A report released by the Lancet Commission on Health and the Johns Hopkins Center for Humanitarian Health found that the global humanitarian aid system is failing and called for shifting decision-making power from donors to affected communities. The report recommends ensuring equal assistance and allocating funds based on need rather than politics.

The report found that funding cuts from major donors including the United States and increased attacks on health workers are eroding the global humanitarian aid system. Over the past two years, the commission conducted hundreds of interviews with aid recipients, many of whom were unable to differentiate between various non-governmental organizations and United Nations agencies and felt their needs were not being met.

"And while it's done a lot of good, it really has lost, I think, its purpose of meaning - to serve people affected from conflict and forced displacement from around the world," Paul Spiegel said. He said the humanitarian system is not meeting the needs of its intended beneficiaries and needs reform.

Some humanitarian workers told the commission that public and private donors dictated where aid funding should go rather than basing allocations on actual needs. Spiegel said Ukrainian refugees received more aid during the Ukraine war compared with the aid received by Syrian refugees.

The United States remains the largest funder of humanitarian aid despite recent cuts and retains influence over aid policy. In the past six months, the U.S. administration backtracked on dismantling the foreign aid system and adopted a new vision for aid focused on accountability and directing more funds to individuals rather than organizations. He said the administration handpicks which countries receive aid, excluding Yemen, Afghanistan and Somalia.

Spiegel said the flux in the humanitarian aid system presents a once-in-a-generation opportunity to reform aid delivery, but that aid groups are reacting to funding cuts instead of developing new strategies. He said that in a reformed system, local officials would have stronger capacity to detect and manage outbreaks independently, and that empowered local systems are key to effectively controlling outbreaks like Ebola. Clinics in the Democratic Republic of Congo lack supplies and are awaiting outside assistance during the outbreak, he said.