David Miliband's address at the launch of John Hopkins Center for Humanitarian Health

June 2, 2026 - IRC CEO and President, David Miliband, speaks at the launch of John Hopkins Center for Humanitarian Health-Lancet Commission on Health, Conflict and Forced Displacement:

This report could not be more timely. As we meet, people in eastern Democratic Republic of Congo and Uganda are battling a renewed Ebola outbreak. This emergency is a reminder of how closely health outcomes are tied to conflict, displacement, fragility, and international support. In fact, the division between conflict states and the rest is the biggest inequality in the world today.

We know conflict disrupts food production, markets, livelihoods, and humanitarian access. It increases food insecurity and malnutrition. It interrupts vaccination campaigns and primary healthcare services. It undermines maternal and child health programs. It weakens disease surveillance and preparedness.

Yet as needs rise from Sudan to Gaza, the great aid recession of 2025 has cut ODA by nearly a quarter. Global health funding has fallen from roughly $80 billion in 2021 to a 15-year low of approximately $40 billion today. In low-income countries, spending on pandemic preparedness remains a small fraction of what is needed. Humanitarian appeals remain chronically underfunded. And health systems in conflict-affected settings are being asked to do more with less.

In Sudan, coverage of the first dose of the diphtheria, tetanus and pertussis vaccine has fallen from nearly 90 per cent to around 50 per cent since the outbreak of civil war. Across conflict-affected settings, low vaccination coverage has contributed to deadly outbreaks of preventable disease. Malnutrition continues to increase mortality among displaced children. And disruptions to reproductive, maternal and newborn healthcare continue to drive preventable illness and death.

At the heart of this report is the insight that the current health and humanitarian architecture faces an inflection point. I think that is right. 60 wars, chronic and mixed displacement, a climate crisis that will only deepen, rising impunity for civilians and aid workers, represent a new normal. But it is not an equilibrium. Either we arrest the slide or it will accelerate and spread.

The real solution lies in politics. Because while humanitarian aid can stop the dying, it takes politics to stop the killing.

The report does not shy away from calling out the impunity emergency in war zones around the world. I applaud that. It's my old stamping ground. But the report also faces head-on what is in our power to address.

For years, humanitarian discussions have often been framed around false choices: global standards versus local adaptation; humanitarian versus development aid; evidence versus context, local organizations versus global organizations. Too often the people who need most help, IRC's clients, are left out of the debate. This report should help address that. These clients face different contexts.

It may seem obvious, but the demarcation between acute widespread crisis, where there is no government support, protracted crisis where government is weak or in conflict, and settings where displaced populations can be served by new local and national systems, is too often neglected. I welcome the delineation. It has real implications for the way our sector works.

In each of these contexts, the actors, whether they be local civil society organizations, UN agencies, government ministries or international humanitarian organizations, have different roles to play. But the missing player is too often the people. Accountability needs to flow to them too. Not just "country leadership". Whole of country leadership, including those marginalized by conflict or politics.

The report pushes for pooled funds, cash-based assistance and innovative financing instruments. This is right. Pooled procurement can reduce costs, cash and voucher assistance empower clients and support communities, and innovative financing has the potential to crowd in private and concessional money in more stable settings.

I would like to see aligned outcomes across all the players, shared metrics and reporting systems, real transparency over who delivers and at what cost.

Every IRC program is organized around one of our key outcomes. That's how we put clients at the center. It challenges the dominant systems.

For example, it calls for reward for anticipatory action rather than late response. It means supporting evidence-based interventions at scale. It means creating incentives for efficiency, effectiveness and innovation-prioritizing those that deliver the best outcomes for each dollar and deprioritizing others.

It also means concentrating resources where they are most needed. Today, more than half of the world's extreme poor live in fragile and conflict affected settings. Life expectancy is seven years shorter and infant mortality more than double that of other developing countries. Roughly half of the world's zero-dose and under-immunized children live in fragile and conflict-affected settings. And yet, these countries receive just a quarter of ODA funding, down from nearly half a decade ago. The IRC has argued that figure should be closer to 60 per cent.

At IRC we see our job as not just "delivery". We want our research and evidence to take away the excuses from policy makers when it comes to fragile states. Three quick examples.

When we launched our vaccination program REACH in 2022, our goal was to immunize zero dose or low dose children in Chad, Ethiopia, Somalia, Nigeria, Sudan and South Sudan. Only 16% of the 156 target communities were accessible to humanitarian actors. Through a combination of humanitarian negotiations and portable vaccine carriers our consortium has delivered 30 million vaccines in 100 per cent of those communities.

Through scale, we drove efficiency. The average cost per dose started at around $3.75 in year one and averaged under $1 in 2025, well below UNICEF's standard benchmark of $2.34. We are now using technical innovations in satellite mapping and route mapping to reach even more children at lower cost.

Another example. Anticipatory action in the face of climate impacts that hit everyone hard and hit those in fragile contexts harder. More than one-third of health facilities lack basic water, more than three-quarters lack basic sanitation, and more than half lack basic hygiene. By integrating climate forecasting, disease surveillance and operational data, IRC teams have been able to trigger earlier water-system rehabilitation, pre-position hygiene supplies and expand community outreach before drought- and flood-related outbreaks escalate.

This allows us to anticipate crises rather than simply respond to them, improving outcomes while making more effective use of scarce resources.

Third we are currently field-testing an AI-powered diagnostic tool to support the detection of Mpox. More than 100,000 people have now been affected, and rapid diagnosis remains a major challenge because symptoms are easily confused with those of other diseases. Through a simple photo of a lesion, frontline health workers can diagnose Mpox without needing clients to travel miles to see a doctor.

In each example, we work with a unique context-tailored combination of local and global actors that allows us to collectively drive toward better solutions and outcomes-from 15 local partners to deliver vaccines, companies to provide the latest satellite data and weather forecasting, local and US universities to collect and analyze data. All supported by donors with a focus on outcomes and learning.

I know that writing reports is difficult. Writing good reports is even more difficult. And this is a good report.

But turning good ideas and insights into practical action is still harder. This is especially the case when arguing for systemic change involving multiple actors.

Change can only be gradual. But our clients cannot afford it to be slow.

That's why we at IRC are trying to embody the future not just debate it. Despite $400 million funding cuts over the last year, we have protected our commitment to impact evaluation, to innovation and to cost effectiveness. In fact, we have doubled down on them. Because the outcome we seek for the people we serve cannot be achieved without them.

That is the way to move beyond not just the false opposites that this report seeks to counter, but also the cruelty and neglect that it seeks to overcome.