May 26, 2026 • 36 mins
On this week's Inside Geneva podcast episode, we take stock of aid cuts and what they mean for new crises such as Ebola.
“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 humanitarian system can survive this crisis without any change,” says Professor Karl Blanchet from the University of Geneva.
A new report says aid delivery must change, but huge cuts are not the way.
“The suspension of funding by major donors, not only the United States but also the UK, Germany and others, [means that] there are going to be excess deaths. Millions of people are going to die who should not have died because of these funding cuts,” says Professor Esperanza Martinez from the Australian National University.
What happens in a crisis like Ebola if aid funding is driven by ‘anti-diversity’ ideology?
“Every process in society follows a gendered pattern, so it is often going to be women who are the caretakers of the sick. It is going to be women who are washing the bodies of the dead and preparing them for burial,” says Hannah Reinl from the Geneva Gender Champions organisation.
Who stands to lose the most from the world’s only superpower withdrawing from aid organisations such as the World Health Organization (WHO)?
“If the US had not withdrawn from the WHO, then we would have been part of the WHO’s response. Which means that when the WHO learned about this, the US government would have learned about it as well. Instead, [US Secretary of State] Marco Rubio is saying that he did not find out about this until ten days later. Well, maybe we should not have pulled out of the WHO, and we would have found out about it earlier,” says Nicholas Enrich, a former USAID official and author of Into the Wood Chipper.
Join Imogen Foulkes on Inside Geneva to listen to the full interviews.
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Episode Transcript
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SPEAKER_07 (00:00):
SwissInfo podcasts.
SPEAKER_09 (00:09):
This is Inside Geneva.
I'm your host, Imogen Folkes,and this is a production from
SwissInfo, the internationalpublic media company of
Switzerland.
In today's program.
SPEAKER_01 (00:30):
A coup, COVID, and cuts.
SPEAKER_07 (00:32):
Myanmar is already a nation in turmoil.
The slashing of the UK's foreignaid budget has come at the worst
possible moment.
SPEAKER_04 (00:40):
It is a catastrophe.
It is not an opportunity.
But now we have an obligation totransform the system.
There's no other way the UMATand system can survive this
crisis without any changes.
SPEAKER_08 (00:55):
There is suspension of funding by major donors, not
only the US but also the UK,Germany, and other donors.
As a result, there are going tobe excess debts.
Millions of people that aregoing to die that shouldn't have
died because of these fundingcuts.
SPEAKER_06 (01:10):
An outbreak of Ebola in the Democratic Republic of
Congo has been declared as apublic health emergency of
international concern by theWorld Health Organization.
SPEAKER_05 (01:19):
Every process in society follows a gendered
pattern.
So it's often going to be thewomen who are the caretakers of
the sick people.
It's going to be the women whoare washing the bodies of the
death and are preparing them forthe burying ceremony.
SPEAKER_00 (01:33):
With U.S.
Secretary of State Marco Rubiostating the World Health
Organization was a little latein identifying it.
SPEAKER_03 (01:39):
The World Health Organization has unfortunately
not done well around the world.
I think they failed miserablyduring COVID.
They covered for China, andthat's how we're getting out of
it.
SPEAKER_02 (01:48):
If the United States had not withdrawn from the World
Health Organization, we wouldhave been part of the WHO's
response, which means that onMay 5th, when WHO learned about
this, the United Statesgovernment would have learned
about this.
Instead, Rubio is saying that hedidn't find out about this until
10 days later.
Well, maybe we shouldn't havepulled out of the WHO and we
would have found out about thisearlier.
SPEAKER_09 (02:28):
Savage funding cuts, more conflicts and crises, and a
growing sense among seasoned aidworkers that the system needs to
change.
And I want to stress here,change not as a knee-jerk
reaction to having less money,but after long experience of
what works and doesn't, radicalroot and branch change to make
(02:51):
the system better.
So in today's programme, we'vegot a series of in-depth
interviews that reflect clearlyand concerningly where
humanitarian work is inmid-2026.
We'll talk to a team from theprestigious medical journal The
Lancet, whose new report saysthe aid system is failing those
(03:14):
most in need.
SPEAKER_04 (03:15):
I'm Carl Blanchet, I'm a professor at the Faculty
of Medicine at University ofGeneva.
I'm the director of the GenevaCentre of Humanitarian Studies
and the co-chair of the LancetCommission on Health Conflict
and Ford Displacement.
SPEAKER_08 (03:28):
My name is Esperanza Martinez.
I am a medical doctor andhumanitarian worker.
I currently work as a professorat the Australian National
University, but my previous workwas with the International
Committee of the Red Cross inGeneva.
SPEAKER_09 (03:40):
And we'll talk to a gender specialist who fears many
traditional donor countries areputting conditions on their aid
that could be damaging to women.
SPEAKER_05 (03:50):
My name is Hannah Reine.
I'm a project manager at theInternational Gender Champions
Secretariat.
SPEAKER_09 (03:56):
And for an even closer look at what's happening
with the traditionally biggestdonor of all, we'll talk to a
man who had a front row seat asElon Musk and his doge team
dismantled the United Statesgovernment's aid and development
arm, USAID.
And it all took place when, asagain now, an Ebola outbreak had
(04:18):
just begun.
SPEAKER_02 (04:18):
My name is Nicholas Enrich.
I was the Acting AssistantAdministrator for Global Health
at the US Agency forInternational Development,
USAID, in January 25 as theagency was dismantled by the
Trump administration.
SPEAKER_09 (04:33):
So a lot to look forward to in today's episode.
And because we're now seeing oneof the most serious Ebola
outbreaks in years, we willspend some time looking
specifically at that.
Is the aid sector fit to cope?
And how might the shift infunding and in ideology around
aid affect how this outbreak ishandled?
(04:56):
We'll begin with that new reportfrom The Lancet.
In it, Professors Carl Blanchetand Esperanza Martinez conclude
that the humanitarian system isfailing millions of people.
But work on their report beganlong before the US, as well as
Europe and the United Kingdom,decided to make such big cuts in
(05:19):
overseas aid funding.
So my first question to CarlBlanchet was: has the report
missed its moment?
SPEAKER_04 (05:27):
This is exactly the right moment to publish this
report.
We started two years ago, and wewere we were about to finish in
a year from now.
We started to accelerateeverything because we could see
that there were so many changeshappening in the world.
Gaza, Sudan, end of Syria, and Imean the new regime,
(05:48):
reconstruction, Yemen, the warstarting, a lot of public ass
emergencies, and now we publishthat exactly at the heart of an
anti-antivirus outbreak and uhan Ebola outbreak in Uganda and
DRC.
This is exactly the right time.
Why?
Because we think that a lot ofgovernments, a lot of donors, a
lot of policy makers and UNagencies are making important
(06:12):
decisions now.
And we do think that they needto be well informed on the
status of the system and on somekey recommendations that need to
take into account for thedecisions.
SPEAKER_09 (06:26):
So do you see the current funding cuts, which are
repeatedly described to me as acatastrophe, a crisis, a
disaster?
Do you see that as anopportunity or as somebody put
it to me, a a trap?
SPEAKER_04 (06:41):
It is a catastrophe.
It is not an opportunity.
But now we have an obligation totransform the system.
There's no other way the UMATand system can survive this
crisis without any changes.
So this obligation does meanthat all the right minds need to
be around the table to reshapeand revisit how the system is
(07:06):
organized and structured.
That's going to be a hugechallenge, that's clear, but we
do think that we can have a fewchanges in the next few years.
And we do hope our work, ourreport, and two years of work is
going to help everybody to shapenew ideas.
SPEAKER_09 (07:23):
The report makes really stresses the idea that
the the money that goes intohumanitarian aid needs to be
better spent, and it's betterspent by the local people who
know what their needs are, whoknow their their community.
But I'm just wondering how yousell that to traditional donor
(07:45):
countries where people aresaying we're struggling
ourselves, we don't want to giveany money at all.
And if we do, we want to seeexactly how it's spent.
SPEAKER_04 (07:54):
Yes, but but absolutely maybe not, because a
lot of donors is very keen toactually bring the localization
agenda at the heart of thefunding.
They just want to do, they wantto know how.
How do we do it?
And when we bring in this reportthis notion of performance of
the response and accountabilityto affected populations.
(08:17):
If we put that at the heart ofthe response, a lot of donors
are going to follow.
It does mean that a lot of localorganizations, NGOs and so on,
will have to be betterperformed, be more transparent
on how they spend the money, anddeliver with being accountable
to populations.
(08:38):
But I trust local actors to bewho come from the community to
actually respect more the needsand the voices coming from
communities.
A couple of examples.
One comes from Sudan, where wehave the emergency response
rooms since 2023.
And they have realized that theinternational response was not
(09:00):
responding to the community'sneeds and was actually very
partial because people stayed ina governed state and instead of
going to the other side of thefront line.
So they decided to getorganized, to call all the
doctors and all the nurses andmidwives, and let's let's get
organized.
It's very much a community-ledorganization, and now they
received money from the EuropeanUnion.
(09:22):
They were nominated for theNobel Prize Prize, and they are
highly recognized.
We have seen that with the whitehelmets in Syria as well.
SPEAKER_09 (09:30):
So the United Nations at the moment is kind of
fighting for its life.
I mean, there's a whole schoolof thought.
Again, we look to America, wejust don't need it.
People just think maybe the USwould actually leave.
I mean, where do you sit withthat?
You're not talking about gettingrid of the of the UN, but you
(09:51):
just think reorganization.
SPEAKER_04 (09:54):
The example of the Ebola outbreak, this is where
you need WHO on the front line,guiding everybody, coordinating
everybody.
We absolutely need WHO.
We do think that doing conflictresponse, we need UN agencies to
be better aligned or to have notthat many agencies being
(10:19):
involved.
There's a lot of fragmentationamong the UN system.
They take a lot of money as wellfrom the international funding.
We do think it's not reallyfair, and this money could be
reallocated to national actors,that's very clear to us.
But we do think that the UNagencies, including WHO, for
example, play a key role, areguiding all the actors in terms
(10:43):
of clinical guidelines, uhtreatment guidelines and
guidance, so that everybody isgoing to work with the same
standards of quality.
That is essential.
But they will need to bereformed, we do think.
They will need to shrink alittle bit.
There are too many UN agencies,and for the local systems and
(11:03):
local actors, they have no cluewho is doing what in the system.
So this has to change.
SPEAKER_09 (11:09):
So Karl Blanchet advocates big changes in how we
deal with aid.
More local, more streamlined,less duplication.
Some listeners like me may knowthat those ideas have been
around and have come from aidworkers themselves, even for
many years.
Blanchet's partner, EsperanzaMartinez, agrees that change is
(11:32):
long overdue.
SPEAKER_08 (11:33):
We know what's wrong and we have known it for a long,
long time, for many years.
That the structure was tooheavy, that we have duplications
in the humanitarian system, thatthe localization that was agreed
and the devolution of power thatwas agreed in Istanbul in the
World Humanitarian Summit hasn'tmaterialized.
And so this report actuallyconfirms that we haven't made
(11:56):
the progress that was required.
At the same time, it identifiesconcrete ways in which we could
advance.
For example, if we talk aboutinverting the power, it's not
just localization in the senseof talking about it.
It's actually giving theresources and the autonomy and
ceding power and decision makingand authority to the communities
(12:16):
and to the local actors, who atthe end of the day are the first
responders.
So there are concrete actions inthe report that point out of
ways where we can use thistransformative period,
challenging and critical periodon the humanitarian sector, to
actually move the needle.
Because we are in a place wherewe are not meeting the needs of
people.
SPEAKER_09 (12:37):
I'm gonna ask you to focus a little bit on this
latest crisis, which is Ebolaoutbreak, a very serious one,
much more serious than oneswe've seen in the last few
years.
How do you kind of square inyour head, you want lots of
change in the way humanitarianaid is delivered?
Right now, we have a crisiswhere the funding that's
(12:57):
available isn't just notpossibly meeting the needs.
Now, I know you say that thelocal people are already trying
to meet the needs, but this isan area that's had conflict for
decades.
The national health system is ina very, very difficult
situation.
SPEAKER_08 (13:12):
The suspension of funding or the ceasing of
funding by major donors, notonly the US but also the UK,
Germany, and other donors,happened at a very critical
period in the humanitariansector.
And as a result, there are goingto be excess deaths, millions of
people that are going to diethat shouldn't have died because
of these funding cuts.
(13:33):
Now, when you look at thehumanitarian sector and the
dependency on a few donors, yousay, well, actually, this was a
crisis in the making.
But no one expected this to beso sudden and so abrupt.
However, in situations like DRC,communities are not waiting for
the international actors toarrive.
Their healthcare workers, theircommunity workers, the
(13:56):
communities themselves, they areacting and they are responding.
And I think that's where weactually need to identify who is
acting, who is legitimate in theeyes of the community, and
actually direct the fundingdirectly there.
SPEAKER_09 (14:12):
How do you see, though, the current shift
towards, I mean, you you talkabout taking geopolitics out of
aid, um, but in fact, it itseems to be going in the other
direction, and there are manydonor countries, and the United
States is clearly the one thatis in the headlines now, which
is determining, deciding how itwill spend its money based on
(14:36):
ideology.
I mean, we see particularly theremoval of programs that target
gender or specifically promotewomen or reproductive health.
Crisis like Ebola, youabsolutely need to involve the
women and probably approach themseparately.
SPEAKER_08 (14:52):
The fact that those donors are also driving agendas
that are against women, againstgender inclusion, against
certain specific diseases or arefocused on one disease and not
on the other, that also was amalaise of the system.
That was something that was notworking.
So we have calls from um middlepowers to actually have the
(15:14):
right conversations.
And this is a conversation thatis not only about money, it's
about principles.
I mean, women, people of diversegenders, children, elderly, they
also have rights.
They have the same right thanother communities to health, to
protection in situations ofarmed conflict.
And those conversations, we needthem to be louder and we need to
(15:37):
be more associated withaccountability and with
compliance.
Moving forward, we need to say,okay, who is actually violating
the rights of civilians?
Who is actually attackinghospitals and health facilities?
And where is the accountabilityand the responsibility for that?
And that is not necessarilyrelated to funding, that is
related to leadership andprincipal leadership.
SPEAKER_09 (15:59):
Unfortunately, many listeners may indulge in a
cynical smile hearing Martinezappeal for political leadership.
A lot of people I talk to thinkthat leadership is pretty thin
on the ground nowadays.
The UN and other humanitarianactors have been plunged into a
cash crisis and into soulsearching about how to go
(16:21):
forward.
Some are even fighting tosurvive.
And what does the end of USAIDmean for crises like an Ebola
(16:44):
outbreak?
But before that, a quick headsup.
Our next Inside Geneva podcastwill be asking, what's the point
of foreign aid at all?
It's out on June 9th, but we'rerecording it with an audience at
Geneva Graduate Institute thisThursday, May 28th.
It starts at 2 pm, and we've gota great lineup.
(17:05):
Chris Lockier, outgoingSecretary General of Médecins
sans frontier, Dica Potzl, EUAmbassador to the UN in Geneva,
Professor Gilles Carbognier,longtime Vice President of the
International Committee of theRed Cross, and Jacqueline Lee, a
master's student ininternational development.
(17:25):
If you're in Geneva this week,do come along.
Meanwhile, back to today'spodcast.
2026 has seen a new conflict inIran.
The closure of the Strait ofHormuz is pushing some regions
of Africa closer to famine.
There's no real peace for Gaza,nor a ceasefire in Ukraine, and
(17:50):
now we're seeing one of the mostdangerous Ebola outbreaks in
years.
Our third interview today iswith Hannah Reinel, project
manager at Geneva-basedinternational gender champions.
She had an important point tomake about Ebola.
SPEAKER_05 (18:07):
If we look at the current outbreak as a lack of
funding for even for just basichygiene and sanitation services,
that is the first piece of it.
The other one is that we need tounderstand that every process in
society follows a genderedpattern.
So it's often going to be thewomen who are the caretakers of
the sick people.
(18:28):
It's going to be the women whoare washing the bodies of the
dead and are preparing them forthe burying ceremony.
So who is more at risk ofcontracting Ebola?
It's it's the women.
And this is just one smallexample that I'm afraid we will
see play out in a myriad ofdifferent ways.
SPEAKER_09 (18:47):
So why does Rhinel fear that?
Well, we know the US has cut aidsavagely, and more of that
shortly, when we talk to aformer USAID official who
witnessed those cutbacksfirsthand.
But we also know that morerecently, Washington has offered
some new money to specifichand-picked crisis zones.
(19:09):
It's not nearly as much asbefore, and Reinal told me, it's
all framed under a rathercurious acronym, PHFA,
introduced by President Trumpearly this year.
SPEAKER_05 (19:22):
Yeah, so it sounds like another unruly acronym from
the UN world.
It stands for promoting humanflourishing and foreign
assistance.
So that sounds quite promising.
It does.
And that's part of the trick, Ibelieve.
Um so it sounds unobjectionable,right?
Why wouldn't we want to promotehuman flourishing?
I believe that this is by designalready to even have a name that
(19:43):
tricks you into thinking um thatthis is something positive when
actually the changes it proposesare quite radical and really
threaten the gender architecturethat we worked so hard to build
here in Geneva.
SPEAKER_09 (19:54):
Well, give me some examples then.
What is it that's that's raisingthe alarm bells with Geneva
gender champions, with you?
SPEAKER_05 (20:01):
Well, I think it's helpful to zoom out and first
understand what it's actuallymade of, um, because it's a it's
an umbrella term that unitesthree different component rules.
And so these rules are called umcombating gender ideology,
protecting life and foreignassistance, and combating the
discriminatory equity ideology.
(20:22):
So this is what DEI now meansfor the US administration.
The policy entered into effectat the end of February this
year.
It's, as I said, quite radicalin what it proposes, um, both in
its reach and in its scope.
And it's something that I thinkwe need to take really seriously
as a community of practitioners.
SPEAKER_09 (20:42):
Let's try and unpick that a little bit.
If an aid agency or an NGO isfound to be in violation, what
would be a violation?
Funding a women's clinic whichprovided reproductive health
advice?
SPEAKER_05 (20:59):
Would that be one?
The problem with this policy isthe ambiguity that's really
built into the design of it.
I spent a lot of time readingthrough 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 ofclarity preferring to rather not
(21:22):
touch something at all.
Currently, based on myinterpretation and also what I
hear from other entities'interpretation of the policy,
yes, everything that's relatingto sexual and reproductive
health seems a bit more offlimits.
Um, there are certain topicsthat are generally considered
more appropriate in context withU.S.
(21:42):
donation conversations.
So, for example, anythingrelated to maternal mortality is
apparently a more palatabletopic.
But um, looking at abortion, forexample, looking at sexual
violence survivors, um, what I'mafraid this policy could really
mean on the Is let's say we havea post-conflict setting, a girl
(22:04):
becomes the victim of sexualviolence, and then does not even
have a menu of options beinglaid out to her in terms of what
the follow-up procedures couldbe, because even mentioning, for
example, abortion as a method oftreatment or for family planning
would be considered prohibitedunder the policy.
(22:24):
The same goes, for instance, forthe distribution of post-rape
kids in conflict settings.
Is this something thatorganizations just don't dare to
venture into anymore becausethey are too afraid that it
might come with financialrepercussions for them?
SPEAKER_09 (22:39):
I see parallels with the media actually here and this
chilling effect that once youget pressure, political
pressure, about a particularsubject, we can think of plenty
of them.
The Middle East is the big oneat the moment.
That you start thinking, well,maybe we'll just leave that
topic alone.
Because we know we're just goingto get in hot water for it.
(23:00):
And you fear the same could behappening now with programs that
directly target women's healthor reproductive health.
SPEAKER_05 (23:08):
Exactly.
And that is one of the hugeconcerns around this new policy.
So if we start with what itapplies to, actually, and that's
that's a big step andqualitative leap from what we've
seen in previous years.
Does promoting human flourishingand foreign assistance policy
with all its sweepingprohibitions that it introduces
(23:29):
applies to foreign NGOs, tointernational and multilateral
organizations, to recipientgovernments, so governments that
receive aid directly from theUS, and as well to US-based
organizations.
It overall is estimated to applyto an amount of close to 40
billion in humanitarian aid andforeign assistance of the US
(23:50):
across 160 countries.
That's huge, right?
So this is a really sweepingchange that is being introduced.
And I believe where the dangerof the policy lies is in one
part, certainly in itsimplementation, but even more so
in the fear of whatnon-compliance might mean for
(24:11):
organizations.
Because what this policy spellsout is that if you don't act in
compliance with the variousprohibitions that it introduces,
the US will either not give yourentity or your recipient state
any money, or it even isentitled to remove money that
has already been distributed.
The other key shift that thispolicy introduces is that this
(24:34):
doesn't only apply to USfunding, but actually it means
that if you have funding comingfrom other sources, so let's say
you're funded by the Swedishgovernment or the German
government, the US prohibitionsor violations of those can also
apply then.
And that means even if you havea completely separate program
that has nothing to do with USfunding, you can still be
(24:56):
penalized as an entity if you'reviewed to be non-compliant.
Now, what does that mean inconcrete terms?
I think it means thatorganizations, first of all,
have to carry huge burdens interms of the compliance.
So there's very detailedprovisions spelling out for
organizations what they have todo in order to be recipients of
(25:18):
US foreign aid.
I believe that it means thatorganizations are likely to
become more careful on how theyuse other donors' money, and
that there will be a leaptowards trying to avoid that
financial risk at all costs byrather not touching the topic at
all.
SPEAKER_09 (25:35):
What Hannah Reinel is outlining there sounds a very
long way from humanitarian aid'sfundamental principles of
impartiality and neutralitybased on need.
What will that mean for a crisislike Ebola?
Our final interview today takesus behind the scenes in
Washington in early 2025, whenElon Musk and his Department of
(25:59):
Government Efficiency, or Doge,were dismantling USAID.
Nicholas Enrich has written awhole book about that called
Into the Wood Chipper, and we'llbe discussing that at length
with him in our Inside GenevaBooks to Make You Think episode
out on June 23rd.
For now, let's hear from himwhat it was like in early 2025
(26:23):
to work in global health atUSAID while the department was
being dismantled and an Ebolaoutbreak was taking place then
too.
SPEAKER_02 (26:33):
It was absolutely terrifying.
First of all, I should say thatI was totally unqualified to be
in charge of dealing with this.
I was promoted to be the head ofglobal health only when Doge had
illegitimately pushed my bossand the 60 other most senior
leaders at USAID ontoadministrative leave.
All of our programs were frozen.
(26:53):
We weren't allowed tocommunicate with anyone.
Our leadership had beendecapitated.
The new political leadership didnot care and had no interest in
dealing with this.
And this was the situation I wasfinding myself in dealing with
my first Ebola outbreak from aposition of responsibility.
I mean, there's no other way todescribe it than just fear and
terror from my side of knowingthat we were failing to respond.
(27:17):
And I knew we wouldn't be ableto put the robust response in
place that USA is usually ableto muster, but we even tried to
get them to do things likescreening at airports for
passengers who were traveling oninternational flights to make
sure they didn't have symptomsof Ebola before getting on
airplanes.
And we couldn't even get the uhthe political appointees to sign
(27:39):
off on that.
SPEAKER_09 (27:40):
There's one which I was a jaw on the floor moment.
The Doge team, when you saidthere is this outbreak, we have
actually committed to sendingPPE protective equipment.
I think it was in uh Kenya, inNairobi.
They said, yeah, if you want itto get there, you can fly over
there and hire a truck and takeit yourself.
(28:01):
This is astonishing.
SPEAKER_02 (28:03):
Yeah, um, you know, it just kind of goes to show
like the disdain that the Dogeand the political leadership had
for our processes and systems.
We we had an outbreak responseteam that knew exactly how to
respond to an Ebola outbreakbecause they've done it before.
And all of those systems brokedown.
And it came to angry people whodidn't understand what was
(28:24):
happening, just kind of likeslamming the table and wondering
how they could do thingsdifferently.
The problem was they didn't wantus to um access the PPE that the
US government had already paidfor because it was being stored
in a warehouse that was operatedby the World Health
Organization, which they were inthe process of withdrawing from.
And rather than engage brieflywith the WHO to get that PPE
(28:45):
into the outbreak zone withinhours, they decided that they
would not do that.
And weeks later, when newsstories started coming about the
PPE sitting in a warehouse whilean outbreak was going on, Pete
Morocco, uh again, the head ofthe agency at the time, ordered
me to go and get it myselfwithout talking to WHO, which I
didn't understand what he meant.
(29:05):
It turns out what he wasactually talking about was me
hopping on a plane, going toNairobi, getting to the
warehouse with a truck, gettingthe PPE somehow across the
border into Uganda.
And, you know, I tried toexplain that that was not
feasible or legal.
And the response that I got wassimply that he emailed my boss
and told me that if I didn'tmove that PPE within 12 hours,
(29:26):
that I should be fired.
SPEAKER_09 (29:27):
Do you think, I mean, perhaps this is a stretch,
but we've got a big, verydangerous actually now Ebola
outbreak in DRC, which has beencirculating for quite some time.
And I hear on a daily basis fromthe agencies, large and small,
they are saying we arecash-strapped.
(29:48):
Do you think the the cuts toUSAID are in any way linked?
I mean, this is an outbreakthat's been circ it's been
circulating for at least twomonths, apparently.
SPEAKER_02 (29:57):
Absolutely.
I do think that the cuts toUSAID are relevant and are
slowing the responsesubstantially.
I mean, from initial detectionum all the way through where we
are today, USAID um had aplaybook in place of how we
would bring in a disasterassistance response team and
would have been in the countrywithin 24 to 48 hours to help
(30:18):
coordinate the USAID partners onthe ground who no longer are
exist because of the cuts toUSAID.
You know, we would have beenable to pre-position PPE in and
we would have been able to uhhave partners working to conduct
contact tracing and support withrisk communication and um safe
barrel procedures, et cetera.
(30:39):
But instead, we we had thatplaybook, and now instead the
State Department is trying torespond to this, something
they've never done beforewithout the expertise, without
the structures, and without theknow-how.
And even to the extent that theyare trying to respond, the speed
that we're losing is thedifference between decisions
that are made in hours anddecisions that are made in days
(31:00):
or even weeks.
And so, yeah, I do think that ifUSA had still existed, the
American government responsewould have been much more swift
and substantial.
SPEAKER_09 (31:09):
What do you think about Secretary Rubio saying the
WHO was late?
SPEAKER_02 (31:13):
Yeah, I mean, to me, the first thing I thought about
that was if we, if the UnitedStates 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 aboutthis, the United States
government would have learnedabout this.
Instead, Rubio is saying that hedidn't find out about this until
(31:34):
10 days later.
Well, maybe we shouldn't havepulled out of the WHO and we
would have found out about thisearlier.
And that's, you know, one of themany, many, many reasons that we
need to engage with the WorldHealth Organization and other
multilateral institutions ifwe're looking for effective
global health response.
And instead of being the firston the scene, the US government
(31:54):
turns out to be the last ones tofind out.
And then once we do, uh, we'restruggling to figure out what to
do about it.
And again, it just stands instark contrast to the way that
we would do outbreak responsejust a year ago.
SPEAKER_09 (32:07):
Clearly, you are, I or I imagine, I assume, from
your answer there, you're not abig fan of the move to leave the
World Health Organization.
Can I ask you, though, overallabout reform maybe of
humanitarian work?
Because there is an ongoingsoul-searching debate here in
(32:30):
Geneva that reform is needed, itshould be less top-down.
I mean, frankly, that'ssomething I've heard for 20
years.
So it's it's not really new.
Some people say that the cutsnot just from the US, they're
coming from Europe too, are agolden opportunity to reform.
And others are saying this is atrap, the cuts are too savage.
(32:53):
You're not gonna havethought-out clever reform in a
climate like this.
I just I just wonder how you seeit.
SPEAKER_02 (33:00):
I think those are both true, right?
That that reform is and wasoverdue.
And unfortunately, I actuallythink that the resistance to
reform over the last severalyears, as you put it, uh, may
have made it easier for the USto have made the decision to
withdraw from the WHO.
On the other hand, they probablywould have done it anyway.
(33:21):
I'm not sure that they were likelooking very specifically at the
reform efforts, but I do thinkthat that did leave the WHO and
other UN agencies vulnerable tothese retaliatory actions by by
the United States.
However, I do think that thereis opportunity.
I do think that the Ebolaoutbreak is just one example of
(33:42):
how we're gonna, it's it's gonnabecome very, very clear over the
next couple of years howimportant it is for the United
States to re-engage and re likeif global health remains a
priority, which I believe thatit will, we're going to need to
re-engage.
But that that engagement doesnot need to look the same.
And it hopefully this is anopportunity to implement some
much needed reforms.
(34:03):
Um, and I and I mean for thatboth in terms of, you know, at
the at the WHO or multilaterallevel, and also within whatever
the US government internationaldevelopment and foreign
assistance uh portfolio lookslike.
I think that we all get caughtup in the way things were and
bureaucracy builds upon itself.
And the one silver lining ofwhat the Trump administration
(34:24):
has done is they've really torndown that bureaucracy and given
us an opportunity for a freshstart when we move forward.
I I don't think it's it's a goodthing that that we've gotten
here, but we do need to takeadvantage of the opportunities
that are there.
SPEAKER_09 (34:46):
My thanks to Carl Blanchet, Esperanza Martinez,
Hannah Reinal, and NicholasEnrich for their time.
A reminder we'll be puttingForeign Aid back in the
spotlight on our next edition ofInside Geneva, asking what the
point of it is and unpicking theoptions for change and
improvement.
You can hear that on June 9th,or join us in person for the
(35:09):
live recording at GenevaGraduate Institute on May 28th.
And don't forget, you can hearmore from Nicholas Enrich in our
June 23rd Books to Make YouThink episode, where he'll be
telling us all about his bookInto the Wood Chipper, the
Inside Story of the Destructionof USAID.
(35:31):
For now, that's it from me,Imogen folks.
Thanks for listening and catchyou next time on Inside Geneva.
A reminder you've been listeningto Inside Geneva, a Swiss Info
production.
You can subscribe to us andreview us wherever you get your
podcasts.
(35:52):
Check out our previous episodeshow the International Red Cross
unites prisoners of war withtheir families, or why survivors
of human rights violations turnto the UN in Geneva for justice.
I'm Imogen folks, thanks againfor listening.
SwissInfo podcasts.
SPEAKER_09 (00:09):
This is Inside Geneva.
I'm your host, Imogen Folkes,and this is a production from
SwissInfo, the internationalpublic media company of
Switzerland.
In today's program.
SPEAKER_01 (00:30):
A coup, COVID, and cuts.
SPEAKER_07 (00:32):
Myanmar is already a nation in turmoil.
The slashing of the UK's foreignaid budget has come at the worst
possible moment.
SPEAKER_04 (00:40):
It is a catastrophe.
It is not an opportunity.
But now we have an obligation totransform the system.
There's no other way the UMATand system can survive this
crisis without any changes.
SPEAKER_08 (00:55):
There is suspension of funding by major donors, not
only the US but also the UK,Germany, and other donors.
As a result, there are going tobe excess debts.
Millions of people that aregoing to die that shouldn't have
died because of these fundingcuts.
SPEAKER_06 (01:10):
An outbreak of Ebola in the Democratic Republic of
Congo has been declared as apublic health emergency of
international concern by theWorld Health Organization.
SPEAKER_05 (01:19):
Every process in society follows a gendered
pattern.
So it's often going to be thewomen who are the caretakers of
the sick people.
It's going to be the women whoare washing the bodies of the
death and are preparing them forthe burying ceremony.
SPEAKER_00 (01:33):
With U.S.
Secretary of State Marco Rubiostating the World Health
Organization was a little latein identifying it.
SPEAKER_03 (01:39):
The World Health Organization has unfortunately
not done well around the world.
I think they failed miserablyduring COVID.
They covered for China, andthat's how we're getting out of
it.
SPEAKER_02 (01:48):
If the United States had not withdrawn from the World
Health Organization, we wouldhave been part of the WHO's
response, which means that onMay 5th, when WHO learned about
this, the United Statesgovernment would have learned
about this.
Instead, Rubio is saying that hedidn't find out about this until
10 days later.
Well, maybe we shouldn't havepulled out of the WHO and we
would have found out about thisearlier.
SPEAKER_09 (02:28):
Savage funding cuts, more conflicts and crises, and a
growing sense among seasoned aidworkers that the system needs to
change.
And I want to stress here,change not as a knee-jerk
reaction to having less money,but after long experience of
what works and doesn't, radicalroot and branch change to make
(02:51):
the system better.
So in today's programme, we'vegot a series of in-depth
interviews that reflect clearlyand concerningly where
humanitarian work is inmid-2026.
We'll talk to a team from theprestigious medical journal The
Lancet, whose new report saysthe aid system is failing those
(03:14):
most in need.
SPEAKER_04 (03:15):
I'm Carl Blanchet, I'm a professor at the Faculty
of Medicine at University ofGeneva.
I'm the director of the GenevaCentre of Humanitarian Studies
and the co-chair of the LancetCommission on Health Conflict
and Ford Displacement.
SPEAKER_08 (03:28):
My name is Esperanza Martinez.
I am a medical doctor andhumanitarian worker.
I currently work as a professorat the Australian National
University, but my previous workwas with the International
Committee of the Red Cross inGeneva.
SPEAKER_09 (03:40):
And we'll talk to a gender specialist who fears many
traditional donor countries areputting conditions on their aid
that could be damaging to women.
SPEAKER_05 (03:50):
My name is Hannah Reine.
I'm a project manager at theInternational Gender Champions
Secretariat.
SPEAKER_09 (03:56):
And for an even closer look at what's happening
with the traditionally biggestdonor of all, we'll talk to a
man who had a front row seat asElon Musk and his doge team
dismantled the United Statesgovernment's aid and development
arm, USAID.
And it all took place when, asagain now, an Ebola outbreak had
(04:18):
just begun.
SPEAKER_02 (04:18):
My name is Nicholas Enrich.
I was the Acting AssistantAdministrator for Global Health
at the US Agency forInternational Development,
USAID, in January 25 as theagency was dismantled by the
Trump administration.
SPEAKER_09 (04:33):
So a lot to look forward to in today's episode.
And because we're now seeing oneof the most serious Ebola
outbreaks in years, we willspend some time looking
specifically at that.
Is the aid sector fit to cope?
And how might the shift infunding and in ideology around
aid affect how this outbreak ishandled?
(04:56):
We'll begin with that new reportfrom The Lancet.
In it, Professors Carl Blanchetand Esperanza Martinez conclude
that the humanitarian system isfailing millions of people.
But work on their report beganlong before the US, as well as
Europe and the United Kingdom,decided to make such big cuts in
(05:19):
overseas aid funding.
So my first question to CarlBlanchet was: has the report
missed its moment?
SPEAKER_04 (05:27):
This is exactly the right moment to publish this
report.
We started two years ago, and wewere we were about to finish in
a year from now.
We started to accelerateeverything because we could see
that there were so many changeshappening in the world.
Gaza, Sudan, end of Syria, and Imean the new regime,
(05:48):
reconstruction, Yemen, the warstarting, a lot of public ass
emergencies, and now we publishthat exactly at the heart of an
anti-antivirus outbreak and uhan Ebola outbreak in Uganda and
DRC.
This is exactly the right time.
Why?
Because we think that a lot ofgovernments, a lot of donors, a
lot of policy makers and UNagencies are making important
(06:12):
decisions now.
And we do think that they needto be well informed on the
status of the system and on somekey recommendations that need to
take into account for thedecisions.
SPEAKER_09 (06:26):
So do you see the current funding cuts, which are
repeatedly described to me as acatastrophe, a crisis, a
disaster?
Do you see that as anopportunity or as somebody put
it to me, a a trap?
SPEAKER_04 (06:41):
It is a catastrophe.
It is not an opportunity.
But now we have an obligation totransform the system.
There's no other way the UMATand system can survive this
crisis without any changes.
So this obligation does meanthat all the right minds need to
be around the table to reshapeand revisit how the system is
(07:06):
organized and structured.
That's going to be a hugechallenge, that's clear, but we
do think that we can have a fewchanges in the next few years.
And we do hope our work, ourreport, and two years of work is
going to help everybody to shapenew ideas.
SPEAKER_09 (07:23):
The report makes really stresses the idea that
the the money that goes intohumanitarian aid needs to be
better spent, and it's betterspent by the local people who
know what their needs are, whoknow their their community.
But I'm just wondering how yousell that to traditional donor
(07:45):
countries where people aresaying we're struggling
ourselves, we don't want to giveany money at all.
And if we do, we want to seeexactly how it's spent.
SPEAKER_04 (07:54):
Yes, but but absolutely maybe not, because a
lot of donors is very keen toactually bring the localization
agenda at the heart of thefunding.
They just want to do, they wantto know how.
How do we do it?
And when we bring in this reportthis notion of performance of
the response and accountabilityto affected populations.
(08:17):
If we put that at the heart ofthe response, a lot of donors
are going to follow.
It does mean that a lot of localorganizations, NGOs and so on,
will have to be betterperformed, be more transparent
on how they spend the money, anddeliver with being accountable
to populations.
(08:38):
But I trust local actors to bewho come from the community to
actually respect more the needsand the voices coming from
communities.
A couple of examples.
One comes from Sudan, where wehave the emergency response
rooms since 2023.
And they have realized that theinternational response was not
(09:00):
responding to the community'sneeds and was actually very
partial because people stayed ina governed state and instead of
going to the other side of thefront line.
So they decided to getorganized, to call all the
doctors and all the nurses andmidwives, and let's let's get
organized.
It's very much a community-ledorganization, and now they
received money from the EuropeanUnion.
(09:22):
They were nominated for theNobel Prize Prize, and they are
highly recognized.
We have seen that with the whitehelmets in Syria as well.
SPEAKER_09 (09:30):
So the United Nations at the moment is kind of
fighting for its life.
I mean, there's a whole schoolof thought.
Again, we look to America, wejust don't need it.
People just think maybe the USwould actually leave.
I mean, where do you sit withthat?
You're not talking about gettingrid of the of the UN, but you
(09:51):
just think reorganization.
SPEAKER_04 (09:54):
The example of the Ebola outbreak, this is where
you need WHO on the front line,guiding everybody, coordinating
everybody.
We absolutely need WHO.
We do think that doing conflictresponse, we need UN agencies to
be better aligned or to have notthat many agencies being
(10:19):
involved.
There's a lot of fragmentationamong the UN system.
They take a lot of money as wellfrom the international funding.
We do think it's not reallyfair, and this money could be
reallocated to national actors,that's very clear to us.
But we do think that the UNagencies, including WHO, for
example, play a key role, areguiding all the actors in terms
(10:43):
of clinical guidelines, uhtreatment guidelines and
guidance, so that everybody isgoing to work with the same
standards of quality.
That is essential.
But they will need to bereformed, we do think.
They will need to shrink alittle bit.
There are too many UN agencies,and for the local systems and
(11:03):
local actors, they have no cluewho is doing what in the system.
So this has to change.
SPEAKER_09 (11:09):
So Karl Blanchet advocates big changes in how we
deal with aid.
More local, more streamlined,less duplication.
Some listeners like me may knowthat those ideas have been
around and have come from aidworkers themselves, even for
many years.
Blanchet's partner, EsperanzaMartinez, agrees that change is
(11:32):
long overdue.
SPEAKER_08 (11:33):
We know what's wrong and we have known it for a long,
long time, for many years.
That the structure was tooheavy, that we have duplications
in the humanitarian system, thatthe localization that was agreed
and the devolution of power thatwas agreed in Istanbul in the
World Humanitarian Summit hasn'tmaterialized.
And so this report actuallyconfirms that we haven't made
(11:56):
the progress that was required.
At the same time, it identifiesconcrete ways in which we could
advance.
For example, if we talk aboutinverting the power, it's not
just localization in the senseof talking about it.
It's actually giving theresources and the autonomy and
ceding power and decision makingand authority to the communities
(12:16):
and to the local actors, who atthe end of the day are the first
responders.
So there are concrete actions inthe report that point out of
ways where we can use thistransformative period,
challenging and critical periodon the humanitarian sector, to
actually move the needle.
Because we are in a place wherewe are not meeting the needs of
people.
SPEAKER_09 (12:37):
I'm gonna ask you to focus a little bit on this
latest crisis, which is Ebolaoutbreak, a very serious one,
much more serious than oneswe've seen in the last few
years.
How do you kind of square inyour head, you want lots of
change in the way humanitarianaid is delivered?
Right now, we have a crisiswhere the funding that's
(12:57):
available isn't just notpossibly meeting the needs.
Now, I know you say that thelocal people are already trying
to meet the needs, but this isan area that's had conflict for
decades.
The national health system is ina very, very difficult
situation.
SPEAKER_08 (13:12):
The suspension of funding or the ceasing of
funding by major donors, notonly the US but also the UK,
Germany, and other donors,happened at a very critical
period in the humanitariansector.
And as a result, there are goingto be excess deaths, millions of
people that are going to diethat shouldn't have died because
of these funding cuts.
(13:33):
Now, when you look at thehumanitarian sector and the
dependency on a few donors, yousay, well, actually, this was a
crisis in the making.
But no one expected this to beso sudden and so abrupt.
However, in situations like DRC,communities are not waiting for
the international actors toarrive.
Their healthcare workers, theircommunity workers, the
(13:56):
communities themselves, they areacting and they are responding.
And I think that's where weactually need to identify who is
acting, who is legitimate in theeyes of the community, and
actually direct the fundingdirectly there.
SPEAKER_09 (14:12):
How do you see, though, the current shift
towards, I mean, you you talkabout taking geopolitics out of
aid, um, but in fact, it itseems to be going in the other
direction, and there are manydonor countries, and the United
States is clearly the one thatis in the headlines now, which
is determining, deciding how itwill spend its money based on
(14:36):
ideology.
I mean, we see particularly theremoval of programs that target
gender or specifically promotewomen or reproductive health.
Crisis like Ebola, youabsolutely need to involve the
women and probably approach themseparately.
SPEAKER_08 (14:52):
The fact that those donors are also driving agendas
that are against women, againstgender inclusion, against
certain specific diseases or arefocused on one disease and not
on the other, that also was amalaise of the system.
That was something that was notworking.
So we have calls from um middlepowers to actually have the
(15:14):
right conversations.
And this is a conversation thatis not only about money, it's
about principles.
I mean, women, people of diversegenders, children, elderly, they
also have rights.
They have the same right thanother communities to health, to
protection in situations ofarmed conflict.
And those conversations, we needthem to be louder and we need to
(15:37):
be more associated withaccountability and with
compliance.
Moving forward, we need to say,okay, who is actually violating
the rights of civilians?
Who is actually attackinghospitals and health facilities?
And where is the accountabilityand the responsibility for that?
And that is not necessarilyrelated to funding, that is
related to leadership andprincipal leadership.
SPEAKER_09 (15:59):
Unfortunately, many listeners may indulge in a
cynical smile hearing Martinezappeal for political leadership.
A lot of people I talk to thinkthat leadership is pretty thin
on the ground nowadays.
The UN and other humanitarianactors have been plunged into a
cash crisis and into soulsearching about how to go
(16:21):
forward.
Some are even fighting tosurvive.
And what does the end of USAIDmean for crises like an Ebola
(16:44):
outbreak?
But before that, a quick headsup.
Our next Inside Geneva podcastwill be asking, what's the point
of foreign aid at all?
It's out on June 9th, but we'rerecording it with an audience at
Geneva Graduate Institute thisThursday, May 28th.
It starts at 2 pm, and we've gota great lineup.
(17:05):
Chris Lockier, outgoingSecretary General of Médecins
sans frontier, Dica Potzl, EUAmbassador to the UN in Geneva,
Professor Gilles Carbognier,longtime Vice President of the
International Committee of theRed Cross, and Jacqueline Lee, a
master's student ininternational development.
(17:25):
If you're in Geneva this week,do come along.
Meanwhile, back to today'spodcast.
2026 has seen a new conflict inIran.
The closure of the Strait ofHormuz is pushing some regions
of Africa closer to famine.
There's no real peace for Gaza,nor a ceasefire in Ukraine, and
(17:50):
now we're seeing one of the mostdangerous Ebola outbreaks in
years.
Our third interview today iswith Hannah Reinel, project
manager at Geneva-basedinternational gender champions.
She had an important point tomake about Ebola.
SPEAKER_05 (18:07):
If we look at the current outbreak as a lack of
funding for even for just basichygiene and sanitation services,
that is the first piece of it.
The other one is that we need tounderstand that every process in
society follows a genderedpattern.
So it's often going to be thewomen who are the caretakers of
the sick people.
(18:28):
It's going to be the women whoare washing the bodies of the
dead and are preparing them forthe burying ceremony.
So who is more at risk ofcontracting Ebola?
It's it's the women.
And this is just one smallexample that I'm afraid we will
see play out in a myriad ofdifferent ways.
SPEAKER_09 (18:47):
So why does Rhinel fear that?
Well, we know the US has cut aidsavagely, and more of that
shortly, when we talk to aformer USAID official who
witnessed those cutbacksfirsthand.
But we also know that morerecently, Washington has offered
some new money to specifichand-picked crisis zones.
(19:09):
It's not nearly as much asbefore, and Reinal told me, it's
all framed under a rathercurious acronym, PHFA,
introduced by President Trumpearly this year.
SPEAKER_05 (19:22):
Yeah, so it sounds like another unruly acronym from
the UN world.
It stands for promoting humanflourishing and foreign
assistance.
So that sounds quite promising.
It does.
And that's part of the trick, Ibelieve.
Um so it sounds unobjectionable,right?
Why wouldn't we want to promotehuman flourishing?
I believe that this is by designalready to even have a name that
(19:43):
tricks you into thinking um thatthis is something positive when
actually the changes it proposesare quite radical and really
threaten the gender architecturethat we worked so hard to build
here in Geneva.
SPEAKER_09 (19:54):
Well, give me some examples then.
What is it that's that's raisingthe alarm bells with Geneva
gender champions, with you?
SPEAKER_05 (20:01):
Well, I think it's helpful to zoom out and first
understand what it's actuallymade of, um, because it's a it's
an umbrella term that unitesthree different component rules.
And so these rules are called umcombating gender ideology,
protecting life and foreignassistance, and combating the
discriminatory equity ideology.
(20:22):
So this is what DEI now meansfor the US administration.
The policy entered into effectat the end of February this
year.
It's, as I said, quite radicalin what it proposes, um, both in
its reach and in its scope.
And it's something that I thinkwe need to take really seriously
as a community of practitioners.
SPEAKER_09 (20:42):
Let's try and unpick that a little bit.
If an aid agency or an NGO isfound to be in violation, what
would be a violation?
Funding a women's clinic whichprovided reproductive health
advice?
SPEAKER_05 (20:59):
Would that be one?
The problem with this policy isthe ambiguity that's really
built into the design of it.
I spent a lot of time readingthrough 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 ofclarity preferring to rather not
(21:22):
touch something at all.
Currently, based on myinterpretation and also what I
hear from other entities'interpretation of the policy,
yes, everything that's relatingto sexual and reproductive
health seems a bit more offlimits.
Um, there are certain topicsthat are generally considered
more appropriate in context withU.S.
(21:42):
donation conversations.
So, for example, anythingrelated to maternal mortality is
apparently a more palatabletopic.
But um, looking at abortion, forexample, looking at sexual
violence survivors, um, what I'mafraid this policy could really
mean on the Is let's say we havea post-conflict setting, a girl
(22:04):
becomes the victim of sexualviolence, and then does not even
have a menu of options beinglaid out to her in terms of what
the follow-up procedures couldbe, because even mentioning, for
example, abortion as a method oftreatment or for family planning
would be considered prohibitedunder the policy.
(22:24):
The same goes, for instance, forthe distribution of post-rape
kids in conflict settings.
Is this something thatorganizations just don't dare to
venture into anymore becausethey are too afraid that it
might come with financialrepercussions for them?
SPEAKER_09 (22:39):
I see parallels with the media actually here and this
chilling effect that once youget pressure, political
pressure, about a particularsubject, we can think of plenty
of them.
The Middle East is the big oneat the moment.
That you start thinking, well,maybe we'll just leave that
topic alone.
Because we know we're just goingto get in hot water for it.
(23:00):
And you fear the same could behappening now with programs that
directly target women's healthor reproductive health.
SPEAKER_05 (23:08):
Exactly.
And that is one of the hugeconcerns around this new policy.
So if we start with what itapplies to, actually, and that's
that's a big step andqualitative leap from what we've
seen in previous years.
Does promoting human flourishingand foreign assistance policy
with all its sweepingprohibitions that it introduces
(23:29):
applies to foreign NGOs, tointernational and multilateral
organizations, to recipientgovernments, so governments that
receive aid directly from theUS, and as well to US-based
organizations.
It overall is estimated to applyto an amount of close to 40
billion in humanitarian aid andforeign assistance of the US
(23:50):
across 160 countries.
That's huge, right?
So this is a really sweepingchange that is being introduced.
And I believe where the dangerof the policy lies is in one
part, certainly in itsimplementation, but even more so
in the fear of whatnon-compliance might mean for
(24:11):
organizations.
Because what this policy spellsout is that if you don't act in
compliance with the variousprohibitions that it introduces,
the US will either not give yourentity or your recipient state
any money, or it even isentitled to remove money that
has already been distributed.
The other key shift that thispolicy introduces is that this
(24:34):
doesn't only apply to USfunding, but actually it means
that if you have funding comingfrom other sources, so let's say
you're funded by the Swedishgovernment or the German
government, the US prohibitionsor violations of those can also
apply then.
And that means even if you havea completely separate program
that has nothing to do with USfunding, you can still be
(24:56):
penalized as an entity if you'reviewed to be non-compliant.
Now, what does that mean inconcrete terms?
I think it means thatorganizations, first of all,
have to carry huge burdens interms of the compliance.
So there's very detailedprovisions spelling out for
organizations what they have todo in order to be recipients of
(25:18):
US foreign aid.
I believe that it means thatorganizations are likely to
become more careful on how theyuse other donors' money, and
that there will be a leaptowards trying to avoid that
financial risk at all costs byrather not touching the topic at
all.
SPEAKER_09 (25:35):
What Hannah Reinel is outlining there sounds a very
long way from humanitarian aid'sfundamental principles of
impartiality and neutralitybased on need.
What will that mean for a crisislike Ebola?
Our final interview today takesus behind the scenes in
Washington in early 2025, whenElon Musk and his Department of
(25:59):
Government Efficiency, or Doge,were dismantling USAID.
Nicholas Enrich has written awhole book about that called
Into the Wood Chipper, and we'llbe discussing that at length
with him in our Inside GenevaBooks to Make You Think episode
out on June 23rd.
For now, let's hear from himwhat it was like in early 2025
(26:23):
to work in global health atUSAID while the department was
being dismantled and an Ebolaoutbreak was taking place then
too.
SPEAKER_02 (26:33):
It was absolutely terrifying.
First of all, I should say thatI was totally unqualified to be
in charge of dealing with this.
I was promoted to be the head ofglobal health only when Doge had
illegitimately pushed my bossand the 60 other most senior
leaders at USAID ontoadministrative leave.
All of our programs were frozen.
(26:53):
We weren't allowed tocommunicate with anyone.
Our leadership had beendecapitated.
The new political leadership didnot care and had no interest in
dealing with this.
And this was the situation I wasfinding myself in dealing with
my first Ebola outbreak from aposition of responsibility.
I mean, there's no other way todescribe it than just fear and
terror from my side of knowingthat we were failing to respond.
(27:17):
And I knew we wouldn't be ableto put the robust response in
place that USA is usually ableto muster, but we even tried to
get them to do things likescreening at airports for
passengers who were traveling oninternational flights to make
sure they didn't have symptomsof Ebola before getting on
airplanes.
And we couldn't even get the uhthe political appointees to sign
(27:39):
off on that.
SPEAKER_09 (27:40):
There's one which I was a jaw on the floor moment.
The Doge team, when you saidthere is this outbreak, we have
actually committed to sendingPPE protective equipment.
I think it was in uh Kenya, inNairobi.
They said, yeah, if you want itto get there, you can fly over
there and hire a truck and takeit yourself.
(28:01):
This is astonishing.
SPEAKER_02 (28:03):
Yeah, um, you know, it just kind of goes to show
like the disdain that the Dogeand the political leadership had
for our processes and systems.
We we had an outbreak responseteam that knew exactly how to
respond to an Ebola outbreakbecause they've done it before.
And all of those systems brokedown.
And it came to angry people whodidn't understand what was
(28:24):
happening, just kind of likeslamming the table and wondering
how they could do thingsdifferently.
The problem was they didn't wantus to um access the PPE that the
US government had already paidfor because it was being stored
in a warehouse that was operatedby the World Health
Organization, which they were inthe process of withdrawing from.
And rather than engage brieflywith the WHO to get that PPE
(28:45):
into the outbreak zone withinhours, they decided that they
would not do that.
And weeks later, when newsstories started coming about the
PPE sitting in a warehouse whilean outbreak was going on, Pete
Morocco, uh again, the head ofthe agency at the time, ordered
me to go and get it myselfwithout talking to WHO, which I
didn't understand what he meant.
(29:05):
It turns out what he wasactually talking about was me
hopping on a plane, going toNairobi, getting to the
warehouse with a truck, gettingthe PPE somehow across the
border into Uganda.
And, you know, I tried toexplain that that was not
feasible or legal.
And the response that I got wassimply that he emailed my boss
and told me that if I didn'tmove that PPE within 12 hours,
(29:26):
that I should be fired.
SPEAKER_09 (29:27):
Do you think, I mean, perhaps this is a stretch,
but we've got a big, verydangerous actually now Ebola
outbreak in DRC, which has beencirculating for quite some time.
And I hear on a daily basis fromthe agencies, large and small,
they are saying we arecash-strapped.
(29:48):
Do you think the the cuts toUSAID are in any way linked?
I mean, this is an outbreakthat's been circ it's been
circulating for at least twomonths, apparently.
SPEAKER_02 (29:57):
Absolutely.
I do think that the cuts toUSAID are relevant and are
slowing the responsesubstantially.
I mean, from initial detectionum all the way through where we
are today, USAID um had aplaybook in place of how we
would bring in a disasterassistance response team and
would have been in the countrywithin 24 to 48 hours to help
(30:18):
coordinate the USAID partners onthe ground who no longer are
exist because of the cuts toUSAID.
You know, we would have beenable to pre-position PPE in and
we would have been able to uhhave partners working to conduct
contact tracing and support withrisk communication and um safe
barrel procedures, et cetera.
(30:39):
But instead, we we had thatplaybook, and now instead the
State Department is trying torespond to this, something
they've never done beforewithout the expertise, without
the structures, and without theknow-how.
And even to the extent that theyare trying to respond, the speed
that we're losing is thedifference between decisions
that are made in hours anddecisions that are made in days
(31:00):
or even weeks.
And so, yeah, I do think that ifUSA had still existed, the
American government responsewould have been much more swift
and substantial.
SPEAKER_09 (31:09):
What do you think about Secretary Rubio saying the
WHO was late?
SPEAKER_02 (31:13):
Yeah, I mean, to me, the first thing I thought about
that was if we, if the UnitedStates 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 aboutthis, the United States
government would have learnedabout this.
Instead, Rubio is saying that hedidn't find out about this until
(31:34):
10 days later.
Well, maybe we shouldn't havepulled out of the WHO and we
would have found out about thisearlier.
And that's, you know, one of themany, many, many reasons that we
need to engage with the WorldHealth Organization and other
multilateral institutions ifwe're looking for effective
global health response.
And instead of being the firston the scene, the US government
(31:54):
turns out to be the last ones tofind out.
And then once we do, uh, we'restruggling to figure out what to
do about it.
And again, it just stands instark contrast to the way that
we would do outbreak responsejust a year ago.
SPEAKER_09 (32:07):
Clearly, you are, I or I imagine, I assume, from
your answer there, you're not abig fan of the move to leave the
World Health Organization.
Can I ask you, though, overallabout reform maybe of
humanitarian work?
Because there is an ongoingsoul-searching debate here in
(32:30):
Geneva that reform is needed, itshould be less top-down.
I mean, frankly, that'ssomething I've heard for 20
years.
So it's it's not really new.
Some people say that the cutsnot just from the US, they're
coming from Europe too, are agolden opportunity to reform.
And others are saying this is atrap, the cuts are too savage.
(32:53):
You're not gonna havethought-out clever reform in a
climate like this.
I just I just wonder how you seeit.
SPEAKER_02 (33:00):
I think those are both true, right?
That that reform is and wasoverdue.
And unfortunately, I actuallythink that the resistance to
reform over the last severalyears, as you put it, uh, may
have made it easier for the USto have made the decision to
withdraw from the WHO.
On the other hand, they probablywould have done it anyway.
(33:21):
I'm not sure that they were likelooking very specifically at the
reform efforts, but I do thinkthat that did leave the WHO and
other UN agencies vulnerable tothese retaliatory actions by by
the United States.
However, I do think that thereis opportunity.
I do think that the Ebolaoutbreak is just one example of
(33:42):
how we're gonna, it's it's gonnabecome very, very clear over the
next couple of years howimportant it is for the United
States to re-engage and re likeif global health remains a
priority, which I believe thatit will, we're going to need to
re-engage.
But that that engagement doesnot need to look the same.
And it hopefully this is anopportunity to implement some
much needed reforms.
(34:03):
Um, and I and I mean for thatboth in terms of, you know, at
the at the WHO or multilaterallevel, and also within whatever
the US government internationaldevelopment and foreign
assistance uh portfolio lookslike.
I think that we all get caughtup in the way things were and
bureaucracy builds upon itself.
And the one silver lining ofwhat the Trump administration
(34:24):
has done is they've really torndown that bureaucracy and given
us an opportunity for a freshstart when we move forward.
I I don't think it's it's a goodthing that that we've gotten
here, but we do need to takeadvantage of the opportunities
that are there.
SPEAKER_09 (34:46):
My thanks to Carl Blanchet, Esperanza Martinez,
Hannah Reinal, and NicholasEnrich for their time.
A reminder we'll be puttingForeign Aid back in the
spotlight on our next edition ofInside Geneva, asking what the
point of it is and unpicking theoptions for change and
improvement.
You can hear that on June 9th,or join us in person for the
(35:09):
live recording at GenevaGraduate Institute on May 28th.
And don't forget, you can hearmore from Nicholas Enrich in our
June 23rd Books to Make YouThink episode, where he'll be
telling us all about his bookInto the Wood Chipper, the
Inside Story of the Destructionof USAID.
(35:31):
For now, that's it from me,Imogen folks.
Thanks for listening and catchyou next time on Inside Geneva.
A reminder you've been listeningto Inside Geneva, a Swiss Info
production.
You can subscribe to us andreview us wherever you get your
podcasts.
(35:52):
Check out our previous episodeshow the International Red Cross
unites prisoners of war withtheir families, or why survivors
of human rights violations turnto the UN in Geneva for justice.
I'm Imogen folks, thanks againfor listening.
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