In conversation with David Miliband

Dr Samir Puri

Well, welcome, everybody, to Chatham House. We are just about a minute or so ahead of schedule, but we shall kick off. A very warm welcome back to David Miliband, to Chatham House. David, I think you were here last September. You mentioned talking about the overlap between climate and conflict. And we’ve got a different subject here today, but just before I start on that, just to remind everybody, this event is being livestreamed, therefore of course, it’s a public event. We’re going to have a Q&A in the second half of the event, so if the microphone does come to you, please make sure you introduce yourself. And I also will be having some questions coming in online as well, and we’ll take a mixture of the two.

So, David Miliband, of course, a former UK Foreign Secretary. You took that post in 2007, if I recall. And I should also add, on a personal note, you were the Foreign Secretary when I entered the Civil Service myself in the FCO. So, a very nice full circle moment to be hosting and chairing you today here.

David Miliband

I was not the Foreign Secretary when you left the Civil Service, I’d like to point out.

Dr Samir Puri

Absolutely not.

David Miliband

I didn’t hound you out.

Dr Samir Puri

I won’t name which one that was, and that was coincidental. So the conversation we’re going to be having here today is the world has changed, aid needs to change too. And without stealing your thunder, just in terms of the contextual points, I think all of us in this room, all of us joining online, will understand that the moment we’re facing right now in terms of international aid is unprecedented, it’s unique, it’s potentially unquestionably bleak, but there are potentially going to be rays of sunlight that we may be able to detect and see in terms of the responses that one can take in relation to the rolling back of USAID and the cuts in aid budgets.

So, without much further ado, David Miliband, who is, of course, the President, CEO of the IRC, is going to take to the podium and speak to us for about 20 minutes or so, before we start to move into discussion, but please welcome David Miliband to the podium. thank you.

David Miliband

Thank you very much. Thank you, everyone and very nice to see you all here. Some people I know well and I’m very grateful to you for coming, loyal friends, and also, Samir, thank you to you for your introduction. I’ll get straight down to it, ‘cause I’ve been warned there’ll be a shaft of lightning will come down and strike me down if I speak for more than 20 minutes. Don’t want to overextend my welcome.

But here, I just want to summarise what I’m going to say to you today. I’m going to make four arguments in the next 20 minutes. First, that the convulsions in the aid system are lead indicators of major geopolitical reordering in other parts of the international system. Second, that aid has lost focus on the extreme poor and has been stretched too thin, especially as the greatest needs are increasingly concentrated in conflict states. Third, that elements of a clear reform agenda are visible if we’re prepared to look. And fourth, that although the UK aid budget is being reduced, Britain can still play an important role.

I know that people always say the world is changing, but this feels like a moment of genuine geopolitical flux, at least as significant as 1989-90, when the world transitioned from the Cold War to a unipolar moment. And for me, the Trump administration is both symptom and cause of the changes underway. The problem is that it’s much more clear what we are inflecting from a world in which the US was the anchor of the global system, but it’s not clear what we are inflecting to.

I know there’s a lot of talk about the idea of a multipolar world, reflecting a redistribution of the balance of power, but I find that concept conveying too much stability, too much security, if you like. I much prefer the idea of a more – well, I should say I prefer it as an analytical tool, not as a normative tool, the idea of a more fluid, more transactional, multi-aligned world. That notion of a multi-aligned world is not mine, it was originated by Shashi Tharoor, who was an Indian Diplomat, in 2006. He’s now an opposition Politician in India. And in this ‘multi-aligned world’ there are different coalitions of values and interests on different issues. And my point to you is that we already see that in the aid sector, both in the problems we face, for example in the world’s greatest humanitarian crisis in Sudan, but also in the struggle for funding and between funding needs to address the problems that we see in the humanitarian sector, focused on areas of conflict and disaster.

I just want to pause for a moment on the idea of the US as the anchor of the global system. I’m not a seafaring person, but I do know that when the anchor of a boat is pulled up in choppy seas, things get dangerous, passengers get seasick. That’s what’s happening in the aid sector at the moment. US foreign aid payments represent around 30% of all funds globally, and over 80% of US programmes have been terminated. The US pays between a third and a half of the bills of the UN agencies, and there’s a review going on, we don’t know how that will conclude. NGOs that are headquartered in the US, including my own organisation, the International Rescue Committee, are big players. US philanthropists, notably the Gates Foundation, are leaders in the field, its private sector are the biggest players, and its scientific, cultural, organisational reach is the widest.

Now, the primary danger of the aid cuts, obviously, is that they cost lives. But there’s another danger, which is that they reinforce salami-slicing and conservatism elsewhere in the aid system. And of course, the aid cuts are not confined to the US, they’re in the UK, they’re in the rest of Europe as well, striking Denmark, a country now exceptional for sticking to its 0.7% commitment of spending aid as a proportion of GDP. And it’s interesting to me that while the political right has criticised the aid system for alleged fraud and the left has criticised the aid system for hierarchy, neither have actually addressed the reality that the aid system can’t do everything on its plate with the money that it currently has, and I’m going to go through some stats for you.

The official development assistance budget was around 212 billion in dollars in 2024. And my point is that over the last 15 – over the last ten years, with the launch of the 18 Sustainable Development Goals in 2015, and especially since COVID, aid funds have been used for a range of goals, each of them desirable in and of themselves, but increasingly in competition with the immediate needs of the poorest people in the world. When you look at what aid is spent on, humanitarian aid, the most extreme forms of life-saving relief, is only about 14% of the total aid budget, and health spending is only around 10%. OECD analysis shows that the largest share, around 60% of bilateral aid in 2017 to 2021, went on global challenges like climate mitigation. Meanwhile, richer donor countries are spending more or less as much of the aid budget on supporting refugees and asylum seekers inside rich countries as they are spending on humanitarian aid globally.

Of course, there are good reasons for all of this spending, but there’s a snag. When it comes to spending on global challenges like climate mitigation, the poorer a country, the weaker its state, the more complex the delivery and the less aid is actually spent. So, when you look at where aid goes, Ukraine gets more foreign aid than any other country. This is not military aid, I’m talking about humanitarian aid. Now, Ukraine needs help and we’re proud to work there as a humanitarian agency. But the other 19 countries on the IRC’s emergency watchlist of 20 countries in greatest humanitarian need, where 84% of the 300 million people who live in humanitarian need reside, get just 12% of the global total aid budget.

And if you look at the website of the ONE Campaign, in 2023 16% of aid went to low-income countries. There are about 25 in the World Bank listing, where average income is no greater than $3.13 a day. There are about twice as many countries in each of the next two categories, and they both get an average – a higher share of total aid distribution. Lower middle-income countries where the average income is between $3 and $12 get 23% of total aid spending, and upper middle-income countries, 22%.

And what I want to put to you is that there are three reasons why there’s this disjunct between where aid spending is going and where most of the poorest people in the world live, three reasons. First, while aid is widely spread, extreme poverty is extreme – is increasingly concentrated. In 1987, 30% of countries were classified as low-income, in 2023, it was 12%. In South Asia, the share of countries classified as low-income has shrunk from 100% to 13%, an extraordinary achievement. Meanwhile, the number of people in extreme poverty in sub-Saharan Africa has risen from 280 million to 460 million. So nearly 70% of the extreme poor live in sub-Saharan Africa. So, there’s geographical concentration of extreme poverty.

Second, conflict is the increasingly common denominator in explaining extreme poverty. But the aid system focuses on government structures, and they find it harder to deliver in these circumstances. In 1990 less than 10% of the extreme poor lived in conflict states. Today, the World Bank says it’s over 50% and by 2030 it will be two thirds. The OECD estimates are actually even higher. But when you look at where aid goes, the share going to fragile and conflict states is declining, from around a third in 2019 to 22% in 2023.

And the third factor explaining the disjunct is the following: aid remains focused on development as the means to reduce poverty, economic development, but aid is not actually the main driver of development. Just think of the story in India or South Korea or Ghana or Vietnam, the success stories of development. Aid was not the driving factor. Markets and governance, domestic policy, were centre stage in development. Remittances, just to take that as an example, $120 billion to India alone, $114 billion to the other countries that I mentioned – the other three countries that I mentioned, $700 billion in remittances globally. And just remember, the aid budget is $200 billion. In other words, aid saves lives, but it takes politics, domestic politics, to make development possible.

And so, if you add all this up, there is a Gordian Knot. Needs are increasingly focused in fragile states where governments are weak or at war. The focus of the aid budget is being diluted across multiple priorities, and its overall size is being reduced. Meanwhile, the hope that public-private partnerships would “turn billions of dollars into trillions of dollars” for the poorer parts of the world has not been fulfilled, and the macroeconomic environment has turned sour, even before the trade war induced by unilateral American tariffs. Because rising interest rates after 2022 have been sucking money out of the budgets of developing countries. So, that’s the Gordian Knot, and the question is how do we cut it?

I think there are some clear implications. First, we should argue as strongly for broadening the base of aid donors as we argue against aid cuts in richer countries. The G7 group of industrialised democracies constitutes 30% of global GDP and 75% of global foreign aid funding. I think it’s legitimate to point out that the combined income of the BRICS countries is equivalent to US GDP, but with nothing like the USAID contribution. And it’s perfectly legitimate, as well, to call on newly wealthy countries, notably in the Gulf, but also elsewhere, to play their full part in helping those left behind by globalisation.

Second, let’s never forget how critical the macroeconomic context is to development. If you look at Larry Summers’ work in 2024 on how the rise in global interest rates has hit the poorest countries, he says the following, quote, “2023 was a disaster in terms of support for the developing world. Rising interest rates and bond and loan repayments meant that nearly $200 billion flowed out of developing countries to private creditors in 2023. Aid can’t fill this gap. That’s why we need new imagination about how to reduce debt burdens, including the idea of humanitarian debt swaps the IRC is trying to support, to shift resources from paying off debts to investing in humanitarian action.”

Third, for stable states that are trying to develop themselves, there’s a big opportunity in leveraged finance and public-private partnership. The struggle to turn public-private partnership into realisable investment in conflict states shouldn’t turn us away from the potential that it has for – to deliver for the common good in more stable places. And remember, funding for key global efforts like climate mitigation was originally meant to be additive to help for the world’s poorest, not in competition with it.

Fourth, where aid is most needed, in the poorest countries with the largest concentrations of very poor people, with the highest levels of humanitarian needs, with the least governmental capacity to meet needs, we need to reform the aid system. I think there are four drives that I want to mention. First, a prioritisation drive, shifting the aid system away from what the Center for Global Development describes as a “Christmas tree of different initiatives,” to investment in a smaller number of high impact, scalable, cost-effective investments. And one example of this is that cash support is the most direct and efficient way of helping people out of poverty. It’s also beneficial for local economies and local people where people flee, but it’s less than 20% of the humanitarian aid budget going on the most evidence-based part of the aid system. And that’s even before US cuts take effect, and the US has been one of the large – the largest supporter of cash as a means of humanitarian intervention.

I also want to highlight in this prioritisation drive the issue of malnutrition, which for me, is the apex of the humanitarian pyramid, because where you have acute malnutrition, you can almost guarantee that everything else is also going wrong, in education, in health, in violence, in local economic disaster. But 80% of acutely malnourished under fives in conflict states today don’t get the appropriate help, despite the proven impact of a reform programme that we have pioneered at the IRC, using community health workers to diagnose and treat the disease. We ran a randomised controlled trial in Mali for 27,000 kids and showed how you could get a 92% recovery rate for children suffering from acute malnutrition.

That example leads me to the second part of the reform drive, which is around cost effectiveness and cost efficiency. We’ve run, over the last ten years, about 400 cost effectiveness and cost efficiency studies. And there are big gains to be had. If you take the malnutrition example, we think we can treat 30% more kids if you reform the system for delivering malnutrition support. We also think that just lengthening the lifecycle of grants from less than a year to multiyear could deliver 30% efficiency gains. That means helping three million kids with severe acute malnutrition or five million with moderate acute malnutrition. We also think bundling programmes together, for example, putting malnutrition programmes alongside immunisation programmes, could save 20% of the cost. A shift towards outcome-based accountability, rather than an obsession with inputs, could deliver a minimum of 10% cost effectiveness and cost efficiency gains. So, there’s a big agenda around cost effectiveness.

Third is an innovation drive. From Farmer information systems to education for kids on the move, our own research has shown how AI holds out the prospect of quite striking advances. We can use AI to make the aid sector more proactive and less reactive. We can also use AI to make the system more personalised. For example, we’re developing an AI-powered offline functional app. I know what each of those individual words mean. I’m not sure I want to be cross-examined on what they mean together. But we’re using this app for frontline health workers to rapidly diagnose mpox by analysing photos of lesions on the bodies of people. So, we can make the system more personalised and more accountable in that way.

Now, none of this should obscure the fourth element, which is a drive for access to conflict-affected populations, which is the biggest impediment on aid delivery at the moment. The poorest people on the planet are cut off from cash and services by conflict, so humanitarian law and humanitarian access need to be defended as legal as well as moral rights. And the power of this to change lives has been shown to – for me, in a programme we run in East Africa with Gavi, the Global Alliance on Vaccines and Immunisation.

They came to us three years ago and they said that in 157 administrative districts in Somalia, Ethiopia, South Sudan and Sudan, they had only 16% access. So, that means – so in 84% of these districts, kids were getting no immunisations at all. And they said, “Look, we’ll give you $50 million if you reach two million kids with vaccine doses.” We’ve delivered 11 million doses of vaccine for £3 a shot. We’ve reached one and a half million kids in that time by negotiating access from rebel groups and other armed forces that means today, 96% of those districts have humanitarian access, rather than just 16%. So, this humanitarian access issue is absolutely fundamental to the fight against global poverty.

Let me just finish up in the last three or four minutes by talking about what the UK should be doing, and I want to start, perhaps, in a surprising place. I looked up the polling that’s done by More in Common, and I had a slight worry when I turned to it, but actually, it’s very interesting. The polling from February this year shows the public are more than twice as likely to say that UK international aid has a positive impact rather than a negative impact. And the public across all parties want aid to focus on urgent humanitarian issues rather than long-term systematic issues. I don’t want to deny at all the struggles and the stress on the finances of families all across the UK, but I still believe that in the heart of Britain there’s a view that while charity begins at home, it doesn’t need to end at home, and that’s what comes through to me from the polling. It doesn’t need to be a political third rail.

The decision to cut the aid budget has been made and I regret it, but now it has been made, the danger can either be mitigated or magnified. Here are some thoughts about mitigation. The commitment to an aid budget worth 0.3% of national income should mean just that. It should mean – it should not mean 0.3% minus refugee and asylum costs and minus a range of other calls on the resource. Let’s sure – let’s make sure it really does what it says on the tin. Let’s also prioritise, that could be by country, per the analysis above, or by programme. But let’s – but in all cases, let’s make the case to invest in proven programmes that can build public support by the impact they have.

Let’s use our voice to support innovation. I’ve said before on this stage that Britain, on the board of the major international institutions, could have a bigger say in an agenda for reform and innovation, including in areas like financial services, where we have expertise. And let’s also work with our allies, notably in Europe, to pool resources and make aid money go further. There’s a reset of European policy being conducted by the government and it could be augmented at the summit next month through aid co-operation. The EU has geographical coverage, scale and a variety of instruments that could make UK aid go further.

So, to return to where I started, this is a moment of flux across the international policy terrain. Global risks, technological revolution and geopolitical fragmentation are combining to break up old systems. I think this is really important. The global risks and the geopolitical fragmentation each exacerbate the other. If you think about COVID, the global risk of COVID and the reality of COVID, it exacerbated the split between China and the rest of the world, but the split between China and the rest of the world exacerbated the global risk of COVID. So, these three factors, the risks, the global risks, the technological revolution and the geopolitical fragmentation are breaking up the old systems, and this is nowhere more true than in the drive to help the poorest people in the world.

I have to say, I have been completely inspired over the last ten years by the commitment, innovation and value for money of the aid sector that I’ve seen. I don’t believe that responsibility from richer countries to poorer should be cut back, but we will only rebuild it with an agenda that is clearer, more impactful and more focused, and I hope that is the debate we can now have. Thanks very much, indeed.

Dr Samir Puri

[Pause] Okay, you’re on time.

David Miliband

I have to say, I’m on budget, but yeah.

Dr Samir Puri

On time and on budget, yeah. Thank you, David, so much for, I think laying out what a commitment to international aid now looks like and what it must overcome as a set of quite unique challenges, in order to be perceived successfully. Before we open up to questions, I wanted to pick up on a couple of the themes that you raised at the start of your comments.

You’re very clear-eyed in terms of prioritisation and how to focus on conflict affected countries, but I want to widen out to this global fragmentation question first of all. Of course, you mentioned the G7 has got, effectively, a declining percentage of the global economy. And I was struck reading – ‘cause you mentioned the Gates Foundation as well, and Mark Suzman wrote a piece in The Economist where he said “There are new donors in the Middle East and Asia who were once recipients of aid, potentially being in a position to be more involved in giving.” What do you see in terms of that changing composition of international characters and donor countries? Is it already changing quite dramatically? ‘Cause it’s unlikely the BRICS as a collective would move on international aid, but within that there may be individual countries that could be leaders and partners of the future.

David Miliband

So, two things about that. First, I think it’s really important for a British audience to just pause for a minute on the following point. It’s true that European and Japanese share of global GDP has gone down in the last 30 years. What’s absolutely extraordinary, as someone who’s a Brit living in America, is that America’s share of global GDP has not changed since 1990. America was 25% of global GDP in 1990 and it’s 25% of global GDP today. And so, the disjunct between how the economy is experienced by Americans, who are very, very angry about the state of the economy, and America’s global position, is very, very striking, indeed.

But America’s still 75% of global capital markets, so it’s still a very rich country, the richest country in the world, with a super-dominant global economic position. We’ll see what happens as a result of what’s underway at the moment, but let’s remember that the political convulsions are happening in a situation where the economic take, if you like, is still very high. The distribution is enormously unequal, but the overall take is very high.

And the short answer to your second question is, we’re not seeing much of it. It’s true that Saudi Arabia and United Arab Emirates have stepped up with some increase in aid, but often side-by-side with the overall system, the multilateral system rather than within it, and often concentrated in their own region. So, at the moment there’s a big sucking sound out of the aid sector, rather than replacement of American or European aid with anyone else’s aid.

Dr Samir Puri

Right, and I know you’re not a fan of the ‘multipolarity’ term, but do you think this is the direction of travel, where there may be more regional givers in terms of the responses to crises, or do you think that it’s still the job of the, sort of, the international co-ordination that the UN – that the US potentially has been able to provide in the past, that is irreplaceable?

David Miliband

Well, I think it’s…

Dr Samir Puri

[Inaudible – 27:42].

David Miliband

…both. I think we’ve got to – it’s got to be both. There’s a big debate to be had about how the World Bank fulfils its mission to end extreme poverty on a liveable planet. As you can tell from what I said, I think that the development agenda and the aid agenda are often equated, when, in fact, they’re different, and that – teasing that out, I think, is really, really important. The UN still has special legitimacy, but we’ve got to recognise that the Coalitions of the Willing, which is a phrase which is an unfort – a phrase which has an unfortunate echo from 20 years ago, but which is being rehabilitated today, if we wait for ‘the world’ to do stuff, we’re going to be waiting forever. So, there are going to be many, many more Coalitions of the Willing to get things done, I think.

The problem at the moment is we have coalitions of the unwilling, both diplomatically and on the humanitarian aid front. I didn’t have time to go into but what’s happening in Sudan today, which is top of our emergency watch list, is a horror show on the humanitarian front and a deadlock on the political front because of a conflict that is wholly unresolved.

Dr Samir Puri

And we’re going to get to some of these topics, potentially also Sudan as well, in our discussion. So, if you’d like to ask a question in the audience, now’s your time to raise your hands, and I’ll take probably a couple to start with in one go. I’ll start with the gentleman right at the front here.

Philip

My name is Philip [inaudible – 29:07].

David Miliband

Do you want to wait for a…?

Dr Samir Puri

The microphone’s just coming.

Philip

I was – the two things that struck me were the points at the beginning about the danger of salami-slicing and to the distribution within the aid budget as between humanitarian and developmental aid, and I saw, well, perhaps they’re trivial, but I saw two parallels with domestic policy in Britain. One, the first one, on the salami-slicing, you see it in the UK defence budget. For the last 50 years, Britain’s been pretending that it’s still a military superpower and has been salami-slicing it and now has a set of defence forces which are really a, sort of, Potemkin village type of military.

The second parallel operates a bit in the opposite direction. It’s on the humanitarian versus development aid. If you look at something like the NHS, the big problem we have is we spend vast amounts of money treating acute illness and not enough at all in dealing with the problems before you get to acute illnesses. And with humanitarian aid, isn’t the danger that you end up treating the problem constantly but not addressing, you know, the fundamental underlying, sort of, causes that get you there? So, could you say a little bit more about how, in this concentration of humanitarian need and civil conflict, I mean, what can one do in those areas? What more can one do in those areas, beyond just giving more humanitarian aid and more efficiently and more effectively, as you said? I mean, surely one has to – there has to be development – there has to be a development element there.

Dr Samir Puri

Let’s start with that one.

David Miliband

Yeah, so a great question, but here’s my way of answering it. At the moment, we’re neither treating the symptoms nor dealing with the causes, which may be a parallel to the – to what you’re saying about domestic policy. But more significant, while there is a humanitarian solution to the symptoms, there isn’t a humanitarian solution to the causes, because every humanitarian emergency is in fact a political emergency. And when you – I think I quote you right, Phil, get to the funda – you said “fundamental underlying issues.” The fundamental underlying issues of extreme poverty today are actually conflict, which are political issues rather than humanitarian issues. And that’s the difference, I think, with the domestic policy challenges that you’re facing.

I would say one other thing in defence of – I mean, I’m hypersensitive to the argument that humanitarian aid is just a, sort of Ban – people say it’s just a Band-Aid. Those one and a half million kids who we’ve immunised in East Africa, that’s a lifetime benefit we’re giving to them. It’s not just a Band-Aid because that immunisation helps them for the rest of their lives. Ditto, if you fail to treat moderate acute malnutrition, it’s a lifetime scar on a kid, and if you do treat it, it’s a lifetime benefit for them.

The education that we do in Afghanistan, which has been cut by the US administration, 200 – 580,000 Afghan boys and girls were getting educated over our programme with USAID that’s been cut. That was a lifetime benefit to them. And this came home to me when I got an email from one of the Afghan – the Afghan Measurement and Evaluation Office, who we’ve had to lay off because the programme’s been closed, he said, “39 years ago I was a kid being educated by the IRC in Afghanistan in Bamyan Province.” So, my – in short, my answer is humanitarian to treat the symptoms, politics to – and diplomacy, sort of, my old job, to get into the fundamentals, but don’t write off humanitarian aid as the first step on the road to any vision of development.

Dr Samir Puri

Brilliant, and we’ll take a question from Olivia at the front, if you can bring the microphone down here, please.

Olivia O’Sullivan

Thank you and thank you for speaking with us here today. I’m Olivia O’Sullivan and I direct the UK in the World Research Programme here at Chatham House. My question to you is, you’ve been Foreign Secretary, if you were Foreign Secretary now, it strikes me that one of the problems you would be facing is not just the problem you articulated so well, that the US is significantly cutting resources and funds from the aid system, but also that it’s withdrawing its political will and leadership. They don’t like the project, arguably, the Trump administration, right? Their attitude towards the WHO, towards UN agencies, is not just, “This costs too much,” but, “We are actually averse to some of these ideas,” it seems to me.

So, would you, if you were Foreign Secretary, prioritise trying to uphold parts of that system in the face of that potential opposition and continued opposition, or, given straitened aid budgets and given some of the flaws that exist in that system, would you prioritise thinking about new groupings and new systems? I appreciate that both would be great, but energy and diplomatic bandwidth and resources are constrained, so how would you think about that dilemma if that were you?

David Miliband

Yeah, well, I’m not going to tell David Lammy how to do his job, because I think he’s doing an excellent job, and so I won’t tell you what I would do if I was Foreign Secretary. What I’ll tell you, what I hope the British Government does as the head of the IRC, and that is that we need them to do both. We can’t afford Britain to absent itself from the multilateral system. We’re on the UN Security Council. That’s a point of – a place of enormous privilege and we’ve got to exercise responsibility there. But if we’re only active there and we’re not in the Co – the other Coalitions of the Willing, whether continuing to lead Gavi, the Global Alliance on Vaccines, whether in Ukraine, obviously, there’s a different balance of military and humanitarian effort. And that is to speak to the reality that we are part of a collective world.

And that was a big theme of your report last July or September, June, just before the election. I was on the Advisory Panel of that, and because we are an open, engaged, medium-sized country in a world that is hyperconnected, but, or and, we have positions of influence that are global but also voluntary, we can’t absent ourselves from them, because we will then genuinely face a legitimacy crisis about what we’re doing there.

Dr Samir Puri

Thank you. I’m going to take a small collection of questions from online, because there’s a lot of engagement from our audience on this issue of conflict countries and aid. So Yusuf Isik has asked, “What is the attitude of conflict countries’ governments and the relevant great powers to overcome any obstacles to the access of aid for those who most need it?” Carl Wright, who is with the Commonwealth Local Government Forum, has asked whether “conflict and post-conflict countries receiving ODA,” whether it should be “best channelled to the sub-national and local community level rather than going through potentially a government that is actually in the midst of a conflict.”

And I think there’s a good example of this from the question from Lola Highlander, which is – thanks to you for the fascinating comments. Asks you about the humanitarian crisis in Syria, which I think brings a lot of these themes into sharp illustration. “What are the current key barriers to aid and humanitarian access since the fall of the Assad regime?”

David Miliband

So, let me start with that, because that actually exemplifies the earlier part of the – the earlier two questions. Syrians – the Syria example has taught me a huge amount. We worked throughout the Syrian Civil War in the North West of Syria, so where Hay’at Tahrir al-Sham were in control, and in the North East, where the Kurds were in control. We’d been told to leave Damascus before I started at the IRC, this was in 2009. So, we sustained our presence in the North West and the North East, where there we de facto authorities. And this is a big part of the new geopolitics. There are – if you read our emergency watch list from December, there are 42 de facto authorities around the world, up from about, I think, 13 ten years ago, so a significant increase in non-state actors in control.

We’ve now, obviously, moved to a whole of Syria approach. What did we find? I’ll give you one example. The health and hospital system is much worse in the government-held areas than in the rebel-held areas. Really interesting, despite the fact that the whole UN system was focused in Damascus and the Assad regime, with its Iranian and Russian support, so it wasn’t delivering for its own citizens. You can begin to put two and two together if you want to try and figure out why the regime collapsed, and that takes me beyond the humanitarian mandate. But I think there’s a lot that’s significant about the fact that we were able to operate in a principled humanitarian way in the North West of Syria since 2013, because that speaks to the earlier part of the question.

To Carl Wright, who’s been a long campaigner for the importance of sub-national local governments, I totally agree with him. All of our experience is that if you channel through civil society, you have less corruption, more legitimacy and acceptance, and you can get to people. Now, I was in Ethiopia in January, and the government is strongly supporting us to be their partner, both where they are able to deliver and where they’re not able to deliver. That’s a very forward-thinking way of conceiving of the role the – this was the Health Ministry that we worked with there.

So, I think that, I mean, in answer to the first question, the humanitarian principles of neutrality, impartiality, independence, humanity as well, are our best defensive shield for getting to places where you’ve got de facto or non-state actors in control.

Dr Samir Puri

Great, thank you very much.

David Miliband

Well, I should also say…

Dr Samir Puri

Yeah.

David Miliband

…we’re facing a crisis of access in Sudan, a crisis of access in Gaza, you name it. I mean, it’s a massive set of problems.

Dr Samir Puri

Thank you. Let’s come back into the room. So, we’ve got a question from the lady at the back, just with the green top, there.

Helena Stolnik Trenkić

Thank you. My name is Helena Trenkić. I’m a PhD candidate at the University of Cambridge, and I wanted to put another Gordian Knot to you, which is I convened a panel in October on reproductive rights in conflict-driven humanitarian crises with, like, IVPF and Care International and Women Deliver and somebody from a refugee camp on the Kenya-Sudan border. And the problem here was that you have, you know, decreased services, obviously, but you also have increased incidents because of sexual violence in conflict and so on.

But then even when you do have access, you have unnecessary, in my opinion, political inhibitions on how you can spend funding, which means that organisations cannot properly communicate with each other, cannot refer people between each other, and obviously now, with America, this has only got even worse, and meanwhile, deaths related to pregnancy or unsafe abortion is one of the driv – it’s the leading cause of death for 15-19 year old girls. So, my question is, I completely agree with you that we need to follow the data, but what happens when you come up against this ideological, dogmatic refusal to look at the evidence? How can we cope with this?

Dr Samir Puri

Let’s take that as a standalone, ‘cause it’s a really important point. It captures the difficulties of the moment we are – the unique difficulties, I think.

David Miliband

Yeah, and I mean, I think there’s two statistics I want to put together. One is yours, about girls, women, aged 15 to 19, but also, correct me if I’m wrong, since you’re the PhD candidate, but I think I’m right in saying 60% of women who die in childbirth in – die in fragile and conflict states, and they die – the major cause is bleeding after giving birth. It’s – you don’t need secondary care. Self-care could save those lives. We’ve actually – I’m sorry – I mean, I hope we can maybe link up with you for your next seminar, ‘cause we’ve got some real experts there.

Now, all I can tell you is what we do, which is when someone says “no,” we then try and find another way to reach the population. And so, in the case that you cite, which is of a decision by the US that anything that involves abortion or even referrals to abortion services by non-American organisations, you can’t use American funds or even partnerships with, then you have to find other ways of reaching, you know, other funds. Now, it’s been a very – even in the Biden years, when the Supreme Court made its rulings on abortion rights for Americans in America, obviously there was a big focus on reproductive rights, we tried to make the argument that yes, there was a big debate to be had in the US, but what about the global position? We found it very difficult to rally around that.

And so, maybe that’s the way we did it, I don’t know, but all I can say is we’re very, very committed on this issue. We have four research and innovation priorities in the areas that we – where we think there’s the greatest need for breakthrough, so around malnutrition, around education, around climate resilience, but the fourth is sexual and reproductive health, maternal and newborn health. So, we’d be very happy to work with you and learn from you on that.

Dr Samir Puri

Fantastic, and we had a couple of questions, actually, just here in the middle. So, I’ll take the lady with the green and white top first of all.

Ruby Kandola

Hi there, my name’s Ruby Kandola. I work in consulting at one of the Big Four. As part of my work, I work a lot with private companies, especially those within the financial services sector, who have a lot of financial capital. Now, a lot of these companies will have philanthropic wings attached to them, trusts or foundations that centre on giving to charities and NGOs. And I wonder, especially in light of the aid cuts, do you feel that the private sector has a role to play in addressing humanitarian issues, and if so, what do you think their role could be? Do you think they could do more? Do you think this should focus on giving to charities? How do you think that they could address some of the humanitarian issues going on in the world?

Dr Samir Puri

So, I’m just going to take…

David Miliband

Of course.

Dr Samir Puri

…actually, the lady just in front as well. We’ll take a pair this time.

David Miliband

Great question, thank you.

Dr Samir Puri

Go ahead.

Kalija

Hi, my name’s Kalija and I work in engagement, so my question is engagement focused. I’m from a – originally from Somalia, but I’m from the North side, where there is de facto non-state players. The reason the country was able to develop itself – it doesn’t have access to aid as much as other countries, ‘cause we’re not a recognised country, but the reason the country was able to develop itself and bring itself from war and famine and all of that, is the diaspora community had a massive impact on it, so like, Somalis that are around the world, in Australia, US, UK.

So, my question is have you guys explored that avenue where there’s conflict going on, where you’d have – where you may not be able to reach the local community, are you in touch with the diaspora community in the West, who can have a massive impact in terms of getting you guys to reach certain areas? In Somaliland, an example of how they’re able to cope is the diaspora taught themselves, taught skills, and that’s, like, a lifetime thing. So, is – technology is definitely a way of using that. Is that something that you guys are thinking about as an organisation?

Dr Samir Puri

That’s a great pair of questions. Please, let’s take those, yeah.

David Miliband

I mean, on the role of the private sector, I’m very careful not to say, “Government’s in retreat, you’ve got to replace them,” ‘cause I think that won’t work. What I say is, “Government’s in retreat from big problems. NGOs and the private sector need to step up to develop the solutions that we then try and persuade governments to back.” Because I think that the private sector will get – or it gets frightened off if you ask it to do government’s job. If you ask it to be a catalytic investor, if you ask it to be a matching investor – I mean, the London Stock Exchange Group is a big partner of ours on emergency response. Citigroup have done a lot of work with us on employment and livelihoods. In both those cases, we’re not saying, you can replace the government, we’re saying, “You’ve got a different role.”

And I think there’s a really big point, which is that if the private sector, which has been big beneficiaries over the last 30 years of globalisation, don’t defend its benefits and take on its responsibilities, then it’s not going to benefit from the next 30 years of globalisation. And I don’t know if that registers or not, because the com – I’ll be very honest with you, the competing fear in the private sector is that they get deemed to be political merely for the fact of trying to help, for example, refugees, which is a really, sort of, shattering situation. When I arrived in America ten years ago, I was told that refugee resettlement was a bipartisan issue, which it was. I mean, Ronald Regan admitting more refugees to America than any other American President, after the 1980 Refugee Act. So, I think it’s really important there’s a collective defence by the private sector of its, if you like, wider response – stakeholder responsibilities.

And then, on the second question, very interestingly, I remember – are you from Somaliland?

Member

Yeah.

David Miliband

Yeah. I had very big delegations to King Charles Street 15 years ago from Cardiff, where I think there’s a very large Somalilander population. I’m not sure I fully satisfied them. I think that we’ve tried hard to reach diaspora populations, not so much for access, but for funding, I think is the simple answer to the question. The access has to be negotiated locally, and we’ve had varying degrees of success, I would say.

Dr Samir Puri

Great. So, we’ve got a question from Chris just here, at the – nearer the front, if you can bring the microphone. Oh, just over here, just in the front.

Christopher Sabatini

Hello, I’m Chris Sabatini. I’m the Senior Research Fellow for Latin America. You mentioned that conflict is one of the major sources of extreme poverty and that we’re seeing in the human suffering, and you’re correct. The problem also, though, and I work on Haiti, is that yes, you have the architecture that’s intended to provide security that allows for even the most basic humanitarian assistance simply has failed. An effort in the UN Security Council to establish a UN peacekeeping mission fell – ran aground on Chinese and Russian opposition. An effort to create a multilateral support – security support mission has floundered as well, though thank you for the Kenyans for attempting. How do you address this – these issues of conflict, when in fact the larger multilateral architecture and processes intended to establish some peace zones to allow the delivery of assistance is, I hate to sound dire, is failing?

Dr Samir Puri

Thank you, Chris. Let’s take another one. The gentleman in the check shirt…

David Miliband

You should hold on to that microphone. You should give us your answer.

Christopher Sabatini

Yeah.

David Miliband

You’re the Senior Researcher on Latin America. What do you think the answer is? I mean, because you’re right, I mean, it’s the two nightmare ‘political contexts’ harder than any others, one is the – and they’re contrasting. One is the Sudan, where you’ve got this internationalisation of a civil conflict, which is a growing theme of external actors making it hyper-complicated to get any kind of diplomatic resolution. The Haiti case is an opposite case. It’s very domestically generated. I mean, both of them are an absolute nightmare for us. We work through local partners in Haiti. I think we make a difference. Obviously, the worry we have is that if you become too successful, your money flows then become an attractive target. But you tell me. You will – will you…?

Christopher Sabatini

That’s happening with the Inter-American Development Bank and a cash transfer programme.

David Miliband

Yes.

Christopher Sabatini

So, they’ve had to halt it, because it was lining the pockets of the gangs. I think in this case, we just need to start to look for ad hoc models, a sort of a Coalition of the Willing, to use an infelicitous phrase, but have to resurrect it, I guess. In this case, I think there needs to be a Global South push, and I’m going to sound, kind of, partisan here in the sense that I think China and Russia need to be called out for their failure to live up to their claims of representing the Global South. And so, you know, building a coalition of the African Union, the Organization of American States, CARICOM countries that push for this.

And in some – but a Global South led, but a developed North funded initiative for a meaningful, sufficiently robust security force is what’s necessary, because I think for now, the UN Security Council can’t move, and the question then is, then the onus falls on the Global South, because these crises are going to become more and more common, and it needs to be organised, and it ain’t going to come through the UN Security Council.

David Miliband

Well, it’s very interesting you say that, and I’m sure – and I had to cut back some of what I was going to say, and one thing I was going to say was that there are a lot of knowns in this multi-aligned world, but there are also a lot of unknowns. And one of the unknowns, I was going to say, was whether and what sort of African solutions can be brought to scale to address African problems. But you’ve given a twist to it, which I think is very well-founded and well-made.

Christopher Sabatini

And there are success stories in Africa, Sierra Leone and Liberia…

David Miliband

Yeah.

Christopher Sabatini

…two success stories that can be highlighted…

David Miliband

Yeah, that’s why I phrased it there.

Christopher Sabatini

…and to avoid this, sort of, doom loop, exactly. Yeah, so, thank you for the question.

David Miliband

Okay, thanks, yeah.

Dr Samir Puri

And interestingly, in Chris’s point, with China, this “community of common destiny” and other phrases have come out. I think, especially at Chatham House, we are certainly very interested, as we all are, to see whether there is action on the notion of global governance provision that the Chinese Foreign Ministry is now actually talking about much more openly, is something that they are doing and about to do, whether it sits inside the Belt and Road or whether there’s something that actually sits outside, around some of these complex themes.

David Miliband

I mean, I’m very glad you’re doing that, because I think there’s a danger that, apart from engaging with China, there’s a retreat from engagement. Now, I’m pleased that the government here are actually pursuing an engagement strategy. In my own small way, I was in China in March, they’re not interested in moving into the humanitarian aid space. But they’ve got very hard questions to answer, and which they don’t have good answers to yet, about what role are they playing diplomatically in all sorts of place where they are big players economically, but are not benign – but are less than benign when it comes to the diplomatic resolution? And I think it’s really good if you’re engaging on multiple tracks on that.

Dr Samir Puri

Brilliant. There’s a cluster of questions just in the corner here, so I’ll take the gentleman with the – just that there, and then the gentleman next to him afterwards.

Owen Gormley

Thank you, and it’s Owen Gormley. I’m an MA student at King’s College London and a former Gavi, Vaccine Alliance, as well. My question was linked, and I suppose, how – you mentioned about synergies, I was curious how organisations like the IRC and Gavi can continue – and other organisations continue to have synergies and innovate – and create innovation, when, you know, both the expertise – the budget, a lot of the expertise are going to be challenged in those organisations, with cuts around aid and if the UK and other partners don’t support that. And really, in terms of the tolerance required or risk for these programmes, particularly in fragile settings for community – for civil society organisations, for engagement with non-state partners. I’m curious if you think the donors – if the UK have strong enough tolerance for that risk that’s required to be able to meet the needs that they have.

Dr Samir Puri

Brilliant, and we’ll take a couple in one go. So the gentleman just two over to your left, yeah?

Mark Mardell

Hi there, Mark Mardell, Chatham House member. Just going on to a couple of points raised earlier with regards to the, sort of, multiple state actors and the BRICS and, sort of, the Global South. The risk of decline in the, let’s say, G7 funding base, is that – are you seeing that that is, kind of – is there countervailing force with other actors coming in under the auspices of aid, but, you know, have military non-humanitarian, sort of, objectives, which is thus increasing not just the barrier to entry, but also a barrier to entry in a declining, sort of, funding base? And how is that, sort of, affecting the aid dynamics globally with respect to, you know, a wider G7 or wider, sort of, you know, political and humanitarian impact?

Dr Samir Puri

Super. Let’s take those two right now.

David Miliband

On the first, I think for Gavi, for the Global Fund and for the World Bank, all of which have really excellent, in two cases, new leadership, in the case – relatively new in the case of the World Bank and in the case of Gavi. Excellent leadership, but a prevailing assumption that the route to delivery is through governance. And the burden of what I’m saying is that we’ve got to normalise the idea that delivering through non-state civil society actors can sit alongside supplementing, complementing what government does where it does exist and what government can’t do where it can’t reach.

Now, the rebuttal to that is often, “Yeah, but that’s not sustainable, because in the end, you need government to be able to do everything.” And the more I think about it, you stop and you think, well, hang on, in our own societies government doesn’t do everything, right? So why should we think that the perfect end state is the government does everything? It’s not. And actually, you want a society in which there is a legitimate and effective government, but you need a strong and respect for property rights private sector, and you need an active and independent civil society. And so, I think we’ve got a real intellectual, political argument to have with the intergovernmental, multilateral, multi-aligned institutions, that it’s going to be normal in the modern world to deliver through and with civil society, not just through governments. And it’s still ‘exceptional’ for the World Bank to work with non-state civil society actors.

On risk tolerance, I love that question because obviously, it’s the hardest thing in government. But we run a $2 million a year innovation fund as part of our $25 million Research and Innovation Team, and we boast of a 40% failure rate. And the funders from the venture capital community say, “No, you need a higher failure rate, because otherwise you’re not taking enough – you’re not thinking radically enough.” And obviously that’s hard in government, but when people ask me, “How do IRC teams sustain hope in the midst of crisis?” I always point to three things. One, a bias to action, two, standing up for universal values, but three, risk appetite. You’ve got to take risk, otherwise you’re not going to reach people. And then I feel like saying, the biggest risk is not to try, because then those people won’t get help. And so, we’ve got to flip it on its head, and one way of doing that is to use this cost efficiency and cost effectiveness thing, because I guarantee you, $3 a dose, £3 a dose, $4 a dose to deliver a vaccine dose in East Africa is cheaper than any governmental system.

On the – on Mark’s question, it’s early days, Mark, it’s very early days. We’re at day 99 today, so other people’s budgets haven’t caught up with the cuts that have been made. We don’t yet know what the full scale of the cuts are going to be. We don’t know what the future of American aid programmes are going to be, so it’s early days. We – I think the Treasury Secretary – the US Treasury Secretary said last week – was inferred to say that the US would be staying inside the World Bank and the IMF. I mean, I very much hope they meet their commitments to IDA, the International Development Association, part of the World Bank. So point one, it’s early days and so, there isn’t an infusion. In 2017, there was an infusion of funds from Europe to make up for USAID cuts. Europe’s not in a position to do that at the moment.

The second thing, though, it’s not just the aid cuts. The report of the US closing all of its embassies in Southern – in Africa resonated very, very strongly in the continent, I think. And I won’t get the quote right, so I won’t try and repeat it, but the Director General of the WTO, Mrs Iweala, I mean, effectively said, “Well, you’re saying Africa’s going to be on its own and is going to have to do without you. Well, okay, we’re going to do without you, and we’re going to have to” - you know, please check the quote to say exactly what she said. But I think that we’ve felt some of that as well, and that’s – and we don’t know how that’s going to play out yet, but I think that there’s more evidence of that second reaction than there is of different funding sources coming in.

Dr Samir Puri

Thank you, and I do apologise if I haven’t had time to take your questions. I think the lady just in the front also had a question, in the white shirt, just here.

David Miliband

Yeah.

Jas

Sorry, Thank you.

Dr Samir Puri

Please make it quick, ‘cause we’re running out of time, but we have – we do have time.

Jas

Okay. Hi, my name’s Jas. I’m coming from Save the Children UK, where I work across both our global programmes and more recently public affairs and campaigning, with a specific focus on responding to the aid cuts. My question maybe branches a bit off of what you’ve just, sort of, been speaking about, which is where the system is changing and we don’t know what that’s going to look like, but with the US having a massive retreat and not seeing how that might change in the imminent future. We’ve spoken a bit, or you’ve spoken a bit about how wealthier countries in Asia and the Middle East could come and step in and take a role. My question is how can they be incentivised? Although I don’t know if ‘incentivised’ is the right word, but how can we bring them into that humanitarian and aid space, when that traditionally hasn’t been theirs?

Dr Samir Puri

Great, thank you very much, yeah.

David Miliband

So I’m a big believer in programmes that work. I mean, sorry to put it like that, but let’s take our immunisation programmes, our malnutrition programmes, our violence against women programmes, and let’s use them as the battering ram against scepticism. That, I think, is the right way to do this, ‘cause there’s often – for all the strength of the 0.7% campaign, it was about a figure that people couldn’t get their heads round. It wasn’t about there are 45 million acutely malnourished kids today, and actually there’s a programme that could reach them, and instead of 80% not being reached, we could reach 80% of them. I think it’s – we’ve got to summon common will through programmes that have demonstrated value for money and impact.

And we’ve, as you probably know, we’ve really made a push at IRC to be the solutions NGO. There are other reasons why suffering children aren’t put on adverts anymore, but the biggest reason is that actually, it’s the wrong end of the challenge. The challenge has got to be there’s a proven programme here that can make a difference, why aren’t you part of the coalition to address it? And I’ve been real – I’m really urging the UN system, which is so – where process is so important, to make product and impact, product’s not quite the right word, but impact, the real lodestone. We should be challenging our publics, our governments, why aren’t they backing proven programmes that would reach tens of millions of people?

And that, I think, is the right way to conceive of the next part of this agenda, because the disinformation about what the aid sector is has been demonising not just of the work we do, but of the populations that we help. And I think that’s what we have to take on.

Dr Samir Puri

Well, I want to thank you, David…

David Miliband

Of course.

Dr Samir Puri

…for your comments, but also ending on an energising note in terms of a positive sense of bandwagoning around what works, because these challenges aren’t going to go away, even if the global context in which they are being responded to has changed beyond recognition in a very short space of time. Apologies once again if I didn’t get to your questions this time round. David, I hope you’re going to be able to come back…

David Miliband

Thank you, hopefully, yeah.

Dr Samir Puri

…sometime to Chatham House and to pick up some of these themes, but in the meantime, let’s thank you for your time today. Thank you very much.

David Miliband

Yes, thanks.