For a moment, set aside consideration of the well-known humanitarian crises of recent years in Lebanon, Iraq, Colombia, Darfur and Zimbabwe, and contemplate northern Uganda. A rebel militia called the Lord's Resistance Army has kidnapped 20,000 children from that region in the last two decades to swell its ranks. Until a ceasefire in 2006, an estimated 40,000 children left their homes every night to gather at public meeting points, seeking safety in numbers.

Did you know that? Probably not. The international system for helping the oppressed is what humanitarian activist Jan Egeland calls an "immoral lottery." Some get attention and aid; others might as well be invisible. Egeland thinks it's a lousy system that needs to be overhauled. He makes his case with strong effect in A Billion Lives: An Eyewitness Report from the Frontlines of Humanity, his memoir of his tenure from 2003-2006 as the United Nations' top emergency relief official.

Egeland, a Norwegian steeped in his country's tradition of unaligned social activism, literally risked his life to negotiate with rebel leaders in Uganda, with some modest success. It's what he's always done, during his time at the UN, Amnesty International and the Norwegian Red Cross: He parachutes into horrendous crises, unflinchingly confronts all sides and usually manages to alleviate the suffering. But he knows better than anyone that he seldom makes much long-term difference.

As Egeland takes us along on his UN journeys to Latin America, the South Pacific tsunami zone, the Middle East and Africa, he is an equal opportunity critic. The U.S., he says, is generous with emergency money for natural disasters, but miserly with development aid. The leaders of developing nations, the "South," too often refuse to take responsibility in their own regions. China pretends it's still a beleaguered underdog rather than the rich superpower it is. Time and time again, both sides in conflicts are intransigent and incompetent, content to see innocents suffer rather than compromise their hard-line positions.

It's a sad picture, but Egeland has some hope. We have all the tools for coherent multilateralism, he argues in his final prescriptive chapter. We just need the political will and the compassion.

Anne Bartlett is a journalist in Washington, D.C.

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