We must redefine future financing for humanitarian emergencies

by Paul Spiegel | Johns Hopkins University
Sunday, 19 August 2018 07:30 GMT

ARCHIVE PHOTO: Girls carry buckets they filled with water from a water pond amid an acute shortage of water supply to houses in the historic city of Thula in Yemen's northwestern province of Amran August 20, 2015. REUTERS/Mohamed al-Sayaghi

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Given the number of complex conflicts and the magnitude of displacement, new sources and mechanisms of financing are needed

What’s happening in Yemen right now is beyond terrible. It is a humanitarian crisis affecting more than 22 million people—three quarters of its population needs humanitarian assistance. More than 2 million people are internally displaced and nearly 280,000 refugees have fled to other countries since the violence erupted in 2015.

This is a staggering number, there is still no plan to end the suffering, and the 2018 humanitarian appeal for Yemen is nearly 40 percent underfunded.

There are many other humanitarian crises that need more funding—Syria, Myanmar, South Sudan and the Democratic Republic of Congo, to name just a few. In 2017, there was a gap of 41 percent in UN humanitarian appeals.

U.S and European media tend to focus on “their” refugee crises. Yet low and middle-income countries (LMICs) host 80% of all refugees. Refugees tend to stay in these countries because of the proximity to their original country, in the hopes that they will be able to return home. For instance, Uganda, Turkey, Lebanon and Pakistan all host more than one million refugees. 

These countries of asylum struggle to develop infrastructure and health systems for their own citizens. It’s unrealistic for them to absorb hundreds of thousands of refugees without massive international support.

Helping LMICs foot the bill is an uphill battle if we continue to rely on traditional Western donors. While the US and European governments generously provided 85 percent of all humanitarian funds in 2017, it is not enough. Furthermore, these contributions are subject to political trends and shifts in priorities.

The recent anti-globalism, populist and anti-refugee environment is extremely concerning. Consider President Trump's 2018 budget, which would decrease migration and refugee assistance by $600 million. As US lawmakers press to maintain the status quo in funding, the number of refugees worldwide continues to climb.

We need to fundamentally redefine the way humanitarian funding is provided. Given the number of complex conflicts and the magnitude of displacement, new sources and mechanisms of financing are needed.

In 2011, for example, faced with increasing health care costs of Afghan refugees, the government of the Islamic Republic of Iran, together with the UN Refugee Agency (UNHCR), launched the largest health insurance plan for refugees ever implemented. A semi-private company covered hundreds of thousands of Afghans; UNHCR covered the premiums and associated costs for the most vulnerable refugees. Four years later, the Iranian government allowed registered Afghan refugees access to its national health system.

Bonds and insurance windows are being used as financial instruments by the World Bank and other multilateral organizations. Catastrophe bonds offer coverage for governments to address earthquakes, tropical storms and other natural disasters. Private funders and companies can trade the bonds on secondary markets even as the bond amounts fluctuate from season to season.

Most recently, the World Bank together with UN agencies issued a short-term investment vehicle to fund the Pandemic Emergency Financing Facility, to support responses in low-income countries to six viruses . Development partners provide the funding for the bonds.

An exploration of a Humanitarian Health Financing Model using bonds and insurance windows should be undertaken to assess its feasibility. At a minimum, the funds could be used as a stopgap when urgent funds are needed at the beginning of an emergency, while being backed by governments to reduce the risk.

Around the world, 68.5 million people are currently forcibly displaced. That’s too many, for so many different reasons. In order to address their plight, we need to redefine humanitarian health financing. Let’s use World Humanitarian Day as an opportunity for change, and provide more permanent help for everyone involved.

Paul Spiegel is the director of the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health.