From the Guardian writer Unni Karunakara of Medicines San Frontiers asks the question of why aid seems to be ineffective and puts the blame on the United Nations.
It is against this backdrop that many non-governmental agencies have launched fundraising appeals, even while their post-earthquake coffers remain filled. The UN's Office for the Co-ordination of Humanitarian Affairs (OCHA) has repeatedly claimed that underfunding of its $174m cholera appeal, launched primarily to benefit private groups, is hampering the response – despite the fact that Haiti is the top-funded UN appeal for 2010. As nearly a million Haitians remain homeless in the face of a full-blown public health emergency, arguments that existing funds are tied up in longer-term programmes ring hollow.
The inadequate cholera response in Haiti – coming on the heels of the slow and highly politicised flood relief effort in Pakistan – makes for a damning indictment of an international aid system whose architecture has been carefully shaped over the past 15 years.
Throughout the 1990s, the UN developed a significant institutional apparatus to provide humanitarian aid through the creation of the Department for Humanitarian Affairs in 1992, later renamed OCHA, all the while creating an illusion of a centralised, efficient aid system. In 2005, after the Asian tsunami, the system received another facelift with the creation of a rapid emergency funding mechanism (CERF), and the "cluster" system was developed to improve aid efforts.
The aid landscape today is filled with cluster systems for areas such as health, shelter, and water and sanitation, which unrealistically try to bring aid organisations – large and small, and with varying capacities – under a single banner. Since the earthquake, the UN health cluster alone has had 420 participating organisations in Haiti.
Instead of providing the technical support that many NGOs could benefit from, these clusters, at best, seem capable of only passing basic information and delivering few concrete results during a fast-moving emergency. Underscoring the current system's dysfunction, I witnessed the Haitian president, René Préval, personally chairing a health cluster meeting in a last-ditch effort to jump-start the cholera response.
Co-ordination of aid organisations may sound good to government donors seeking political influence. In Haiti, though, the system is legitimising NGOs that claim responsibility for health, sanitation or other areas in a specific zone, but then do not have the capacity or know-how to carry out the necessary work. As a result, people's needs go unmet.