The president of South Sudan warns that his nation faces terrible famine, with more than a million people fleeing their homes since fighting erupted at the end of last year. And many more families face critical food shortages, according to British aid groups who say they have less than half the money they need to prevent a catastrophe.

Their desperate pleas come as the number of global refugees exceeds 50 million for the first time since the second world war. From Afghanistan to Ukraine, from Syria to Somalia, conflict and civil war are crippling countries and devastating lives.

This makes an incendiary new report by Médecins Sans Frontières well timed. The paper – provocatively titled Where is Everyone? – highlights how other big aid groups are withdrawing from emergency work, especially in dangerous conflict zones, in favour of lucrative work on modish concepts such as conflict resolution, capacity building and governance. Two years ago I heard this from the head of their Haiti mission in Port-au-Prince, despairing as he watched the aid caravan move on despite a cholera outbreak and thousands still homeless after the devastating earthquake.

The report accuses the UN of being at the heart of dysfunction in three trouble spots, with conflicts of interest caused by its triple role as donor, coordinator and implementer of programmes. Few who have seen its bumbling efforts in action could dispute such a claim. But this report marks the moment that MSF – the most tenacious and transparent of major European relief agencies – goes public with accusations that other groups focus on the wrong things.

The charity clearly believes the core issue is attitude, not money. "It cannot be said that the main barrier to better response is lack of funding," it says. The authors found few aid workers from other NGOs outside major urban areas – and those who were in the field, sometimes performing heroically, felt frustrated at the shift from critical work to fulfilling donor demands and keeping bureaucracies in business.

The problem is a competitive sector swollen with money – especially in Britain, where campaigners and politicians have focused on hitting an outdated aid target, instead of on results. They want easy wins with minimum effort. So highly paid charity chiefs cuddle up to governments to promote the illusion they can spur democracy and development, despite evidence that torrents of foreign cash prop up repressive regimes, fuel corruption and foster conflict.

Huge sums can be raised for emergency relief, but there is less public compassion for conflict victims. Compare the £95m raised by the Disasters Emergency Committee after the Philippines typhoon with the paltry £25m given for Syrian refugees in the appeal's first year. In South Sudan aid groups feared that the cost of running an appeal could outweigh donations.

This means that charities reduce spending on logistics, avoid the most chaotic regions and target the victims who are easiest to reach. In the effort to help Syrian refugees they concentrate on people registering with the UN, not those in urban areas avoiding the huge camps for fear of sexual violence, or Bashar Assad's secret police.

Yet as charity chiefs sell their phoney ideas of conflict prevention with costly conferences, their public fundraising efforts portray emergency work as their primary focus. One claims to be helping Congolese rape victims, when it merely runs a radio campaign. Another boasted of running 40 health clinics in one region of the same country, when doing little more than doling out drugs for four basic diseases: a properly staffed MSF hospital in the same place costs £10m a year.

The charity deserves credit for raising issues that should provoke soul-searching. Yet it is unlikely to change attitudes. Behind the slick campaigns, too many aid groups have evolved into self-serving corporations dressed in the clothing of compassion.

Twitter: @ianbirrell