In Biafra in 1968, a generation of children was starving to death. This was a year after oil-rich Biafra had seceded from Nigeria, and, in return, Nigeria had attacked and laid siege to Biafra. Foreign correspondents in the blockaded enclave spotted the first signs of famine that spring, and by early summer there were reports that thousands of the youngest Biafrans were dying each day. Hardly anybody in the rest of the world paid attention until a reporter from the Sun, the London tabloid, visited Biafra with a photographer and encountered the wasting children: eerie, withered little wraiths. The paper ran the pictures alongside harrowing reportage for days on end. Soon, the story got picked up by newspapers all over the world. More photographers made their way to Biafra, and television crews, too. The civil war in Nigeria was the first African war to be televised. Suddenly, Biafra’s hunger was one of the defining stories of the age—the graphic suffering of innocents made an inescapable appeal to conscience—and the humanitarian-aid business as we know it today came into being.

London, 1969: The worldwide reaction to the Biafran war gave rise to the modern humanitarian-aid industry. Photograph by Evening Standard / Getty

“There were meetings, committees, protests, demonstrations, riots, lobbies, sit-ins, fasts, vigils, collections, banners, public meetings, marches, letters sent to everybody in public life capable of influencing other opinion, sermons, lectures, films and donations,” wrote Frederick Forsyth, who reported from Biafra during much of the siege, and published a book about it before turning to fiction with “The Day of the Jackal.” “Young people volunteered to go out and try to help, doctors and nurses did go out to offer their services in an attempt to relieve the suffering. Others offered to take Biafran babies into their homes for the duration of the war; some volunteered to fly or fight for Biafra. The donors are known to have ranged from old-age pensioners to the boys at Eton College.” Forsyth was describing the British response, but the same things were happening across Europe, and in America as well.

Stick-limbed, balloon-bellied, ancient-eyed, the tiny, failing bodies of Biafra had become as heavy a presence on evening-news broadcasts as battlefield dispatches from Vietnam. The Americans who took to the streets to demand government action were often the same demonstrators who were protesting what their government was doing in Vietnam. Out of Vietnam and into Biafra—that was the message. Forsyth writes that the State Department was flooded with mail, as many as twenty-five thousand letters in one day. It got to where President Lyndon Johnson told his Undersecretary of State, “Just get those nigger babies off my TV set.”

That was Johnson’s way of authorizing humanitarian relief for Biafra, and his order was executed in the spirit in which it was given: stingily. According to Forsyth, by the war’s end, in 1970, Washington’s total expenditure on food aid for Biafra had been equivalent to “about three days of the cost of taking lives in Vietnam,” or “about twenty minutes of the Apollo Eleven flight.” But Forsyth, who was an unapologetic partisan of the Biafran cause, reserved his deepest contempt for the British government, which supported the Nigerian blockade. Even as Nigeria’s representative to abortive peace talks declared, “Starvation is a legitimate weapon of war, and we have every intention of using it,” the Labour Government in London dismissed reports of Biafran starvation as enemy propaganda. Whitehall’s campaign against Biafra, Forsyth wrote, “rings a sinister bell in the minds of those who remember the small but noisy caucus of rather creepy gentlemen who in 1938 took it upon themselves to play devil’s advocate for Nazi Germany.”

The Holocaust was a constant reference for Biafra advocates. In this, they were assisted by Biafra’s secessionist government, which had a formidable propaganda department and a Swiss public-relations firm. The cameras made the historical association obvious: few had seen such images since the liberation of the Nazi death camps. Propelled by that memory, the Westerners who gave Biafra their money and their time (and, in some cases, their lives) believed that another genocide was imminent there, and the humanitarian relief operation they mounted was unprecedented in its scope and accomplishment.

In 1967, the International Committee of the Red Cross, the world’s oldest and largest humanitarian nongovernmental organization, had a total annual budget of just half a million dollars. A year later, the Red Cross was spending about a million and a half dollars a month in Biafra alone, and other N.G.O.s, secular and church-based (including Oxfam, Caritas, and Concern), were also growing exponentially in response to Biafra. The Red Cross ultimately withdrew from the Nigerian civil war in order to preserve its neutrality, but by then its absence hardly affected the scale of the operation. Biafra was inaccessible except by air, and by the fall of 1968 a humanitarian airlift had begun. The Biafran air bridge, as it was known, had no official support from any state. It was carried out entirely by N.G.O.s, and all the flying had to be done by night, as the planes were under constant fire from Nigerian forces. At its peak, in 1969, the mission delivered an average of two hundred and fifty metric tons of food a night. Only the Berlin airlift had ever moved more aid more efficiently, and that was an Air Force operation.

The air bridge was a heroic undertaking, and a stunning technical success for a rising humanitarian generation, eager to atone for the legacies of colonialism and for the inequities of the Cold War world order. In fact, the humanitarianism that emerged from Biafra—and its lawyerly twin, the human-rights lobby—is probably the most enduring legacy of the ferment of 1968 in global politics. Here was a non-ideological ideology of engagement that allowed one, a quarter of a century after Auschwitz, not to be a bystander, and, at the same time, not to be identified with power: to stand always with the victim, in solidarity, with clean hands—healing hands. The underlying ideas and principles weren’t new, but they came together in Biafra, and spread forth from there with a force that reflected a growing desire in the West (a desire that only intensified when the Berlin Wall was breached) to find a way to seek honor on the battlefield without having to kill for it.

Three decades later, in Sierra Leone, a Dutch journalist named Linda Polman squeezed into a bush taxi bound for Makeni, the headquarters of the Revolutionary United Front rebels. In the previous decade, the R.U.F. had waged a guerrilla war of such extreme cruelty in the service of such incoherent politics that the mania seemed its own end. While the R.U.F. leadership, backed by President Charles Taylor, of Liberia, got rich off captured diamond mines, its Army, made up largely of abducted children, got stoned and sacked the land, raping and hacking limbs off citizens and burning homes and villages to the ground. But, in May, 2001, a truce had been signed, and by the time Polman arrived in Sierra Leone later that year the Blue Helmets of the United Nations were disarming and demobilizing the R.U.F. The business of war was giving way to the business of peace, and, in Makeni, Polman found that former rebel warlords—such self-named men as General Cut-Throat, Major Roadblock, Sergeant Rape Star, and Kill-Man No-Blood—had taken to calling their territories “humanitarian zones,” and identifying themselves as “humanitarian officers.” As one rebel turned peacenik, who went by the name Colonel Vandamme, explained, “The white men are soon gonna need drivers, security guards, and houses. We’re gonna provide them.”

Colonel Vandamme called aid workers “wives”—“because they care for people,” according to Polman, and also, presumably, because they are seen as fit objects of manipulation and exploitation. Speaking in the local pidgin, Vandamme told Polman, “Them N.G.O. wifes done reach already for come count how much sick and pikin [children] de na di area.” Vandamme saw opportunity in this census. “They’re my pikin and my sick,” he said. “Anyone who wants to count them has to pay me first.”

This was what Polman had come to Makeni to hear. The conventional wisdom was that Sierra Leone’s civil war had been pure insanity: tens of thousands dead, many more maimed or wounded, and half the population displaced—all for nothing. But Polman had heard it suggested that the R.U.F.’s rampages had followed from “a rational, calculated strategy.” The idea was that the extreme violence had been “a deliberate attempt to drive up the price of peace.” Sure enough, Polman met a rebel leader in Makeni, who told her, “We’d worked harder than anyone for peace, but we got almost nothing in return.” Addressing Polman as a stand-in for the international community, he elaborated, “You people looked the other way all those years. . . . There was nothing to stop for. Everything was broken, and you people weren’t here to fix it.”

In the end, he claimed, the R.U.F. had escalated the horror of the war (and provoked the government, too, to escalate it) by deploying special “cut-hands gangs” to lop off civilian limbs. “It was only when you saw ever more amputees that you started paying attention to our fate,” he said. “Without the amputee factor, you people wouldn’t have come.” The U.N.’s mission in Sierra Leone was per capita the most expensive humanitarian relief operation in the world at the time. The old rebel believed that, instead of being vilified for the mutilations, he and his comrades should be thanked for rescuing their country.

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Is this true? Do doped-up maniacs really go a-maiming in order to increase their country’s appeal in the eyes of international aid donors? Does the modern humanitarian-aid industry help create the kind of misery it is supposed to redress? That is the central contention of Polman’s new book, “The Crisis Caravan: What’s Wrong with Humanitarian Aid?” (Metropolitan; $24), translated by the excellent Liz Waters. Three years after Polman’s visit to Makeni, the international Truth and Reconciliation Commission for Sierra Leone published testimony that described a meeting in the late nineteen-nineties at which rebels and government soldiers discussed their shared need for international attention. Amputations, they agreed, drew more press coverage than any other feature of the war. “When we started cutting hands, hardly a day BBC would not talk about us,” a T.R.C. witness said. The authors of the T.R.C. report remarked that “this seems to be a deranged way of addressing problems,” but at the same time they allowed that under the circumstances “it might be a plausible way of thinking.”

Polman puts it more provocatively. Sowing horror to reap aid, and reaping aid to sow horror, she argues, is “the logic of the humanitarian era.” Consider how Christian aid groups that set up “redemption” programs to buy the freedom of slaves in Sudan drove up the market incentives for slavers to take more captives. Consider how, in Ethiopia and Somalia during the nineteen-eighties and nineties, politically instigated, localized famines attracted the food aid that allowed governments to feed their own armies while they further destroyed and displaced targeted population groups. Consider how, in the early eighties, aid fortified fugitive Khmer Rouge killers in camps on the Thai-Cambodian border, enabling them to visit another ten years of war, terror, and misery upon Cambodians; and how, in the mid-nineties, fugitive Rwandan génocidaires were succored in the same way by international humanitarians in border camps in eastern Congo, so that they have been able to continue their campaigns of extermination and rape to this day.

And then there’s what happened in Sierra Leone after the amputations brought the peace, which brought the U.N., which brought the money, which brought the N.G.O.s. All of them, as Polman tells it, wanted a piece of the amputee action. It got to the point where the armless and legless had piles of extra prosthetics in their huts and still went around with their stubs exposed to satisfy the demands of press and N.G.O. photographers, who brought yet more money and more aid. In the obscene circus of self-regarding charity that Polman sketches, vacationing American doctors turned up, sponsored by their churches, and performed life-threatening (sometimes life-taking) operations without proper aftercare, while other Americans persuaded amputee parents to give up amputee children for adoption in a manner that seemed to combine aspects of bribery and kidnapping. Officers of the new Sierra Leone government had only to put out a hand to catch some of the cascading aid money.

Polman might also have found more heartening anecdotes and balanced her account of humanitarianism run amok with tales of humanitarian success: lives salvaged, epidemics averted, families reunited. But in her view the good intentions of aid—and the good that aid does—are too often invoked as excuses for ignoring its ills. The corruptions of unchecked humanitarianism, after all, are hardly unique to Sierra Leone. Polman finds such moral hazard on display wherever aid workers are deployed. In case after case, a persuasive argument can be made that, over-all, humanitarian aid did as much or even more harm than good.

“Yes, but, good grief, should we just do nothing at all then?” Max Chevalier, a sympathetic Dutchman who tended amputees in Freetown for the N.G.O. Handicap International, asked Polman. Chevalier made his argument by shearing away from the big political-historical picture to focus instead, as humanitarian fund-raising appeals do, on a single suffering individual—in this instance, a teen-age girl who had not only had a hand cut off by rebels but had then been forced to eat it. Chevalier wanted to know, “Are we supposed to simply walk away and abandon that girl?” Polman insists that conscience compels us to consider that option.

The godfather of modern humanitarianism was a Swiss businessman named Henri Dunant, who happened, on June 24, 1859, to witness the Battle of Solferino, which pitted a Franco-Sardinian alliance against the Austrian Army in a struggle for control of Italy. Some three hundred thousand soldiers went at it that day, and Dunant was thunderstruck by the carnage of the combat. But what affected him more was the aftermath of the fight: the battlefield crawling with wounded soldiers, abandoned by their armies to languish, untended, in their gore and agony. Dunant helped organize local civilians to rescue, feed, bathe, and bandage the survivors. But the great good will of those who volunteered their aid could not make up for their incapacity and incompetence. Dunant returned to Switzerland brooding on the need to establish a standing, professionalized service for the provision of humanitarian relief. Before long, he founded the Red Cross, on three bedrock principles: impartiality, neutrality, and independence. In fund-raising letters, he described his scheme as both Christian and a good deal for countries going to war. “By reducing the number of cripples,” he wrote, “a saving would be effected in the expenses of a Government which has to provide pensions for disabled soldiers.”

Humanitarianism also had a godmother, as Linda Polman reminds us. She was Florence Nightingale, and she rejected the idea of the Red Cross from the outset. “I think its views most absurd just such as would originate in a little state like Geneva, which can never see war,” she said. Nightingale had served as a nurse in British military hospitals during the Crimean War, where nightmarish conditions—septic, sordid, and brutal—more often than not amounted to a death sentence for wounded soldiers of the Crown. So she was outraged by Dunant’s pitch. How could anyone who sought to reduce human suffering want to make war less costly? By easing the burden on war ministries, Nightingale argued, volunteer efforts could simply make waging war more attractive, and more probable.

It might appear that Dunant won the argument. His principles of unconditional humanitarianism got enshrined in the Geneva Conventions, earned him the first Nobel Peace Prize, and have stood as the industry standard ever since. But Dunant’s legacy has hardly made war less cruel. As humanitarian action has proliferated in the century since his death, so has the agony it is supposed to alleviate. When Dunant contemplated the horrors of Solferino, nearly all of the casualties were soldiers; today, the U.N. estimates that ninety per cent of war’s casualties are civilians. And Polman has come back from fifteen years of reporting in the places where aid workers ply their trade to tell us that Nightingale was right.

The scenes of suffering that we tend to call humanitarian crises are almost always symptoms of political circumstances, and there’s no apolitical way of responding to them—no way to act without having a political effect. At the very least, the role of the officially neutral, apolitical aid worker in most contemporary conflicts is, as Nightingale forewarned, that of a caterer: humanitarianism relieves the warring parties of many of the burdens (administrative and financial) of waging war, diminishing the demands of governing while fighting, cutting the cost of sustaining casualties, and supplying the food, medicine, and logistical support that keep armies going. At its worst—as the Red Cross demonstrated during the Second World War, when the organization offered its services at Nazi death camps, while maintaining absolute confidentiality about the atrocities it was privy to—impartiality in the face of atrocity can be indistinguishable from complicity.

“The Crisis Caravan” is the latest addition to a groaning shelf of books from the past fifteen years that examine the humanitarian-aid industry and its discontent. Polman leans heavily on the seminal critiques advanced in Alex de Waal’s “Famine Crimes” and Michael Maren’s “The Road to Hell”; on Fiona Terry’s mixture of lament and apologia for the misuse of aid, “Condemned to Repeat?”; and on David Rieff’s pessimistic meditation on humanitarian idealism, “A Bed for the Night.” All these authors are veteran aid workers, or, in Rieff’s case, a longtime humanitarian fellow-traveller. Polman carries no such baggage. She cannot be called disillusioned. In an earlier book, “We Did Nothing,” she offered a prosecutorial sketch of the pathetic record of U.N. peacekeeping missions. Then, as now, her method was less that of investigative reporting than the cumulative anecdotalism of travelogue pointed by polemic. Her style is brusque, hardboiled, with a satirist’s taste for gallows humor. Her basic stance is: J’accuse.

Polman takes aim at everything from the mixture of world-weary cynicism and entitled self-righteousness by which aid workers insulate themselves from their surroundings to the deeper decadence of a humanitarianism that paid war taxes of anywhere from fifteen per cent of the value of the aid it delivered (in Charles Taylor’s Liberia) to eighty per cent (on the turf of some Somali warlords), or that effectively provided the logistical infrastructure for ethnic cleansing (in Bosnia). She does not spare her colleagues in the press, either, describing how reporters are exploited by aid agencies to amplify crises in ways that boost fund-raising, and to present stories of suffering without political or historical context.

Journalists too often depend on aid workers—for transportation, lodging, food, and companionship as well as information—and Polman worries that they come away with a distorted view of natives as people who merely suffer or inflict suffering, and of white humanitarians as their only hope. Most damningly, she writes: “Confronted with humanitarian disasters, journalists who usually like to present themselves as objective outsiders suddenly become the disciples of aid workers. They accept uncritically the humanitarian aid agencies’ claims to neutrality, elevating the trustworthiness and expertise of aid workers above journalistic skepticism.”

Maren and de Waal expose more thoroughly the ignoble economies that aid feeds off and creates: the competition for contracts, even for projects that everyone knows are ill-considered, the ways in which aid upends local markets for goods and services, fortifying war-makers and creating entirely new crises for their victims. Worst of all, de Waal argues, emergency aid weakens recipient governments, eroding their accountability and undermining their legitimacy. Polman works in a more populist vein. She is less patient in building her case—at times slapdash, at times flippant. But she is no less biting, and what she finds most galling about the humanitarian order is that it is accountable to no one. Moving from mess to mess, the aid workers in their white Land Cruisers manage to take credit without accepting blame, as though humanitarianism were its own alibi.

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Since Biafra, humanitarianism has become the idea, and the practice, that dominates Western response to other people’s wars and natural disasters; of late, it has even become a dominant justification for Western war-making. Biafra was where many of the leaders of what de Waal calls the “humanitarian international” got their start, and the Biafra airlift provided the industry with its founding legend, “an unsurpassed effort in terms of logistical achievement and sheer physical courage,” de Waal writes. It is remembered as it was lived, as a cause célèbre—John Lennon and Jean-Paul Sartre both raised their fists for the Biafrans—and the food the West sent certainly did save lives. Yet a moral assessment of the Biafra operation is far from clear-cut.

After the secessionist government was finally forced to surrender and rejoin Nigeria, in 1970, the predicted genocidal massacres never materialized. Had it not been for the West’s charity, the Nigerian civil war surely would have ended much sooner. Against the lives that the airlifted aid saved must be weighed all those lives—tens of thousands, perhaps hundreds of thousands—that were lost to the extra year and a half of destruction. But the newborn humanitarian international hardly stopped to reflect on this fact. New crises beckoned—most immediately, in Bangladesh—and who can know in advance whether saving lives will cost even more lives? The crisis caravan rolled on. Its mood was triumphalist, and to a large degree it remains so.

Michael Maren stumbled into the aid industry in the nineteen-seventies by way of the Peace Corps. “In the post-Vietnam world, the Peace Corps offered us an opportunity to forge a different kind of relationship with the Third World, one based on respect,” he writes. But he soon began to wonder how respectful it is to send Western kids to tell the elders of ancient agrarian cultures how to feed themselves better. As he watched professional humanitarians chasing contracts to implement policies whose harm they plainly saw, he came to regard his colleagues as a new breed of mercenaries: soldiers of misfortune. Yet, David Rieff notes, “for better or worse, by the late 1980s humanitarianism had become the last coherent saving ideal.”

How is it that humanitarians so readily deflect accountability for the negative consequences of their actions? “Humanitarianism flourishes as an ethical response to emergencies not just because bad things happen in the world, but also because many people have lost faith in both economic development and political struggle as ways of trying to improve the human lot,” the social scientist Craig Calhoun observes in his contribution to a new volume of essays, “Contemporary States of Emergency,” edited by Didier Fassin and Mariella Pandolfi (Zone; $36.95). “Humanitarianism appeals to many who seek morally pure and immediately good ways of responding to suffering in the world.” Or, as the Harvard law professor David Kennedy writes in “The Dark Sides of Virtue” (2004), “Humanitarianism tempts us to hubris, to an idolatry about our intentions and routines, to the conviction that we know more than we do about what justice can be.”