Is aid failing?

Summary

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Inside Geneva: "Is Aid Failing?"

Host: Imogen Foulkes
Date: May 26, 2026
Produced by: SWI swissinfo.ch

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Episode Overview

In this urgent and revealing episode, Imogen Foulkes and guests confront the escalating crisis in international humanitarian aid. Against a backdrop of shocking funding cuts, ideological realignment, and the dismantling of major donor agencies (notably USAID in the US), the podcast explores whether the current aid system is failing those who need it most. Key themes include the current Ebola outbreak, the impact of donor politics on gender and reproductive health, and deep debates about localization, reform, and the resilience of the humanitarian system under extreme pressure.

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Key Discussion Points & Insights

1. Humanitarian Aid at a Breaking Point (03:03–06:18)

• Severe funding cuts from the US, UK, Germany, and other traditional donors are creating existential threats for aid organizations and leaving millions at risk.
• There is a growing urgency for structural reform—not as a mere response to budget cuts, but out of recognition that the aid system has long been inefficient and inequitable.

"It is a catastrophe. It is not an opportunity. But now we have an obligation to transform the system."
— Carl Blanchet, 01:31/07:32

2. The Lancet Report: Aid Is Not Working (06:18–10:46)

• Carl Blanchet and Esperanza Martinez highlight their new Lancet report arguing that the system is failing, even before recent cuts.
• Emphasis on the need for radical change: more power and funding directly to local organizations, less duplication, and greater accountability to affected communities.
• Example: Sudan's Emergency Response Rooms (community-led, now Nobel-nominated) and the White Helmets in Syria as proof local actors are more effective.

“All the right minds need to be around the table to reshape and revisit how the system is organized.”
— Carl Blanchet, 07:32

• Nevertheless, donors still demand stringent reporting and oversight, often stifling local agency.

3. Structural Problems and Accountability (12:25–15:43)

• Esperanza Martinez stresses that duplication, top-heavy structures, and failure to cede power to local actors have long been recognized but little changed.
• The sudden, abrupt nature of recent funding cessations will directly result in unnecessary deaths, especially in fragile health systems like the DRC during the Ebola crisis.

“There are going to be excess deaths, millions of people that are going to die that shouldn’t have died because of these funding cuts.”
— Esperanza Martinez, 01:46/14:03

• Martinez calls for real localization, autonomy, and resource transfer to the real first responders: communities themselves.

4. Politics and the Erosion of Impartiality (15:03–16:50)

• Donor agendas are increasingly ideological, putting conditions (often anti-gender or anti-reproductive health) on aid.
• Martinez warns this trend distorts priorities and undermines rights for women, LGBTQ+ people, children, and the elderly.

“Those conversations ... need to be louder and ... associated with accountability and with compliance moving forward.”
— Esperanza Martinez, 15:43

5. Gender Perspective: Dangers of New US Policy (18:58–26:27)

• Hannah Reinel explains that in crises like Ebola, women disproportionately bear the burden and are at higher risk due to their caregiving roles.
• The US’ new PHFFA policy (Promoting Human Flourishing and Foreign Assistance) unites three ideologically motivated rules (“Combating Gender Ideology,” “Protecting Life,” and “Combating Discriminatory Equity Ideology”).
• These rules introduce ambiguity, create a chilling effect, and essentially penalize or prohibit funding for sexual and reproductive health, even extending these restrictions to non-US-funded programs of recipient organizations and governments.

“...everything relating to sexual and reproductive health seems a bit more off limits. ...Even mentioning abortion as a method of treatment... would be considered prohibited under the policy.”
— Hannah Reinel, 21:52/21:52

• The new US rules could impact $40 billion of aid across 160 countries, with organizations forced to self-censor to avoid losing funding.

“This is a really sweeping change... the danger of the policy lies... in the fear of what non compliance might mean for organizations.”
— Hannah Reinel, 24:00

6. The USAID Dismantling and On-the-Ground Impact (27:24–32:00)

• Nicholas Enrich (former Acting Assistant Administrator for Global Health, USAID) shares frontline insights from 2025, when USAID was abruptly dismantled by the Trump administration.
• Leadership “decapitated,” programs frozen—US response capacity to Ebola all but collapsed.
• Political appointees displayed “disdain” for established outbreak response procedures; critical PPE left unused in WHO warehouses due to the US withdrawal and refusal to collaborate.

“It was absolutely terrifying. ... All of our programs were frozen. We weren't allowed to communicate with anyone. Our leadership had been decapitated.”
— Nicholas Enrich, 27:24

• Result: US agencies went from “first on the scene” in outbreaks to “the last ones to find out,” with inefficiency and delays.

“Now, instead, the State Department is trying to respond to this, something they've never done before, without the expertise, without the structures, and without the know-how.”
— Nicholas Enrich, 30:48

7. Reform: Trap or Opportunity? (32:58–35:34)

• While some see current chaos as a bitter opportunity to drive reform, others caution that deep, strategic change is unlikely in crisis mode with decimated budgets.
• Enrich argues the system became vulnerable to attack due to years of resisting reform, yet—if re-engagement is prioritized—there is a rare chance for a “fresh start”.

“The one silver lining... is they've really torn down that bureaucracy and given us an opportunity for a fresh start when we move forward.”
— Nicholas Enrich, 33:51

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Notable Quotes & Moments

• Carl Blanchet on Reform:
  “All the right minds need to be around the table to reshape and revisit how the system is organized.” (07:32)

• Esperanza Martinez on Deaths from Funding Cuts:
  “There are going to be excess deaths, millions of people that are going to die that shouldn’t have died because of these funding cuts.” (14:03)

• Hannah Reinel on PHFFA Policy:
  "If you have funding coming from other sources... you can still be penalized as an entity if you're viewed to be non compliant." (24:00)

• Nicholas Enrich on Experiencing USAID Collapse:
  “It was absolutely terrifying... Our leadership had been decapitated. ...The new political leadership did not care and had no interest in dealing with this.” (27:24)

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Important Timestamps

• (06:18–10:46): Blanchet and Martinez discuss the failings of the humanitarian system and the call for localization.
• (12:25–14:03): Martinez’s assessment of the consequences of aid cuts during the Ebola outbreak.
• (15:03–16:50): The politicization of donor aid and threats to rights-based approaches.
• (18:58–26:27): Reinel’s gendered analysis of Ebola and the chilling effects of the new US policy.
• (27:24–32:00): Enrich recounts firsthand experience of USAID’s dismantling during the Ebola crisis.
• (32:58–35:34): Debate over whether today’s crisis is an opportunity or trap for real reform.

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Tone & Language

The episode alternates between analytical, urgent, and personal. The experts speak candidly about what they view as catastrophic failings, the loss of life already visible, and the chilling political interference shaping today’s humanitarian landscape. The tone is thoughtful, but underscored with deep concern, sometimes bleak, sometimes tenacious in its hopes for overdue change.

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Summary

“Is Aid Failing?” gives listeners an unvarnished look at a humanitarian sector in crisis, buffeted by politics, savage budget cuts, and the collapse of traditional systems. Expert guests detail both the depth of the current challenge—millions at risk and fundamental principles under threat—and the stubborn hopes that out of this catastrophe might finally come change, if the political will can be found. Highly recommended for anyone grappling with the realities and future of international aid.

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Transcript

[Swiss Connection Science Podcast Host]

The Swiss Connection Science Podcast is back with brand new stories. They're all connected by one overarching the climate challenges we face today and the smart solutions that can help us tackle them. This season, we're diving into the depths of Swiss lakes where invasive mussels are threatening the delicate indigenous ecosystem. We'll also travel to the Arctic to discover how ancient ice can reveal vital clues for pioneering climate research. And we'll explore the critical world of the semiconductor industry, looking at its global importance and Switzerland's potential role within it. All this and more is coming soon in the new season of the Swiss Connection Science Podcast. Swissinfo podcasts.

[Imogen Foulkes]

This is Inside Geneva. I'm your host Imogen folks and this is a production from swissinfo, the international public media company of Switzerland. In today's program, the shock dismantling of

[Nicholas Enrich]

the U.S. agency for International Development is reverberating around the world.

[Imogen Foulkes]

A coup Covid and Cuts Myanmar is already a nation in turmoil. The slashing of the UK's foreign aid budget has come at the worst possible moment.

[Carl Blanchet]

It is a catastrophe. It is not an opportunity. But now we have an obligation to transform the system. There is no other way the human system can survive this crisis without any changes.

[Esperanza Martinez]

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 to be excess deaths, millions of people that are going to die that shouldn't died because of these funding cuts.

[Imogen Foulkes]

An outbreak of Ebola in the Democratic Republic of Congo has been declared as

[Interviewer (Possibly Imogen Foulkes or another host)]

a public health emergency of international concern

[Imogen Foulkes]

by the World Health Organization.

[Hannah Reinel]

Every process in society follows a gendered pattern. So it's often going to be the women who are the caretakers of the sick people. It's going to be the women who are washing the bodies of the dead and are preparing them for the burying ceremony.

[Esperanza Martinez]

With US Secretary of State Marco Rubio stating the World Health Organization was a little late in identifying it.

[Nicholas Enrich]

The World Health Organization has unfortunately not done well around the world.

[Hannah Reinel]

I think they failed miserably during COVID

[Nicholas Enrich]

They covered for China and that's how we're getting out of it. If the United States had not withdrawn from the World Health Organization, we would have been part of the WHO's response. Which means that on May 5, when WHO learned about this, the United States government would have learned about this. Instead, Rubio is saying that he didn't find out about this until ten days later. Well, maybe we shouldn't have pulled out of the WHO and we would have found out about this earlier foreign

[Imogen Foulkes]

hello and welcome again to Inside Geneva. I'm Imogen folks. Now everyone working in or with the United nations in aid and development on humanitarian projects knows the whole sector is facing huge challenges. Savage funding cuts, more conflicts and crises and a growing sense among seasoned aid workers 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. Radical root and branch change to make the system better. So in today's program we've got a series of in depth interviews that reflect clearly and concerningly where humanitarian work is in mid-2026. We'll talk to a team from the prestigious medical journal the Lancet whose new reports is aid system is failing those Most in need.

[Carl Blanchet]

I'm Carl Blanchet. I'm a professor at the Faculty of Medicine at University of Geneva. I'm the director of the Geneva center of Humanitarian Studies. I'm the co chair of the LANSD Commission on Health, Conflict and Force Displacement.

[Esperanza Martinez]

My name is Esperanza Martinez. I am a medical doctor and humanitarian worker. I currently work as a professor at the Australian National University. But my previous work was with the International Committee of the Red Cross in Geneva.

[Imogen Foulkes]

And we'll talk to a gender specialist who fears many, many traditional donor countries are putting conditions on their aid that could be damaging to women.

[Hannah Reinel]

My name is Hannah Reinel. I'm a project manager at the International Gender Champions Secretariat.

[Imogen Foulkes]

And for an even closer look at what's happening with the traditionally biggest donor of all, we'll talk to a man who had a front row seat as Elon Musk and his DOGE team dismantled the United States government's aid and development arm, usaid. And it all took place when, as again now, an Ebola outbreak had just begun.

[Nicholas Enrich]

My name is Nicholas Enrich. I was the Acting Assistant Administrator for Global health at the U.S. agency for International Development, USAID, in January 25 as the agency was dismantled by the Trump administration.

[Imogen Foulkes]

So a lot to look forward to in today's episode. And because we're now seeing one of the most serious Ebola outbreaks in years, we will spend some time looking specifically, specifically at that. Is the AIDS sector fit to cope? And how might the shift in funding and in ideology around aid affect how this outbreak is handled? We'll begin with that new report from the Lancet. In it, Professors Carl Blanchet and Esperanza Martinez conclude that the humanitarian system is failing millions of people. But work on their report began long before the US as well, as Europe and the United Kingdom decided to make such big cuts in overseas aid funding. So my first question to Carl Blanchet was, has the report missed its moment?

[Carl Blanchet]

This is exactly the right moment to publish this report. We started two years ago, and we were about to finish in a year from now. We started to accelerate everything because we could see that there were so many changes happening in the world. Gaza, Sudan, end of Syria and the new regime reconstruction, Yemen, the war starting, a lot of publicized emergencies. And now we publish that exactly at the heart of an antivirus outbreak and Ebola outbreak in Uganda and drc. This is exactly the right time. Why? Because we think that a lot of governments, a lot of donors, a lot of policymakers and UN agencies are making important decisions now. And we do think that they need to be well informed on the status of the system and on some key recommendations they need to take into account for their decisions.

[Interviewer (Possibly Imogen Foulkes or another host)]

So do you see the current funding cuts, which are repeatedly described to me as a catastrophe, a crisis, a disaster, do you see that as an opportunity, or somebody put it to me a trap?

[Carl Blanchet]

It is a catastrophe. It is not an opportunity. But now we have an obligation to transform the system. There is no other way the human system can survive this crisis without any changes. So this obligation does mean that all the right minds need to be around the table to reshape and revisit how the system is organized and structured. That's going to be a huge challenge. That's clear. But we do think that we can have a few changes in the next few years, and we do hope our work, our report and two years of work is going to help everybody to shape new ideas.

[Interviewer (Possibly Imogen Foulkes or another host)]

The report makes really stresses the idea that the money that goes into humanitarian aid needs to be better spent, and it's better spent by the local people who know what their needs are, who know their community. But I'm just wondering how you sell that to traditional donor countries where people are saying, we're struggling ourselves, we don't want to give any money at all, and if we do, we want to see exactly how it's spent.

[Carl Blanchet]

Yes, but absolutely maybe not, because a lot of donors is very keen to actually bring the localization agenda at the heart of the funding they just want to do. They want to know how, how do we do it? And when we bring in this report, this notion of performance of the response and accountability to affected populations, if we put that at the heart of the response a lot of donors are going to follow, it does mean that a lot of local organizations, NGOs and so on will have to be better performed, be more transparent on how they spend their money and deliver with being accountable to population. But I trust local actors who come from the community to actually respect more the needs and the voices coming from communities. A couple of examples. One comes from Sudan, where we have the emergency response rooms since 2023. And they have realized that the international response was not responding to the community's needs and was actually very partial because people stayed in a governed state and instead of going to the other or the front line, so they decided to get organized to call all the doctors and all the nurses and midwives and let's get organized. It's very much a community led organization. And now they receive money from the European Union. They were nominated for the Nobel Peace Prize and they are highly recognized. We have seen that with the White Helmets in Syria as well.

[Interviewer (Possibly Imogen Foulkes or another host)]

So the United nations at the moment is kind of fighting for its life. I mean, there's a whole school of thought. Again, we look to America. We just don't need it. People's society think maybe the US would actually leave. I mean, where do you sit with that? You're not talking about getting rid of the un but you just think reorganization,

[Carl Blanchet]

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 conflict response, we need UN agencies to be better aligned or to have not that many agencies being involved. There's a lot of fragmentation among the UN system. They take a lot of money as well from the international funding. We do think it's not really fair and this money could be reallocated to national actors. That's very clear to us. But we do think that the UN agencies, including who, for example, play a key role in guiding all the actors in terms of clinical guidelines, treatment guidelines and guidance, so that everybody is going to work with the same standards of quality. That is essential. But they will need to be reformed. We do think they will need to shrink a little bit. There are too many UN agencies. And for the local systems and local actors, they have no clue who is doing what in the system. So this has to change.

[Imogen Foulkes]

So Karen Blanchet advocates big changes in how we deal with aid. More local, more streamlined, less duplication. Some listeners like me may know that those ideas have been around and have come from aid workers themselves, even for many years. Blanchet's partner, Esperanza Martinez agrees that change is long overdue.

[Esperanza Martinez]

We know what's wrong and we have known it for A long, long time, for many years, that the structure was too heavy, that we have duplications in the humanitarian system, that the localization that was agreed and the evolution of power that was agreed in Istanbul, in the world humanitarian summit hasn't materialized. And so this report actually confirms that we haven't made the progress that was required. At the same time, it identifies concrete ways in which we could advance. For example, if we talk about inverting the power, it's not just localization in the sense of talking about it. It's actually giving the resources and the autonomy and seeding power and decision making and authority to the communities and to the local actors, who at the end of the day are the first responders. So there are concrete actions in the report that point out ways where we can use this transformative, pie, challenging and critical period on the humanitarian sector to actually move the needle. Because we are in a place where we are not meeting the needs of people.

[Interviewer (Possibly Imogen Foulkes or another host)]

I'm going to ask you to focus a little bit on this latest crisis, which is Ebola outbreak, a very serious one, much more serious than ones we've seen in the last few years. How do you kind of square in your head, you want lots of change in the way humanitarian aid is delivered. Right now we have a crisis where the funding that's available isn't just meeting the needs. Now, I know you say that the local people are already trying to meet the needs, but this is an area that's had conflict for decades. The national health system is in a very, very difficult situation.

[Esperanza Martinez]

The suspension of funding or the ceasing of funding by major donors, not only the US but also the uk, Germany and other donors, happen at a very critical period in the humanitarian sector. And as a result, there are going to be excess deaths. Millions of people that are going to die that shouldn't have died because of these funding cuts. Now, when you look at the humanitarian sector and the dependency on a few donors, you say, well, actually this was a crisis in the making, but no one expected this to be so sudden and so abrupt. However, in situations like drc, communities are not waiting for the international actors to arrive. Their healthcare workers, their community workers, the communities themselves. They are acting and they are responding. And I think that's where we actually identify who is acting, who is legitimate in the eyes of the community, and actually direct the funding directly there.

[Interviewer (Possibly Imogen Foulkes or another host)]

How do you see, though, the current shift towards. I mean, you talk about taking geopolitics out of aid, but in fact it seems to be going in the other direction. And There are many donor countries. The United States is clearly the one that is in the headlines now, which is determining, deciding how it will spend its money based on ideology. I mean, we see particularly the removal of programs that target gender or specifically promote women or reproductive health crisis like Ebola.

[Imogen Foulkes]

You absolutely need to involve the women and probably approach them separately.

[Esperanza Martinez]

The fact that those donors are also driving agendas that are against women, against gender inclusion, against certain specific diseases who are focused on one disease and not on the other, that also was a malaise of the system. That was, that was not working. So we have calls from middle powers to actually have the right conversations. And this is a conversation that is not only about money, it's about principles. I mean, women, people of diverse genders, children, elderly, they also have rights. They have the same right than other communities to health, to protection in situations of armed conflict. And those conversations, we need them to be louder and we need to be more associated with accountability and with compliance moving forward. We need to say, okay, who is actually violating the rights of civilians? Who is actually attacking hospitals and health facilities? And where is the accountability and the responsibility for that? And that is not necessarily related to funding, that is related to leadership and principal leadership.

[Imogen Foulkes]

Unfortunately, many listeners may indulge in a cynical smile hearing Martinez appeal for political leadership. A lot of people I talk to think that leadership is pretty thin on the ground nowadays. The UN and other humanitarian actors have been plunged into a cash crisis and into soul searching about how to go forward. Some are even fighting to survive. Coming up in the second half of the program is Washington's new ideology driven approach to foreign a harming women. And what does the end of USAID mean for crises like an Ebola outbreak? But before that, a quick heads up. Our next Inside Geneva podcast will be asking, what's the point of foreign aid at all? It's out on June 9th, but we're recording it with an audience at Geneva Graduate institute this Thursday, May 28th. It starts at 2pm and we've got a great lineup up. Chris Lockyer, outgoing Secretary General of Medicine Frontier, Djka Potzel, EU Ambassador to the UN in Geneva, Professor Gilles Carbonier, longtime Vice President of the International Committee of the Red Cross, and Jacqueline Lee, a master student in international development. If you're in Geneva this week, do come along. Meanwhile, back to today's podcast. 2026 has seen a new conflict in Iran. The closure of the Strait of Hormuz is pushing some regions of Africa closer to famine. There's no real peace for Gaza, nor a ceasefire in Ukraine. And now we're seeing one of the most dangerous Ebola outbreaks in years. Our third interview today is with Hannah Reinel, Project manager at Geneva based International Gender Champions. She had an important point to make about Ebola.

[Hannah Reinel]

If we look at the current outbreak, there's a lack of funding even for just basic hygiene and sanitation services. That is the first piece of it. The other one is that we need to understand that every process in society follows a gendered pattern. So it's often going to be the women who are the caretakers of the sick people. It's going to be the women who are washing the bodies of the dead and are preparing them for the burying ceremony. So who is more at risk of contracting Ebola? It's the women. And this is just one small example that I'm afraid we will see play out in a myriad of different ways.

[Imogen Foulkes]

So why does Reinhold fear that? Well, we know the US has cut aid savagely and more of that shortly when we talk to a former USAID official who witnessed those cutbacks firsthand. But we also know that more recently, Washington has offered some new money to specific hand picked crisis zones. It's not nearly as much as before, and Rynell told me it's all framed under a rather curious acronym, phffa, introduced by President Trump early this year.

[Hannah Reinel]

Yeah, so it sounds like another unruly acronym from the UN world. It stands for Promoting Human Flourishing and Foreign Assistance.

[Interviewer (Possibly Imogen Foulkes or another host)]

So that sounds quite promising.

[Hannah Reinel]

It does. And that's part of the trick, I believe. So it sounds unobjectionable. Right. Why wouldn't we want to promote human flourishing? I believe that this is by design already to even have a name that tricks you into thinking that this is something positive, when actually the changes it proposes are quite radical and really threaten the gender architecture that we work so hard to build here in Geneva.

[Interviewer (Possibly Imogen Foulkes or another host)]

Well, give me some examples then. What is it that's. That's raising the alarm bells with Geneva gender champions with you?

[Hannah Reinel]

Well, I think it's helpful to zoom out and first understand what it's actually made of, because it's a. It's an umbrella term that unites three different component rules. And so these rules are called Combating Gender Ideology, Protecting Life and Foreign Assistance, and Combating the Discriminatory Equity ideology. So this is what DEI now means for the US Administration. The policy entered into effect at the end of February this year. It's, as I said, quite radical in what it proposes, both in its reach and in its scope. And it's something that I think we need to take really seriously as a community of practitioners.

[Interviewer (Possibly Imogen Foulkes or another host)]

Let's try and unpick that a little bit. If an aid agency or an NGO is found to be in violation, what would be a violation? Funding a women's clinic which provided reproductive health advice, would that be one?

[Hannah Reinel]

The problem with this policy is the ambiguity that's really built into the design of it. I spent a lot of time reading through 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 of clarity, preferring to rather not touch something at all. Currently, based on my interpretation and also what I hear from other entities interpretation of the policy, yes, everything that's relating to sexual and reproductive health seems a bit more off limits. There are certain topics that are generally considered more appropriate in context with US donation conversations. So for example, anything related to maternal mortality is apparently a more palatable topic. But looking at abortion, for example, looking at sexual violence survivors, what I'm afraid this policy could really mean on the ground is let's say we have a post conflict setting. A girl becomes the victim of sexual violence and then does not even have a menu of options being laid out to her in terms of what, what the follow up procedures could be. Because even mentioning, for example, abortion as a method of treatment or family planning would be considered prohibited under the policy. The same goes for instance, for the distribution of post rape kids in conflict settings. Is this something that organizations just don't dare to venture into anymore because they are too afraid that it might come with financial repercussions for them?

[Interviewer (Possibly Imogen Foulkes or another host)]

I see parallels with the media actually here. This chilling effect that once you get pressure, political pressure about a particular subject, we can think of plenty of them. The Middle east is the big one at the moment that you start thinking, well, maybe we'll just leave that topic alone because we know we're just going to get in hot water for it. And you fear the same could be happening now with programs that directly target women's health or reproductive health?

[Hannah Reinel]

Exactly. And that is one of the huge concerns around this new policy. So if we start with what it applies to actually, and that's a big step and a qualitative leap from what we've seen in previous years. Does promoting human flourishing and foreign assistance policy, with all its sweeping prohibitions that it introduces, applies to foreign NGOs, to international and multilateral organizations, to recipient governments. So governments that receive aid directly from the US and as well to US based organizations, it overall is estimated to apply to an amount of close to 40 billion in humanitarian aid and foreign assistance of the US across 160 countries. That's huge, right? So this is a really sweeping change that is being introduced. And I believe where the danger of the policy lies is in one part, certainly in its implementation, but even more so in the fear of what non compliance might mean for organizations. Because what this policy spells out is that if you don't act in compliance with the various prohibitions that it introduces, the US will either not give your entity or your recipient state any money, or it even is entitled to remove money that has already been distributed. The other key shift that this policy introduces is that this doesn't only apply to US funding, but actually it means that if you have funding coming from other sources. So let's say you're funded by the Swedish government or the German government, the U.S. prohibitions or violations of those can also apply then. And that means even if you have a completely separate program that has nothing to do with US funding, you can still be penalized as an entity if you're viewed to be non compliant. Now what does that mean in concrete terms? I think it means that organizations first of all have to carry huge burdens in terms of the compliance. So there's very detailed provisions spelling out for organizations what they have to do in order to be recipients of US foreign aid. I believe that it means that organizations are likely to become more careful on how they use other donors money and that there will be a leap towards trying to avoid that financial risk at all cost by rather not touching the topic at all.

[Imogen Foulkes]

What Hannah Reinl is outlining there sounds a very long way from humanitarian aid's fundamental principles of impartiality and neutrality based on need. What will that mean for a crisis like Ebola? Our final interview today takes us behind the scenes in Washington in early 2025 when Elon Musk and his Department of Government Efficiency, or doge, were dismantling usaid. Nicholas Enrich has written a whole book about that called into the Wood Chipper, and we'll be discussing that at length with him in our Inside Geneva books to make you think episode out on Jo, June 23rd. For now, let's hear from him what it was like in early 2025 to work in global health at USAID while the department was being dismantled and an Ebola outbreak was taking place then too.

[Nicholas Enrich]

It was absolutely terrifying. First of all, I should say that I was totally unqualified to be in charge of dealing with this. I was promoted to be the Head of Global Health. Only when Doge had illegitimately pushed my boss and the 60 other most senior leaders at USAID onto administrative leave. All of our programs were frozen. We weren't allowed to communicate with anyone. Our leadership had been decapitated. The new political leadership did not care and had no interest in dealing with this. And this was the situation I was finding myself in, dealing with my first Ebola outbreak from a position of responsibility. I mean, there's no other way to describe it than just. Just fear and terror from my side of knowing that we were failing to respond. And I knew we wouldn't be able to put the robust response in place that USA is usually able to muster. But we even tried to get them to do things like screening at airports for passengers who were traveling on international flights to make sure they didn't have symptoms of Ebola before getting on airplanes. And we couldn't even get. Get the. The political appointees to sign off on that.

[Interviewer (Possibly Imogen Foulkes or another host)]

There's one which I was a jaw on the floor moment. The Doge team, when you said, there is this outbreak, we have actually committed to sending PPE protective equipment. I think it was in. Was it in Kenya? In Nairobi? They said, yeah, if you want it to get there, you can fly over there and hire a truck and take it yourself. This is astonishing.

[Nicholas Enrich]

Yeah. You know, it just kind of goes to show, like, the disdain that Doge and the political leadership had for our processes and systems. We had an outbreak response team that knew exactly how to respond to an Ebola outbreak because they've done it before. And all of those systems broke down. And it came to angry people who didn't understand what was happening, just kind of like slamming the table and wondering how they could do things differently. The problem was they didn't want us to access the PPE that the US Government had already paid for because it was being stored in a warehouse that was operated by the World Health Organization, which they were in the process of withdrawing from. And rather than engage briefly with the WHO to get that PPE into the outbreak zone, within hours, they decided that they would not do that. And weeks later, when news stories started coming about the PPE sitting in a warehouse while an outbreak was going on, Pete Morocco, again, the head of the agency at the time, ordered me to go and get it myself without talking to who, which I didn't understand what he meant. It turns out what he was actually talking about was me hopping on a plane, going to Nairobi, getting to the warehouse with a truck, getting the PPE somehow across the border into Uganda. And you know, I tried to explain that that was not feasible or legal. And the response that I got was simply that he emailed my boss and told me that if I didn't move that PPE within 12 hours that I should be fired.

[Interviewer (Possibly Imogen Foulkes or another host)]

Do you think. I mean, perhaps this is a stretch, but we've got a big, very dangerous, actually now Ebola outbreak in DRC which has been circulating for quite some time. And I hear on a daily basis from the agencies large and small, they are saying we are cash strapped. Do you think the, the cuts to USAID are in any way linked? I mean, this is an outbreak that's been circ. It's been circulating for at least two months, apparently.

[Nicholas Enrich]

Absolutely. I, I do think that the cuts to USAID are relevant and are slowing the response substantially. I mean, from initial detection all the way through where we are today, USAID had a playbook in place of how we would bring in a disaster assistance response team that would have been in the country within 24 to 48 hours to help coordinate the USAID partners on the ground who no longer exist because of the cuts to usaid. You know, we would have been able to pre position PPE in and we would have been able to have partners working to conduct contact tracing and support with risk communication and safe burial procedures, et cetera. ERA but instead we had that playbook. And now instead, the State Department is trying to respond to this, something they've never done before without the expertise, without the structures and without the know how. And even to the extent that they are trying to respond, the speed that we're losing is the difference between decisions that are made in hours and decisions that are made in days or even weeks. And so, yeah, I do think that if USA had still existed, the American government response would have been been much more swift and substantial.

[Interviewer (Possibly Imogen Foulkes or another host)]

What do you think about Secretary Rubio saying the WHO was late?

[Nicholas Enrich]

Yeah, I mean, to me, the first thing I thought about that was, was if we, if the United States 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 5, when WHO learned about this, the United States government would have learned about this. Instead, Rubio is saying that he didn't find out about this until ten days later. Well, maybe we shouldn't have pulled out of the WHO and we would have found out about this earlier. And, and that's one of the many, many, many reasons that we need to engage with the World Health Organization and other multilateral institutions if we're looking for effective global health response. And instead of being the first on the scene, the US Government turns out to be the last ones to find out. And then once we do, we're struggling to figure out what to do about it. And again, it just stands in stark contrast to the way that we would do outbreak response just a year ago.

[Interviewer (Possibly Imogen Foulkes or another host)]

Clearly you are, or I imagine, I assume from your answer there, you're not a big fan of the move to leave the World Health Organization. Can I ask you though overall about reform, maybe of humanitarian work? Because there is an ongoing soul searching debate here in Geneva that reform is needed, it should be less top down. I mean frankly that's something I've heard for 20 years. So it's not really new. Some people say that the cuts, not just from the US they're coming from Europe too, are a golden opportunity to reform. And others are saying this is a trap, the cuts are too savage. You're not going to have thought out clever reform in a climate like this. I just wonder how you see it.

[Nicholas Enrich]

I think those are both true, right, that reform is and was overdue. And unfortunately I actually think that that the resistance to reform over the last several years, as you put it, may have made it easier for, for the US to have made the decision to, to withdraw from the who. On the other hand, they probably would have done it anyway. I'm not sure that they were like looking very specifically at the reform efforts. But I do think that that did, did leave the WHO and other UN agencies vulnerable to these retaliatory actions by, by the United States. However, I do think that there is opportunity. I do think that the Ebola outbreak is just one example of how we're going to, it's going to become very, very clear over the next couple of years how important it is for the United States to re engage. And if global health remains a priority, which I believe that it will, we're going to need to re engage. But that engagement does not need to look the same. And hopefully this is an opportunity to implement some much needed reform. And I, and I mean for that both in terms of, you know, at the, at the WHO or multilateral level and also within whatever the US Government international Development and Foreign assistance portfolio looks like. I think that we all get caught up in, in the way things were and bureaucracy builds upon itself. And the one silver lining of, of what the Trump administration has done is they've really torn down that bureaucracy and given us an opportunity for a fresh start when we move forward. I don't think it's it's a good thing that, that we've gotten here, but we do need to take advantage of the opportunities that are there.

[Imogen Foulkes]

And that brings us to the end of this edition of Inside Geneva. My thanks to Carl Blanchet, Esperanza Martinez, Hannah Reinel and Nicholas Enrich for their time. A reminder, we'll be putting foreign aid back in the spotlight on our next edition of Inside Geneva, asking what the point of it is and unpicking the options for change and improvement. You can Hear that on June 9, or join us in person for the live recording at Geneva graduate Institute on May 28. And don't forget, you can hear more from Nicholas ENRICH in our June 23rd books to make you think episode where he'll be telling us all about his book into the Woodchipper, the inside story of the destruction of usaid. For now, that's it from me. Imogen folks, thanks for listening and catch you next time on Inside Geneva. A reminder, you've been listening to Inside Geneva, a Swiss info production. You can subscribe to us and review us wherever you get your podcasts. Check out our previous episodes how the International Red Cross Unites Prisoners of War with their Families or why Survivors of Human Rights Violations Turn to the UN in Geneva for justice. I'm Imogen folks, thanks again for listening.