David Miliband, President and CEO of the International Rescue Committee, discusses humanitarian aid around the world with Foreign Affairs Editor Gideon Rose. Read his recent article “Improving Humanitarian Aid.”

This interview has been edited and condensed. A rush transcript is below.

Gideon Rose: David, thanks for being here. What is humanitarian aid doing right and doing wrong these days?

David Miliband: Thanks, Gideon, it's good to be here. I think that the best thing that you can say about humanitarian aid around the world is it's genuinely saving lives. I've seen that through the work in my own organization. I've seen it in other organizations. And I think that the premium on that kind of life saving in the midst of conflict; international agencies employing local people and making the difference between life and death by addressing, above all, health needs, water and sanitation needs is the most heroic and the most humbling thing to see. And the truth is that nongovernmental organizations are being pushed into the front line as more countries, 30, 35 countries around the world, are consumed by increasingly violent, increasingly chaotic, increasingly lawless conflict.

So, the upside of the story is that in the midst of chaos and conflict, there is some fantastic work being done. The downside is, or the challenge is, not just that there's more and more need for this kind of international humanitarian work, 50, 60 million people now, according to the UN, displaced by conflict and disaster by the end of last year, but their needs are changing. They're more urban rather than in refugee camps. They're long term rather than short term. They're in the midst of armed opposition groups, not countries fighting according to certain Geneva Conventions and other rules.

So, the challenge for the humanitarian sector is to reach more people, but it's also to reach them in a more fulfilling and deeper way, so that we're doing more than just keeping them alive.

Gideon Rose: In your article in the new issue of Foreign Affairs, an excellent article, by the way, you talk about the need to bring sort of social science techniques and scientific evidence to bear on how you give aid. What sorts of options are most cost effective? What things are not? Is that something that you've made a priority at the IRC, and is that something you think this area of international aid can do a lot more of?

David Miliband: It's interesting. If you think about the change that's happened in international development since the inauguration of the Millennium Development Goals 15 years ago, the revolution there has been the application of top-grade social science. Two-and-a-half thousand randomized control trials or equivalent studies in stable, poor contexts that have taught us best practice in vaccination, in education, in water and sanitation. In conflict settings, there's been less than 100 of those randomized control trials or equivalent. It's obviously tougher in some ways in emergency settings, but in a way, it's even more important to figure out what's really making the greatest impact for the greatest number of people.

I've been very struck, in the 22 months that I've been leading the IRC, how our sector, our humanitarian aid sector, by contrast with the development sector, has a really long way to go to make sure that our practice really is founded not just on profound experience, but also on real evidence. It would be stupid to say all of our programs will be evidence based because then you'd never try anything thing that hadn't been tried before. But, where we try things for which there isn't a substantive evidence base, we're honor bound to make sure that we learn from it.

Gideon Rose: One of the things that I've been struck by looking at this literature is the surprising to me value of direct cash grants as opposed to aid in-kind. Instead of giving the farmer a cow, give them the money to buy a cow. If they want a cow, they can buy it. If they want something else, they'll use that money to buy that. Do you find that direct cash transfers are forming an increasing part of what the aid agenda can and should be?

David Miliband: Well, they're not forming an increasing part, but they should be. If anything, the data suggests there's actually a decreasing part, despite the increasing amount of evidence for how much good it can do. In the article in your magazine, in Foreign Affairs, we point out there's probably less than 4% of the total humanitarian budget... The humanitarian budget is about $22 billion this year. Less than 4% is going on cash grants despite the fact that there's increasing evidence, including from the IRC... We did a recent study in Lebanon on this, that cash grants don't just give choice to beneficiaries, they're not just empowering in that way, they're also making a difference to some of the most unequal, unstable, exploitative markets in the world.

People have often assumed there is no market economy in a refugee camp or in a war-torn urban setting. But there are markets, they're just very unequal and unstable markets. And doing something for the most vulnerable of the poor to give them a foothold in those markets is very, very important, indeed. And the evidence that we've got shows the money is very well used.

Gideon Rose: What do you say to the argument that one hears sometimes these days that international aid is dominated by a small elite club of rich, white western organizations and needs to be democratized to devolve authority, responsibility, funds and so forth down to the communities in the war-torn or strife-torn countries themselves?

David Miliband: Well I'd say two things about that, first of all at one level it's obviously right. The paternalism is not going to work in international aid policy anymore than it works in domestic policy. And so the idea that local people have to be engaged in finding solutions to some of the toughest problems is always right.

The second thing that I would say is that the international NGOs are increasingly international in their staffing complement. We have 11,000 full-time employees, another five or six thousands part-time employees. The vast bulk of those people, 90+ percent, are local people.

Gideon Rose: The IRC specializes in helping people in extreme crisis, refugees, displaced people, people really in immediate desperation. How does one segue, even from successfully providing that kind of help, to helping them actually transfer to normal stable lives and get real development going?

David Miliband: Well I think that the first thing I'd say is that the humanitarian sector defines itself by staunching the dying, but it takes politics to stop the killing. And you've written books about this, [chuckle] so you should be telling me about it, but the point that in the end, without a political settlement wars don't end, is profound and important. And in contexts like Congo or like Somalia, or like Afghanistan and it's neighbor Pakistan, these long-term sub-civil conflicts place an absolute premium on being really hard-headed about the kind of work we do, but we shouldn't be hubristic. The idea that we are going to create a path to development on our own absent the wider politics is obviously not right. What we can do is recognize fundamental truths, that social programs on their own are not going to work over a long duration, they need to be allied to economic programs.

Secondly, programs designed for refugee camps aren't going to work when you've got increasing numbers of displaced people, internally displaced or displaced across border in urban areas. And I think as we remodel the humanitarian aid system we can create the seeds of more functioning societies, and certainly at IRC as we discuss the exit criteria that we have, we have entry criteria for going into conflict areas, but we also have exit criteria, that we'd like to think of ourselves as part of the bridge to development.

Gideon Rose: David Miliband, thank you very much.

David Miliband: Thank you.

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