The international aid system is failing those who most need help despite having more resources and greater know-how than ever before, a leading medical charity said on Monday.
In a damning report, Medecins Sans Frontieres (MSF) says U.N. agencies and international aid groups are increasingly absent from the field in emergencies, especially when there are significant security or logistical problems.
Many agencies also focus on the people who are easiest to reach and ignore the more difficult places, MSF International President Joanne Liu said in the foreword to the report.
"... people in desperate need of lifesaving assistance are not getting it - because of the internal failings of humanitarian aid system," she added.
In crises like Central African Republic and South Sudan, Liu said persistent problems remained with the scale-up of the U.N. and international aid groups' response, which was "characterised by bureaucracy and risk aversion".
The report, Where is everyone?, follows research into three major displacement emergencies - South Sudan, Democratic Republic of Congo (DRC) and Jordan which is hosting many Syrian refugees.
It said the United Nations was "at the heart of the dysfunction" in all three cases. Funding systems in particular were slow, cumbersome and not suited to emergency situations.
But it said aid groups also appeared to lack technical capacities in some cases in areas such as health, water and sanitation, and assistance to victims of sexual violence.
For example, it said the provision of water and sanitation at refugee camps in South Sudan's Maban county was totally inadequate to meet the needs of tens of thousands of Sudanese who sought shelter there in 2012, contributing to catastrophic mortality rates.
In DRC, MSF said very few agencies were able to provide medical services during emergencies in eastern North Kivu province which has been wracked by violence. Aid agencies seemed to have stopped the practice of negotiating access with all armed actors, limiting their presence to zones patrolled by U.N. troops, it added.
Assistance to people uprooted by fighting in North Kivu was also overwhelmingly concentrated on the 14 percent living in recognised camps. The vast majority of displaced people generally received no help. And camps closest to the regional capital Goma received more help than those in the worse-affected periphery.
In Jordan, humanitarian agencies have also focused attention on the most easy to reach Syrian refugees - those living in the colossal Zaatari camp near the border. Aid agencies have not done enough to help the hundreds of thousands of refugees in Jordan's cities, where many live in destitution.
MSF said that in the worst emergencies, when help was most needed, international staff were rapidly evacuated and programmes were downgraded to skeleton staff or were suspended.
Many humanitarian groups now worked at arm's length through local non-government organisations or government authorities, acting more as technical experts, intermediaries or donors.
The report highlighted the huge burden placed on local organisations, but said they often lacked the skills to conduct difficult operations. It can also be hard for local organisations to be seen as impartial if they are operating in areas affected by conflict.
MSF stressed it did not exempt itself from the criticism it leveled at others and hoped the report would open up debate ahead of a World Humanitarian Summit in 2016 when experts will consider the structure and funding of future humanitarian work.
U.N. refugee agency spokesman Adrian Edwards said it was reviewing MSF's criticism, adding: "Anyone who has been in a full-blown humanitarian emergency will know that they can indeed be chaotic and dangerous, especially in the initial phases."