A humanitarian system in failure, and the cost in lives.

Both health and human rights are being dismantled globally in plain sight and with escalating impunity, driven by geopolitical fragmentation, erosion of the rule of law, and transactional approaches to aid and security that undermine protection and accountability. Conflict-related deaths nearly doubled between 2021 and 2024, and an estimated 239 million people require humanitarian assistance in 2026. The health systems and humanitarian ecosystem meant to protect health and life are buckling under the scale, duration, and political complexity of contemporary crises. International law and humanitarian principles are increasingly violated with impunity, and civilians are bearing the cost. In 2024, violence against or obstruction of health care reached its highest level on record, with 3663 documented incidents. Protections for civilians, forcibly displaced people, and humanitarian workers are routinely breached. Humanitarian assistance is instrumentalised for political and military ends, access is manipulated as leverage, and health professionals are imprisoned or killed for providing impartial care. Humanitarian needs have outpaced a politicised, fragile, and structurally inadequate funding model. In 2025, the Global Humanitarian Overview was cut mid-year from US$44 billion to $29 billion, with only 55% funded by year's end. For 2026, a downsized and hyperprioritised Overview seeks $33 billion, of which $23 billion is required to meet the most life-threatening needs. For scale, this is equivalent to roughly 1% of annual global military expenditure. The result is rationing by design: assistance reduced from 239 million people in need to 87 million selected for lifesaving assistance. This narrow prioritisation has become a mechanism to legitimise abandonment rather than mitigate harm, reflecting a system deliberately organised around donor control, geopolitical priorities, and the transfer of risk onto civilians. The governance and financing landscape is overtly politicised, with humanitarian and global health funding increasingly shaped by national security and foreign policy priorities rather than humanitarian need. Donor withdrawals, budget cuts, and tightly conditioned funding have further recast humanitarian and public health financing as statecraft. A system governed in this way will not self-correct: exclusion becomes normalised, accountability is reduced to compliance, and humanitarian health becomes increasingly selective and unreliable, with large-scale need left outside response plans. The consequences for population health are immediate and cumulative. In conflict and displacement settings, excess mortality is driven less by direct violence than by the breakdown of essential health services, public health functions, and the social determinants of health. Disruptions to vaccination, primary care, maternal and newborn services, and to the continuity of care for chronic conditions turn manageable illness into preventable disability and death. [...]