IRC President and CEO David Miliband delivered a keynote address at the University of Notre Dame's Keough School of Global Affairs titled "The future of international aid." In the lecture, Miliband argued that global poverty has become increasingly concentrated in conflict and climate-vulnerable states, yet aid budgets remain misaligned with only a fraction reaching those most in need. He called for a "triple shift" in international aid: focusing resources on the poorest people in fragile countries, investing in proven and innovative programs, and demanding accountability for outcomes rather than inputs.

14 October 2025 - I am very grateful to the Keough School of Global Affairs and especially Dean Mary Gallagher for inviting me to speak today. This University and this School combine local roots and service with global vision and conscience, and that combination has been core to the International Rescue Committee’s mission since its foundation by Albert Einstein in the 1930s. Since then we have worked with successive US governments to welcome and integrate over three million refugees into American life, and (the focus of this lecture) worked with government, philanthropists and the private sector to fund and deliver the leading edge of humanitarian aid around the world. Last year, we helped over 36 million people around the world to survive and recover from conflict and crisis. 

America’s role in international aid has been thrust close to the center of political debate since January of this year. The new Administration has closed the institutions of governance, torn up the assumptions of policy, and cut drastically the scale of funding. America is so central to the global aid system that it’s as if the anchor has been pulled up just as the seas are getting rougher – leaving the entire humanitarian vessel rocking at the worst possible moment. But what comes next, either for American policy, the aid system or the world’s poorest, is not clear. That is why my focus today is on the future. My purpose is to set out what I think aid should be for, how it should be delivered, and who should pay for it. In summary, we need international aid to be different not smaller, with more funds devoted to proven programs that help the extreme poor, more innovation in funding and delivery, and more alignment between economic and social interventions. American policy can and should play a positive role in these shifts, because a well-functioning aid system is not just morally right, it is also in America’s interests. 

Where we stand 

I want to start today with four statements about where things stand. They are all true. But they point in different directions. They point to competing narratives about the future of the aid system.   

My contention is that until we reconcile these competing truths, we won’t be able to define a sustainable future for international aid. 

My approach starts with the purposes of aid and more particularly the pathway to achieve its goals. There are two, which overlap but are distinct. One is to focus on helping poor countries develop their economies. The other is to help poor people improve their condition. 

For a long time the former (development) was seen as the way to address the latter (fight poverty). The rationale was simple: help poor countries develop and you help poor people out of poverty. Fighting poverty and promoting development were synonymous. The international measure for funding the fight against poverty is called “Official Development Assistance”. 

The evidence shows the impact, especially but not only in global health, from the 50 year vaccination campaign that is estimated to have saved 150 million to the US-led PEPFAR program focused on AIDS that has saved 25 million lives. From 1990 to 2015, the number of people living in extreme poverty fell by an average of 52 million a year, even as the population rose. 

But the relationship promoting development in poorer countries and fighting poverty among poor people, and especially the poorest people, has changed in the last thirty years. Here is what has happened. 

Development has been predominantly driven by combinations of home and global markets, effective governance, debt relief and to some extent remittances. Countries like China, India, Vietnam, Ghana, South Korea have been transformed. From a situation in 1987 where 100 percent of South Asian countries were classified as low income, today the figure is 13 percent. Aid has been helpful to some of the poor in those countries, but has not been one of the main drivers of economic development. 

Poverty on the other hand has become concentrated in war torn states. The World Bank calls them “Fragile and Conflict- affected Situations”. In 1990, less than one in ten of the extreme poor lived in conflict affected countries. Today in total over 50 percent of the global extreme poor live in these states, and the figure is predicted to rise to two thirds in the next five years. Nearly 70 percent are in sub Saharan Africa. Fully 40 percent of the populations of these countries live on less than $3 a day, and in places like Sudan or Gaza it is much higher, compared to 6 percent in other Emerging Market and Developing Economies.   

These are states where instability and risk preclude development and immiserate the population. What’s more,19 of the 25 countries at the bottom of Notre Dame's Global Adaptation Initiative Index, which measures climate vulnerability, fall in this fragile and conflicted affected group. So challenges of conflict and climate increasingly go together. 

However, while extreme poverty is increasingly driven by conflict, aid budgets have been spread increasingly thin. 

Only 10 percent of the $210 billion official global aid budget goes to humanitarian aid and 13 percent to health. According to the OECD, spending on “global public goods” which are cross-border issues like climate mitigation, biodiversity, refugee support and infection prevention grew to as much as 60 percent of Development Assistance Committee (DAC) members’ international assistance.  And that money is generally spent in middle income rather than the poorest countries. In total, around 43 percent of aid flows to lower-middle and upper-middle income countries. 

It is also worth noting two other points about aid spend. Since the Russian invasion of Ukraine, Ukraine has become the biggest global aid recipient. Before the invasion, the largest recipient was Bangladesh in 2020 and 2021. Furthermore, European countries are increasingly spending funds classified as “overseas aid” on refugee integration at home. The figure is around 13 percent of the total aid bill, about the same as spent on health. 

Charting the Future 

All of this is to say that now is the time for a rethink about the future of international aid: what aid is for, how it is delivered, and how it is paid for. That is what I turn to now. 

First, we need to focus grant aid (which is over 90 percent of the global aid budget, the rest being concessional loans) on the poorest people in the poorest places. That means addressing the mismatch between the more or less fifty percent of the extreme poor who live in fragile and conflict affected states, and the approximately 25 percent of the aid budget that goes to those countries. In 2023, 42% of US aid went to these countries - but when Ukraine is excluded, the number drops to only 22%. 

At IRC, we have run the numbers on which countries are dependent on US aid, have a UN Humanitarian Response Plan, are highly dependent on grant-funded ODA, are at risk of or in debt distress, and are conflict or climate affected. It yields a list of 13 countries whose people are in most desperate need of grant aid: Afghanistan, Burkina Faso, CAR, Chad, DRC, Ethiopia, Haiti, Mali, Mozambique, Somalia, South Sudan, Sudan and Yemen. 

29 percent of the world’s extreme poor live in this subset of hardest hit countries. But only 9 percent of ODA is allocated to them. The difference is worth $35 billion. 

For countries that are stable, concessional loans and support for private sector instruments can work well. In many cases, like Kenya or Bangladesh or Lebanon, they are hosting refugees from neighboring states caught up in conflict. The role of the US Development Finance Corporation and the Millennium Challenge Corporation can be powerful. Paired with effective domestic resource mobilization, they can be pivotal. But we shouldn’t kid ourselves that the private sector is going to ride to the rescue of the poorest people in fragile and conflict affected states. 

Second, we don’t just need geographic focus, we need programmatic focus. We need to pile resource behind evidence-based, proven, cost-effective programming, like the community-based vaccine drive IRC has pioneered in east Africa, delivering 20 million vaccine shots for $2 a shot, or our proposal for a combined and simplified protocol for treating moderate and severe acute malnutrition, which in our study involving 27,000 acutely malnourished kids in Mali delivers cost efficiency savings of around 30 percent. This kind of focus will take a change of approach from donors, so that their efforts aggregate impact rather than dilute it. 

The President of the Center for Global Development has called for radical simplification of foreign assistance budgets. Rachel Glennerster explains that the median ODA project is worth less than $100,000. This is seriously inefficient. Our own cost effectiveness work shows the inefficiencies of small scale.

It also means spurring radical alignment of bilateral assistance budgets. At the moment, as Charles Kenny, also of CGD shows, aid partnerships from rich countries to poor ones are in over 90 percent of cases worth less than a high school renovation project here in Indiana ($100m). But it is inefficient for donors to pursue multiple, fragmented relationships and projects. Third, we need innovation in programs, in finance, and in delivery. 

Programs first. AI is cutting disease diagnosis from two weeks to five minutes. Anticipatory cash transfers are turning floods from disasters into recoverable shocks. These are not ideas on paper — they are tools we are using to save lives today. We have also shown how AI can help achieve impressive learning outcomes for kids whose education is interrupted by conflict and disaster. 

Not everything needs tech. We also pioneer low tech solutions, for example for diagnosing acute malnutrition. But there is a tech revolution underway, and it is doubly unfair for the poorest in the world not to benefit from it. 

This will take new commitments of risk capital, with a readiness to learn and accept failure in the interest of finding new ways of helping people out of poverty. 

We also need financial innovation. That starts with the stark reality that the global debt burden of poor countries is incompatible with fighting poverty and overcoming dependence. Over 70 percent of fragile and conflict states are in or at high risk of debt distress, up sharply from a decade ago. The macroeconomics must be addressed. However there are more micro-economic interventions that could help. 

Disaster risk financing, like parametric insurance, which pays out as soon as triggers are hit for rainfall, make for predictable and fast flows of finance. Also we are interested in bringing debt swaps to the humanitarian area. By using public development bank guarantees, interest rates are reduced on debt. These approaches have been used, so far, to fund environmental improvement projects worth $1.7bn in 7 countries. We would like to see that in the humanitarian space. 

There is also pressing need to recognize that in a world of more than 40 “de facto authorities”, non-state actors who control territory, we need to diversify delivery mechanisms from the assumption that strengthening government systems will deliver for people in need. This is especially true for the international financial institutions led by the World Bank, whose vision of ending poverty cannot be delivered until it radically diversifies its delivery model in fragile states. 

The World Bank has done a great job in more than doubling the size of its International Development Association (IDA) facility since 2015.  It treats fragility, conflict and violence as a cornerstone of implementation. But last mile delivery in fragile contexts depends on civil society organizations and their ability to negotiate access in the midst of conflict, train and organize local staffing, and build trust with war-torn communities, in order to reach people in need. That takes new ways of working for organizations like the Bank, whose Annual Meeting in Washington I will be attending after leaving here today. 

Fourth, we need accountability for results, for outcomes, rather than for inputs, in order to cut bureaucracy, increase flexibility, promote value for money, and drive innovation. 

The truth is that we need governments and international institutions to follow the example of Sweden, which holds us as an NGO accountable for the outcomes that are achieved for people: education results not numbers of teachers trained, healthy births not health consultations, children fed not food parcels tallied, need met not cash distributed, farmers sustained not seed delivered. Instead of funding individual projects, often detached from each other, the income, health, safety and educational outcomes for people would count more.  This would allow more comparisons of performance, and of value for money, which would make the most of the transparency that should be a hallmark of the sector.  For those interested in IRC’s approach to outcomes and evidence, please look online at our Outcomes and Evidence Framework. 

Fifth, we need to spread the aid burden, as the shape of the global economy shifts. The Administration is within its rights to say that it makes no sense for the G7 group of countries, which account for 45 percent of global GDP, to pay 75 percent of the aid bill. For reference, America is 25 percent of global income, with a percentage of national income devoted to foreign aid now estimated around 0.15 percent of gross national income (GNI), which is low by international developed world standards (half of Italy). But countries that are newly wealthy should increase their contribution. 

I still believe this could be a unifying mission for America and Americans. As the polling shows, the humanitarian heart of the country still beats strong. If the changes I have outlined are instituted, then the excuses that are used to displace the moral case for aid will be much reduced. 

Congress has a critical role to play in authorizing, funding and overseeing aid efforts. The recent House Bill provides $46bn for foreign assistance for next year, a cut of 22 percent, which is severe, but lower than that suggested by the Administration. It also directs effort to a multi year strategy on aid effectiveness, and efforts to promote innovation and accountability, with calls for milestone-based funding and expanded use of evaluations. There is also flex in the budget for the Secretary of State to meet emerging priorities, which if used strategically and well would be positive. 

It is also worth recognizing that from the beginning aid has had a strategic function as well as a moral one. It is only fair to refer to it. 

Strategy not just Morality 

When he set up USAID, President Kennedy put the Cold War front and center. His purpose in relieving poverty was not just to help people in need; it was also to show those people and their leaders  that the American way was the better way than Soviet communism. American soft power, in all its forms of turning relationships into alliances and admiration into a model, was part of the story of western aid. “Richesse oblige” was only part of it. There was also a strong strand of self interest. It was not a case of “America second”. In today’s parlance, it had a clear view of making America safer, stronger and more prosperous. 

Today, the Cold War of western and Soviet blocs (plus a lot of “non-aligned” states) is over. I don’t see competition with China through the same Cold War lens. But I do see competition with China. And where America retreats, there is growing evidence that China is ready to fill the vacuum. Just in the last month, two serious China scholars, Jeffrey Prescott and Julian Gewirtz, have written in Foreign Affairs that “(President) Xi sees a window of opportunity to forge a China-centric world without directly taking on the United States by moving assertively into areas where (President) Trump’s “America First” policies leave openings”. They point to the 18 leaders, including India, at the Shanghai Cooperation meeting, the BRICS meeting hosted by Brazil with President Xi as a keynote speaker, the Chinese cuts to tariffs on Africa as America increased its tariffs, plus initiatives on global governance, development and AI. 

For me as the leader of a humanitarian organization, the future of international aid should be driven by the imperative to save lives, alleviate suffering and preserve dignity. But I don’t mind why countries commit to international aid, as long as they do so, according to principles that put crisis-affected people at the center. 

The future of international aid should be different from the past. But as more than 60 conflicts rage around the world, as impunity takes root, as civilians are more and more the victims of conflict, as rights to aid become increasingly diluted, as 300 million people depend on humanitarian aid to survive, we need to recognize some basic truths. 

If we can save people from destitution, we should. Those delivering on the ground need to embody commitment to value for money and efficient delivery. The donors need to put clients front and center. The new resources of science and technology need to be used to help the poorest, not just the richest. We need innovation in service delivery as well as product design. And the western world has an interest in leading this drive, not hanging back. 

Today, 80 percent of acutely malnourished children in conflict zones are not treated, 60 percent of maternal deaths in childbirth are in fragile states, over 52 million kids in countries affected by conflict are not in school. Effective international aid is the answer to these challenges, not the problem. There are more resources in the world to do more good than at any time in human history, so it is on us to use those resources wisely. One percent of the federal budget is not excessive; it can be put to good use; it is in America’s interest to do so; and the sooner it happens the better.