

3. Localization as Efficiency, Not Charity

Local actors aren't just politically correct - they're more efficient:

• Lower overheads
• Better access
• Deeper community connections
• Faster response times

Yet they're being cut first. This is both morally wrong and operationally stupid.

Egeland made what he called a "radical recommendation" - fewer staff at capitals and larger presence in field locations. Radical? This should be common sense. But in our inverted system, having more people where the crisis is happening rather than in air-conditioned offices is considered revolutionary.

4. Honest Conversation About What We're Doing

Stop pretending we're doing comprehensive humanitarian assistance. We're not. We're doing emergency triage. And that requires different tools, different structures, and different accountability mechanisms.

The barriers are clear, and I've documented them extensively:

Institutional Mandates vs. Human Lives: When every dollar counts, the 25% efficiency loss from forcing cash into sectoral silos is no longer acceptable. It translates directly into the closed clinics and reduced rations the GHO describes. Yet agencies cling to their mandates like life rafts while people drown around them.

Fragmented Coordination vs. Collective Action: The current cluster-led model creates the duplication and gaps that a hyperprioritized system cannot afford. We have nutrition clusters, food security clusters, health clusters - all serving the same hungry, sick child who doesn't care about our organizational charts. The $230M saved in Ukraine could have funded the entire hyperprioritized appeal for Colombia and Haiti combined. Let me repeat that: our coordination failures in ONE country cost more than two entire country responses.

Egeland and Msuya didn't mince words about this: they called for "rationalizing overlapping and large coordination bodies" and recommended smaller, decision-focused meetings instead of the current parade of information-sharing circuses. They even suggested integrating cluster coordination into agencies' core functions rather than maintaining parallel structures. Revolutionary idea: make coordination part of your job, not a separate empire.

Field practitioners have an even sharper term for what's happening: "performative coordination." Endless meetings that produce no decisions. Cash Working Groups given responsibility without power. Data hoarded as a political tool rather than shared to improve response. And because Multi-Purpose Cash doesn't fit neatly into any single cluster's silo, it becomes a political orphan - no powerful champion, easy to cut when budgets tighten.

Perverse Incentives vs. Impact: The system incentivizes agencies to protect overhead, not maximize efficiency. As the GHO report notes, local NGOs face the biggest cuts despite being the most efficient delivery channel in many contexts. Why? Because the system rewards those who control funding flows, not those who deliver results.

The Fork in the Road

We stand at a crossroads. One path leads to managed decline - we keep our institutional structures while watching the humanitarian system slowly collapse, response by response, crisis by crisis.

The other path requires admitting hard truths and making harder changes. It means putting efficiency above independence, impact above mandates, and lives above logos.

I've spent months documenting how we got here - from the US aid freeze to the donor domino effect to the current hyperprioritized reality. But dwelling on the past won't save the 73 million people we're about to abandon.

What might save them is radical honesty about what we're doing and revolutionary change in how we do it.

A Personal Note

I've been in this sector for decades. I've seen reforms come and go. I've watched working groups produce recommendations that gather dust while people die.

This time feels different. Not because the bureaucrats have suddenly developed courage, but because we've run out of options. When you're already deciding which children get food and which don't, maintaining institutional comfort zones becomes impossible to justify.

To my colleagues in headquarters debating mandate preservation and coordination structures: look at the GHO's sectoral allocations. Education at 2%. Protection at 8%. Prevention programs eliminated. That's the cost of your resistance to change.

To donors wringing their hands about efficiency while maintaining earmarks and restrictions: you're forcing us to watch children starve while warehouses sit full of items they don't need. Your conditions are killing people.

To everyone saying reform is too hard, too complex, too politically challenging: we're already doing the hardest thing imaginable - choosing who lives and who dies. Organizational change is nothing compared to that.

The Bottom Line

The Hyperprioritized Global Humanitarian Overview isn't just a funding document. It's a confession. An admission that our system is failing so fundamentally that we can no longer pretend to uphold humanitarian principles.

But if we're honest about that failure - if we're willing to name it and own it - then maybe we can find the courage to do what should have been done decades ago: build a system that puts efficiency and impact above all else.

Because when you're doing triage, when you're literally choosing between saving a life today or giving someone a future tomorrow, every dollar wasted is a life lost. Every duplicated system is a closed clinic. Every preserved mandate is an abandoned child.

The math isn't just cruel. It's clarifying. And what it clarifies is this: radical reform isn't an option anymore. It's the only moral choice left.

Where We Go From Here

The hyperprioritized GHO is both an ending and a beginning. It's the end of our ability to pretend the humanitarian system works. But it could be the beginning of the radical transformation we've needed for decades.

Here's what I'm watching for:

Will the UN80 process embrace real consolidation, or will it be another reshuffling of deck chairs? The merger proposals on the table - UNHCR, IOM, and OCHA into one operational agency - could save billions. Not millions. Billions.

Will donors finally abandon earmarking and embrace pooled funding? The evidence is overwhelming. The efficiency gains are proven. The only question is whether donor ego can handle not seeing their flag on every bag of rice.

Will we finally empower local actors, or continue the colonial charade of "capacity building" while we steal their best staff and ignore their solutions?

Will we implement the technologies and systems that could transform aid delivery - unified beneficiary databases, blockchain for transparency, AI for needs prediction - or will we keep filling out the same forms in triplicate while people starve?

The choices we make in the next six months will determine whether the humanitarian system survives this crisis or becomes another historical footnote about good intentions gone wrong.

Discussion Questions

1. How do we reconcile humanitarian principles with the reality of triage - is it time to rewrite the fundamental frameworks of humanitarian action?
2. What would it take for your organization to give up operational independence in favor of system-wide efficiency? What's the real barrier - technical or political?
3. If we accept that we're sacrificing long-term development for immediate survival, how do we prevent creating permanent crisis states?
4. For those defending current structures: can you justify maintaining any inefficiency when we're literally calculating the minimum needed to prevent death?

Share your thoughts. Challenge my analysis. But please, let's stop pretending we can reform our way out of this with incremental changes. The hyperprioritized reality demands hyperprioritized reform.