How much does it cost to save someone’s life after an emergency? What price do you put on dignity, safety, confidence etc? In the run up to World Humanitarian Day Sophie Mack Smith, Communications & Knowledge Management Advisor, highlights some of the key issues which humanitarian agencies face.
How much does it cost to save someone’s life after an emergency? This is a question aid agencies are often asked, and it’s one we try hard to answer. It’s only fair after all, to account for the money given to us by our donors – we couldn’t do any of our work without it. But what is ‘cost-effectiveness’ when people’s lives, health, and livelihoods are at stake, and at what point does the cost become too great for someone to think it’s worth paying for?
consider the most basic camping trip we would be prepared to go on… For Oxfam, an emergency is a crisis in public health, usually caused by sudden displacement as a result of a natural disaster or conflict. People leave their homes with very little – this means no spare clothing, no household necessities, and certainly no money with which to buy adequate food, drink, medicines, or anywhere to stay. If we all take a minute to consider the most basic camping trip we would be prepared
to go on, there are certain bare necessities for shelter, preparing food, storing water, and going to the loo that constitute minimum requirements for life, health, and hygiene. And that’s just for a few days, not for months or years.
It is self-evident that the cost of supplying people with these sorts of basic items differs widely between countries. So measures of cost-effectiveness that simply divide the cost of a programme by the number of people who benefited are too simplistic to mean much, and certainly should not be used to compare different responses. Speed too, makes a difference to cost. Soap, for example, is available in most countries and buying locally has obvious advantages, but if hundreds of thousands of bars are needed urgently in say, a cholera epidemic, the benefits of buying it
abroad in bulk and freighting it in quickly may outweigh the higher cost of the operation.
In big emergencies we appeal to the public for additional funds and every appeal comes with its list of ‘money handles’ – Â£10 will buy this, Â£25 will buy that etc. With items such as soap or buckets, it’s a fairly straightforward business because we know how much we are paying for these. But water requires a more complicated calculation because
the process of delivering a sufficient daily allowance of clean water to one family differs massively depending on where you are.
In one place Oxfam staff are treating river water and piping it a few hundred feet to a tap; in another, we are drilling 100m into the ground for it and paying for fuel to pump it out. In many situations we truck in clean water supplies from the source to a community whose supply has run out, as a temporary measure while a longer term solution is found. In one place we will just supply water for drinking because the community can use a different source for washing – in others we are supplying all the community’s water needs. The supporter who wrote in to complain about the daily
cost per person of trucking water over a large distance may have been absolutely right in his calculation, but when does the cost become ‘too much’ to pay for?
Even harder to calculate are people’s more intangible needs. What price do you put on dignity, safety, confidence etc? They aren’t measurable, but they are an essential result of good programming, and by ignoring them we could well be wasting the money we’ve spent on more physical things. If we build a women’s toilet in a dark distant corner they
probably won’t use it. If the clean water supply is situated by an army checkpoint, people may prefer to drink from the dirty supply further off.
When Ebola hit parts of West Africa in 2014 it sparked a huge international response focused overwhelmingly on providing medical health facilities, isolation units and protective clothing, but it didn’t do enough to address people’s fear of the white suits, or the ambulances that came to take their relatives away. Far from referring themselves for check-ups, many people actually hid from the medical services which were there to help them. A whole new approach was needed using local people to mobilise other local people,
talking about the risks, being reassuring about what happened inside Ebola hospitals, and encouraging individuals to feel confident about seeking treatment. Without this additional aspect of the response, the expensive hospitals and foreign doctors sent in by Western governments would have remained underemployed.
no one actually wants to be in the position of being the beneficiary… All this tells us what I imagine each one of us knows in our own hearts – if you don’t take the time to talk to people then you won’t find out how they live or what they need, and the chances are high that you’ll waste a lot of money giving them things they don’t want. But what we also all know is that no one actually wants to be in the position of being the beneficiary of an emergency response at all; we would all prefer not to have been that vulnerable in the
first place. Emergency response costs more than long term development (clever people have calculated it at four times more expensive), and our beneficiaries are reluctant ones.
One of the most uplifting testimonies from our field programmes is from Jarina, a woman in Bangladesh (pictured above) who was not on Oxfam’s list of beneficiaries after a monsoon. She had instead, benefited from a longer term programme in which she received Â£142 to raise her house and compound about 10 feet. Her house was undamaged by floodwater and she was ‘proud’ to give shelter to her relatives the following day. When she went to see the government boats arriving with food aid she looked at the lists of recipients, and told us: ‘my name wasn’t
there. I have never been so proud as I was at that moment, and I never want my name to be on that list again’.
- Visit our World Humanitarian Day page
- Read more about our work on conflicts and disasters
- Read more introductions to key issues
- Jarina with her daughter, Shaheha and grandson, Saju.Having a raised homestead meant that Jarina could offer shelter to her daughter and her family, Bangladesh. Credit: Jane Beesley/Oxfam GB
- Protected spring in the Democratic Republic of Congo installed by Oxfam to prevent water contamination.”there is a lot of water here. It is good to have this; it is much easier to collect water now.” Said one woman (names withheld) Credit: Caroline Gluck/Oxfam
- Men working on a tubewell in Chad. Credit: Carmen Rodriguez/Oxfam
Author: Sophie Mack Smith
Archive blog. Originally posted on Oxfam Policy & Practice.