Where Does the Money Go?

Julia Nagel
Web and Social Media Assistant, Global Health Policy Center

On October 15th, the United States Institute of Peace held an informative event entitled – “Relief Efforts in the Wake of the Pakistan Floods.” Among the panelists were Mark Ward of USAID/OFDA, Rabih Torbay of the International Medical Corps, and Moeed Yusuf of the U.S. Institute of Peace. All of the panelists held an expert knowledge of Pakistan and each had been to Pakistan since the flooding began.

US Relief EffortsThough many themes arose throughout the event, I felt that each topic discussed, each challenge presented, and each lesson extrapolated all revolved around one central question: where does the money go? In fact, Mark Ward mentioned that in the countless interviews he’s participated in, he is asked this question in almost every single one.

Although answering this is no easy feat, I think the persistence and stubbornness of this question reveals a tremendous amount about how foreign aid is perceived. The Pakistan floods have affected over twenty million people; this far exceeds the combined total of those affected by the 2004 Indian Ocean tsunami, the 2005 Kashmir earthquake, and the 2010 Haiti earthquake. Yet charitable donations for Pakistan’s flood have been slow to arrive and beyond this, a considerable majority of foreign aid has come from the United States. While there are numerous theories as to why this is – donor fatigue, tightened budgets during a recession, mistrust of the Pakistani government and how it would spend aid – I also think, all too often, people do not actually know where the money goes. A poll conducted by the Kaiser Family Foundation in September, for example, concluded that Americans are skeptical of foreign aid but look favorably on money spent towards public health initiatives abroad. This is a clear example of how perceptions of aid do not align with reality.

So where does the money go? All three panelists agreed that in addressing this natural disaster, the first priority has been to avoid a public health catastrophe. The floods submerged one third of Pakistan, a country roughly the size of Florida. The vulnerability to disease outbreak was acute. However by acting swiftly – the U.S. military, NGOs and Pakistani health officials were able to deliver basic services to millions of people and prevent countless epidemics. As of September 30th, the international community contributed over $620 million towards Pakistan’s relief effort; over $200 million of this was put towards food security, $50 million towards health initiatives, $25 million towards nutrition, and $57 million towards water, sanitation, and hygiene. In essence, about half of foreign aid went towards ensuring that the floods did not produce another disaster: infectious disease epidemics.

Rabih Torbay stressed that in emergency situations like these, early money is what saves lives. His organization, The International Medical Corps, has been in Pakistan since 1984 training Pakistanis in public health and development. Because of this continuing relationship and deep investment in the country, Torbay said, trained Pakistanis were the first line of response to the floods and certainly, one of the most effective.

It seems from these examples that often times, when money is spent effectively, people do not see where it goes. This is because it prevents public health emergencies; it wards off starvation; and it trains officials on the ground. While millions of Pakistanis are still displaced from the floods, health problems are still prevalent, and there are numerous examples of foreign dollars not being appropriately spent, there is no question that aid was effective in saving lives and forestalling a public health catastrophe. The problem is, as Mark Ward expressed, the international community simply could not meet the need for an event of this magnitude. Thus we need to change our methods of operation – especially in Pakistan. We need to foster long-term relationships and continue developing these relationships after the cameras stop rolling. If we do not do this, we will have to start from scratch if/when the next disaster occurs and we will lose any trust the Pakistani people have in the international community.

Trust is enormously important. All three panelists agreed that while the Pakistani floods are tragic, this is a key moment for the United States to improve its image in Pakistan. All aid, therefore, must be marked with an American handshake or some sort of signage, to prove it is being provided by the U.S. Though this idea seems simple in theory, both Ward and Torbay mentioned that NGOs are often put at risk when the Taliban knows the food they are providing or the medicine they are administering is supplied by America. It doesn’t benefit the U.S. or any other donor government if NGOs cannot operate and carry out their relief efforts.

Both Torbay and Yusuf shared the view that the U.S. needs to put more pressure on the Pakistani government to publicly acknowledge that the majority of assistance is funded by U.S. dollars. Yusuf added that the U.S. must do a better job of publicizing its role in the flood relief. Yusuf’s point was made all the more clear when, during the Q & A portion of this October 15th event, a reporter from Voice of America asked Mark Ward: in Sindh province, where does the money go? Though somewhat comical – because Mark Ward opened the event mentioning that he cannot avoid this question – it is incredibly telling that after an hour discussion about American relief efforts, this question still surfaced.

Mark Ward answered the reporter with various statistics and then added that perhaps, in dangerous parts of Pakistan, the U.S. doesn’t do a great job telling its story. I would argue that the U.S. needs a new strategy on how to do this and it needs to do so quickly. If the U.S. doesn’t clearly define its intentions and answer the recurring question – where does the money go? – someone else will. 

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