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Emergency Aid refers to help given to populations affected by unpredictable natural disasters or human conflicts. It is often very difficult to calculate the cost-effectiveness of disaster relief because charities do not provide information about their achievements and because there is so much variation between each disaster. From the existing evidence, however, we do not believe that emergency aid charities are typically among the most cost-effective.
Recent Natural Disasters
2011 Horn of Africa drought and famine
Since mid-2011 the Horn of Africa has been experiencing a terrible drought following two consecutive failed rainy seasons in 2010 and 2011. Whether through direct impact of the drought or through the influx of refugees, the countries experiencing the worst of the crisis are Djibouti, Ethiopia, Kenya, and Somalia. The impact of the drought and the extraordinarily high levels of malnutrition that have ensued, combined with internal and cross-border population displacement and conflict, has exacerbated physical and food insecurity and resulted in a crisis estimated to involve in excess of 10 million people. The World Health Organization (WHO) reported that ‘Global acute malnutrition (GAM) rates in some areas of Somalia at one point reached nearly 50%, with death rates exceeding 6 per 10,000 per day’.1
2010 Pakistan floods
In August 2010, the floods that swept Pakistan reportedly affected 20 million people in 78 districts and killed nearly 2,000 people. As well as this, the floods damaged or destroyed about 2 million homes and 514 health facilities and swamped a land mass the size of England. Before the flood, Pakistan already had about four million internally displaced people and refugees due to the war along the Afghan border and the 2005 earthquake in Khyber-Pakhtunkhwa (formerly North-West Frontier Province). Even before the flood, health indicators in Pakistan were bleak, with maternal mortality at 230 (190–280) per 100,000 live births and under-5 mortality at 89 per 1,000 live births. Most of the populations affected by the floods were comprised of the lowest socioeconomic quintiles and were already facing neglect.2
2010 Haiti earthquake
Many will remember the shocking news reports from 12th January 2012, when an earthquake measuring 7.0 on the Richter scale shook Haiti. The epicenter of the earthquake was 17 km from the capital Port-au-Prince, which had a population approximately 2 million. The earthquake ‘inflicted significant damage, particularly to critical infrastructure, including basic utilities, transport, communication, and health’.3
Many structures collapsed, including hospitals and health centers in the Port-au-Prince area, with heavy loss of staff. One of the most disastrous loses was the destruction of the drinking water and sewer systems.
Following the earthquake, immediate health priorities included search and rescue for survivors trapped underneath the rubble, providing surgical/medical services to treat injured survivors, preventing wound infection and providing shelter, food, clean water, and sanitation.4
2004 Indian Ocean earthquake and tsunami
On the morning of Boxing Day, 26th December 2004, an earthquake that measured 9.0 on the Richter scale struck the west of northern Sumatra. The quake triggered a powerful tsunami that swept the coasts of neighboring countries and caused serious damage and loss of life. At least five million people were affected in Indonesia, Sri Lanka, Maldive Islands, India, Thailand, Seychelles and Myanmar. The death toll was immense (exceeding 280,000 people) and more than one million persons were displaced as a result of the destruction.5
Beginning in 2002, a conflict between the government of Sudan and rebel groups (members of the SLM/A and JEM) resulted in the displacement of at least one million people in the Darfur region of Sudan. A commission found that government forces and militias conducted ‘indiscriminate attacks, including killing of civilians, torture, enforced disappearances, rape and other forms of sexual violence, destruction of villages and pillaging’.6
The extensive destruction and displacement resulted in a loss of livelihood and means of survival for countless civilians. The vast majority of the victims of all of these violations were from so-called “African” tribes.7
Most charities that focus on emergency aid do not provide sufficient information to estimate, even to a very rough extent, the valuable outcomes of their spending on a particular disaster. The reasons for this vary. Sometimes they provide very little information of any sort about their achievements. Sometimes they describe only a small subset of their achievements. Sometimes they record only ancillary outputs (such as the number of people who have attended a course) that do not reveal an intervention’s potentially valuable outcomes. And sometimes the descriptions of their achievements are unhelpfully vague: for example, many charities give the number of people a project has “helped” or “reached” without describing how. As it's very difficult to assess cost-effectiveness with this type of “anecdata”, Giving What We Can will be looking at how cost-effective interventions in this area have the potential to be by looking at interventions that have good reputations in that regard.
DEC’s “Headline Achievements”
The Disasters Emergency Committee (DEC) is an umbrella organization for up to 14 leading UK aid agencies, the mission of which is to “finance relief for people suffering major disasters in poorer countries.” According to their website, they ensure that ‘at least 50 percent of appeal funds forwarded to their member agencies go towards supplies and materials, although the figure is typically more than 60 per cent. The remainder pays for support, including employing staff, transport, and monitoring.’
The DEC’s list of “Headline Achievements” for its 2010 Pakistan Floods appeal is a good example of how difficult it is to measure outcomes of emergency aid.8
The DEC gives the total raised and a large list of achievements, such as “290,000+ people provided with emergency shelter” and “10,000 people supported with cash for work”. This allows only an extremely rough estimate of outcomes and it is difficult to compare even this relatively informative list to what is achievable with donations to our recommended charities.
Ready-to-Use Therapeutic Food
Ready-to-use therapeutic food (RUTF) is a widely used treatment for malnutrition in famines. Plumpy’nut—a paste made with peanuts, milk powder, sugar, vegetable oils, and a fortified vitamin and mineral mixture—is probably the best known ready-to-use therapeutic food. RUTFs can be consumed directly by children and provides sufficient nutrient intake for complete recovery from malnutrition.9
It has been estimated that it costs one dollar to feed one child for one day with RUTF. This covers only the food itself, and does not include staff, administration, finding cases, distributing food, providing security and more. One peer-reviewed paper estimates the cost of a life year gained with RUTF to be between US$12 and US$132.10
Another estimates the cost of a DALY to be US$53.11
http://www.ncbi.nlm.nih.gov/pubmed/20950075 , GiveWell suggested that these studies probably covered above average RUTF interventions, and a donor’s marginal dollar is probably buying a marginal, below average intervention. We are very grateful to GiveWell as always, as they were helpful in our research of RUTFs, though they have not yet published on the subject. (Close footnote)
However, while even the best estimate of the cost-effectiveness of RUTF is lower than our estimate of our recommended charities’ cost-effectiveness, it is sufficiently high to merit further research.
The “fungibility argument” provides a strong theoretical reason to doubt that a donation of x dollars to many particular disaster relief projects will increase the amount they spend on that project by x dollars. This applies both across and within organizations. The most cost-effective disaster relief interventions, such as RUTF, are well known to major charities, who can already fund those interventions to the extent they think cost-efficient. This provides a moderately strong reason to think that they will fund them to the extent that is cost-efficient during a disaster situation. If this is the case, it is not cost-efficient for donors to try to increase the amount spent on these interventions, even if the organizations carrying them out can overcome the issue of fungibility. Donations may end up funding a different intervention altogether, and could be better spent by giving to our recommended charities.
Emergency aid is a very difficult type of intervention to assess; because it is so wide-ranging, there is little quantitative data, and each emergency is unique. When charities do provide sufficient information to roughly estimate the valuable outcomes of their spending on a particular disaster, the outcomes do not appear to better or even match those of donations to our recommended charities.
However, though there is reason to think that, in many cases, there will be little room for more funding, the best interventions in this area may be sufficiently cost-effective to be worth looking into further.
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