Jamie, thank you so much for this thoughtful and constructive feedback! I really appreciate you taking the time to engage with this so carefully.

You're absolutely right that these claims need more substantiation. I made a deliberate choice to keep the initial post relatively brief to give people baseline knowledge and invite engagement rather than overwhelming readers with data upfront. But I'm glad you're pushing me to go deeper.

Let me provide more detail on each dimension, while being honest about where the evidence is strong and where it's limited:

On Scale: According to UN OCHA's December 2024 report, an estimated 30.4 million people need assistance in 2025, nearly two thirds of the country's population and marking an increase of 5.6 million people from 2024. The ACAPS October 2024 report notes that conflict-induced displacement has affected more than ten million people, while livelihoods, markets, and services across the country have collapsed.

According to UN OCHA's report from August 2024, famine conditions are now prevalent in Zamzam internally displaced persons camp in North Darfur State, marking the first such report globally since 2017, with the IPC Famine Review Committee concluding that thousands more people are likely experiencing similar conditions in 13 other areas at risk of famine.

The IRC's 2025 Emergency Watchlist ranks Sudan at the top for the second year running, describing it as "the largest humanitarian crisis ever recorded," accounting for 10% of people in humanitarian need globally despite being home to just 1% of the global population.

On Neglectedness: This is what I think has the strongest case. The SSHAP October 2024 case study notes that in April 2024, donors came together in Paris in an effort to raise the USD 2.7 billion that the UN estimated is required. I helped prepare US government officials for that meeting, and remember how unbelievably difficult it was for donors to agree on coordinated action. But current estimation suggests funding is just 41% of what is needed. Media coverage, political will and funding all remain low when compared to the magnitude of the crisis. 

According to UN OCHA's July 2024 dashboard, by the end of July, the 2024 Sudan Humanitarian Needs and Response Plan was still less than 40 per cent funded of the $2.7 billion required.

The Norwegian Refugee Council's 2023 report found that Sudan was among the nine most underfunded crises globally, with funding coverage between 2019 and 2023 averaging 15 percent lower than other humanitarian response plans.

And critically: the SSHAP report notes that in December 2023, research indicated that only 16% of aid was able to reach those in need, with access most restricted in the besieged Khartoum, Darfur and Kordofan states.

On Tractability and Cost-Effectiveness: This is where I need to be most honest about evidence limitations. I cannot provide you with a GiveWell-style cost-per-life-saved calculation. Here's what I can tell you from the independent research reports:

Efficiency indicators:

• The ACAPS report documents that ERR volunteers have worked unpaid for over two years, meaning overhead costs are near-zero
• Some ERRs in Khartoum voiced that intermediary NGOs would take a significant percentage (often 10%) of grants for administrative fees while not doing much in terms of operational work, with ERRs carrying out implementation including running kitchens and clinics
• ERRs implement informal yet effective accountability measures, such as public complaint handling and transparent procurement rules, including the formation of procurement committees 

Access advantage:

• ERRs' adaptability, presence in conflict areas, and proximity to communities have enabled them to respond where other national and international responders could not
• This means the counterfactual impact is potentially very high - these aren't services duplicating what others could provide, they're often the only services reaching certain populations

Demonstrated scale:

• By October 2024, an estimated 360 ERRs were operating across seven states
• Between 2023-2024, ERRs provided first aid, delivered medicines including for chronic diseases, mapped safe evacuation routes, supported IDPs in shelters, established communal kitchens, distributed food, and operated hospitals and local health facilities

The Honest Comparison to Top Cause Areas: You asked for explicit quantitative comparisons. I can't provide them at the level of rigor EA typically expects, and I want to be clear about why:

1. Global health interventions (malaria nets, deworming, etc.) have decades of RCT evidence. I cannot compete with that level of certainty.
2. What I can argue: In a context where two-thirds of a country's population needs humanitarian assistance including confirmed famine conditions, volunteer networks with ~0% overhead operating where no one else can reach might have cost-effectiveness in the same ballpark as top interventions. But I'm making an educated argument based on the available evidence, not proving it with RCTs.
3. The epistemic challenge: This raises a real question about EA's framework. Should we only fund interventions we can measure with near-certainty? Or should we have some capacity for high-uncertainty, high-potential-impact interventions during acute emergencies?

What Would Stronger Evidence Look Like?

Honestly? It would probably require EA funding a proper evaluation. You could fund:

• Retrospective analysis of ERR operations with health economists
• Prospective monitoring of specific interventions
• Comparative analysis of ERR vs. traditional NGO cost structures in Sudan

But there's a chicken-and-egg problem: we can't get that evidence without some initial funding, but we can't get funding without that evidence.

My Ask: I'm not claiming Sudan definitively beats GiveWell top charities on cost-effectiveness. I'm arguing it's plausible enough that it warrants serious evaluation, and that the combination of massive scale + extreme neglectedness + demonstrated local capacity should be enough to trigger that evaluation.

What would you need to see to consider this worth deeper investigation? I'd really value your thoughts on how EA might approach situations like this where the need is urgent but the evidence base doesn't yet meet our typical standards. Thanks again for engaging with this so thoughtfully!

Thank you. I really value this kind of thoughtful engagement, and I think you're raising exactly the right questions about efficiency and trade-offs.

I want to explore whether Sudan might actually meet the cost-effectiveness bar, even when compared to GiveWell top charities. Here's what the independent research suggests:

Efficiency indicators that might rival malaria prevention:

• Volunteers working unpaid for over two years = essentially 0% overhead
• Operating in areas where international responders cannot reach = extremely high counterfactual impact
• Community-based accountability without expensive M&E infrastructure
• Direct cash to services: when funding goes through intermediaries, ERRs complain that 10% administrative fees could instead fund more relief supplies or volunteer stipends 

The epistemic challenge: You're right that we lack the kind of rigorous cost-per-life-saved calculations GiveWell produces. But I want to distinguish between two scenarios:

1. "We studied this and it's not cost-effective"
2. "We can't study this during an active war, so we'll assume it's not cost-effective"

The independent research from SSHAP (London School of Hygiene & Tropical Medicine) and ACAPS confirms ERRs are operating at massive scale. Between 2023-2024, they provided first aid, delivered medicines, mapped evacuation routes, supported IDPs, ran communal kitchens, distributed food, and operated hospitals. We just can't quantify it the way we'd like.

A question for the community: Should EA develop any framework for responding to acute crises where traditional cost-effectiveness analysis isn't possible? Or is our position that if we can't measure it with near-certainty, we won't fund it - even during famines?

I'm genuinely asking, because I think this gets at something important about what EA is for. If the answer is "we focus exclusively on interventions we can measure precisely over long timeframes," that's a legitimate choice, but it means explicitly ceding all emergency response to non-EA actors. I'm not sure that's the right call, especially when volunteer networks with exceptional efficiency characteristics are already operating at scale.

What do you think?

Great question! I completely understand wanting to see rigorous data on cost-effectiveness. You're right that traditional humanitarian efforts don't always meet the same standards as GiveWell charities. However, the Sudan context presents some unique challenges for quantitative measurement.

I know of two independent research reports on ERRs:

1. Social Science in Humanitarian Action Platform (SSHAP) case study (June-August 2024, published October 2024) affiliated with the London School of Hygiene & Tropical Medicine and the Institute of Development Studies (linked here: SSHAP report)

2. ACAPS report (October 2024) - ACAPS is an independent humanitarian analysis organization (linked here: ACAPS report) 

What we know about ERR impact:

Both reports confirm ERRs are operating at significant scale. Between 2023-2024, ERRs provided first aid, delivered medicines including for chronic diseases, mapped safe evacuation routes, supported IDPs in shelters, established communal kitchens, distributed food, and operated hospitals and local health facilities. Between December 2024 and May 2025, after over 1 million people returned to Khartoum, ERRs initiated water and electricity infrastructure repairs, rehabilitation of damaged health facilities, and provision of food and health services.

The challenge with quantifying lives saved:

Both reports acknowledge a critical limitation: ERRs are volunteer networks operating in active conflict zones, not formal organizations with monitoring & evaluation systems. ERRs face time-consuming reporting obligations that volunteers describe as onerous and a mismatch with their communal neighborhood accountability mechanisms. They use transparency with their local communities rather than the formal impact metrics international NGOs produce.

Why ERRs might be more cost-effective than you'd expect:

1. Extremely low overhead: Volunteers have worked unpaid for over two years, meaning nearly 100% of donations go directly to services
2. Access where others can't reach: ERRs' adaptability, presence in conflict areas, and proximity to communities have enabled them to respond where other national and international responders could not
3. Community accountability: Being members of communities themselves allows ERRs to implement informal yet effective accountability measures, such as public complaint handling and transparent procurement rules 

My honest assessment: You won't find GiveWell-style cost-per-life-saved calculations for ERRs. The operating environment makes that impossible. They're running communal kitchens during bombardments and evacuating people from active conflict zones. The independent research confirms they're filling critical gaps at massive scale, but if you're looking for quantified cost-effectiveness metrics, those don't exist yet.