It’s a Tuesday in December, and Jared Malone is in Hawaii relaxing with his family prior to the Christmas holiday. Still, the North Idaho resident and Marine veteran wakes early and joins a Zoom call.

The subject?

Ukrainian medical supplies.

On the call are top doctors from a hospital in the Donetsk region, one of the hardest hit areas of eastern Ukraine, and a representative from the national police, plus a handful of other Americans, including some veterans who served with Malone, 38, in Iraq.

A haggard doctor sits in a dimly lit room and lays out the facts of the situation. There has been a surge in casualties, she said, and the hospital she works at, the largest for civilians in the region, is accepting about 15 new patients every day. Doctors are amputating limbs, stanching wounds and otherwise dealing with the human toll of near-constant shelling and missile strikes. Meanwhile, frostbite cases have skyrocketed, an increasingly common ailment as the Ukrainian winter sets in amid a beleaguered power grid. Still, the 374-bed hospital continues to provide nonwar-related services despite damage from shelling. One week earlier this month, 13 women gave birth amid the chaos.

And while the hospital needs medical supplies, they have a pedestrian request as well: washers and dryers. The constant power outages have fried the machines, the doctor said.

Malone listens intently, taking notes and asking questions. The call ends with Malone assuring the Ukrainians that his team will consider their requests. Two days later, Malone – via the nonprofit Project Victory Ukraine, which he founded in March – ordered two washers and two dryers, and was arranging shipment.

The operation is small, as far as the war in Ukraine goes. Since Malone started the nonprofit, he’s raised $220,000 and delivered slightly more than $1 million in donated medical supplies. Meanwhile, analysts estimate more than $100 billion has gone to Ukraine since Jan. 24 from governments. Donations from nongovernmental aid organizations, like the Red Cross, are harder to tabulate, although as of August, the American Red Cross had donated $140 million. The sheer scale of need is part of what drives Malone.

“There are innocent people who are suffering every day. Now they’re going into a winter that’s going to be the hardest winter of their entire life,” Malone said, adding later, “The hardest part for me personally is the amount of pressure. If we go over and we help 500 people, I come home feeling like, ‘Why couldn’t we help 1,000?’ ”

Malone’s efforts represent a broader shift in how – and who – delivers humanitarian aid. While large nonprofits, like the Red Cross and Doctors Without Borders, still dominate international aid work, experts say some of the most effective work in Ukraine and throughout the world is done by smaller, more nimble groups; groups that prioritize providing money or goods directly to those in need. And while many praise that shift, noting that smaller groups are often better integrated into the communities they serve, the change does raise questions about oversight and, in the case of war, neutrality.

“When it comes to the volunteers both inside and outside, you also don’t see the bright line drawn between humanitarian aid and military support,” said Abby Stoddard, a former aid worker who founded Humanitarian Outcomes, a think tank focused on humanitarian aid research. “Which, of course, is very problematic from the humanitarian standpoint.”

• • •

Malone first arrived in Ukraine in late March and almost immediately headed to Kyiv, which at that time was nearly surrounded. The Post Falls husband and father of two had recently become a licensed counselor, a calling he came to after working through his own war-related PTSD from two combat tours in Iraq. On that first trip, he traveled throughout Ukraine, mostly via the network of a Ukrainian church. Malone, a devout Christian, trained Ukrainian first responders in the basics of mental health care and helped evacuate civilians from then-embattled Kyiv.

“My mindset going into this was, if this was going to be a long-term mission, I needed to gain the trust of the locals,” he said.

On that first trip, he connected with the Ukrainian national police, a meeting that proved fortuitous. He recalls sitting in a bomb shelter during a missile attack eating dinner with three Ukrainian men who would eventually become the core facilitators of his work in the country.

“Partnerships formed under fire seem to have the deepest connection,” he said of that dinner.

The overwhelming need he experienced in Ukraine convinced him to do more. So, he decoupled his efforts from any religious or political organization, instead registering as a nonprofit, a move that made it easier to work with the Ukrainian government, he said.

He’s been back to Ukraine four times since that first trip, most recently in November, when he and others helped train Ukrainian police in the basics of trauma care and delivered donated supplies. Like during his first visit, he traveled near the front lines, going where he was told no American had yet been. The risk is real but necessary to build connections and trust, he said; connections that in turn allow Malone to assure donors that the money or goods they provide actually go to good use.

“Every life is worth saving,” he said, although he is aligned closely with the Ukrainian cause.

• • •

In June 1859, a young and wealthy Swede stumbled into the macabre theater of war. Henri Dunant was traveling through Italy and came across the aftermath of the Battle of Solferino, a brutal brawl involving 300,000 men under the respective commands of Napoleon III and the Austrian Emperor Franz Joseph I. Dunant was so horrified by the suffering that he stayed and tended to wounded soldiers from both sides. Afterward, he wrote a book, “A Memory of Solferino,” which recounted the brutality and unintentionally set the foundation for modern humanitarian aid.

“Here is hand-to-hand struggle in all its horror and frightfulness; Austrians and Allies trampling each other under foot, killing one another on piles of bleeding corpses, felling their enemies with their rifle butts, crushing skulls, ripping bellies open with sabre and bayonet,” he wrote. “No quarter is given; it is a sheer butchery; a struggle between savage beasts, maddened with blood and fury. Even the wounded fight to the last gasp. When they have no weapon left, they seize their enemies by the throat and tear them with their teeth.”

The book, and Dunant’s later activism, are credited with the creation of the International Committee of the Red Cross and the eventual adoption of the first Geneva Convention. A fundamental tenet of Dunant’s work is humanitarian neutrality: Staying unaffiliated in a conflict gives aid workers the ability to help all who are suffering.

“If you’re seen as delivering military assistance, that makes you a legitimate target,” Stoddard said. “If you’re not a neutral humanitarian aid provider, there is no international code that says you should be protected and not shot at.”

That’s a particularly pernicious problem in Ukraine. The majority of humanitarian aid organizations are based in Western democracies, countries and cultures generally united behind Ukraine and publicly opposed to the Russian invasion.

“I know those who are trying to do it (provide aid via the Russia border) are keeping it very quiet. They are going in from the Russian side, and it would just not be good for anyone to know,” she said. “But it’s the right thing to do. You need to negotiate access and aid.”

In late March, the president of the International Committee of the Red Cross, Peter Maurer, visited Moscow (days after visiting Kyiv) and was photographed shaking hands with Russia’s Foreign Minister. The visit was lambasted, a Molotov cocktail was thrown at the Red Cross office in Ukraine and it was rumored, falsely, that the organization was setting up refugee camps in Russia for Ukrainians kidnapped by Russian forces.

In response, the Red Cross reiterated its neutrality, pointing to previous examples where it stayed impartial, in hopes of preserving lines of negotiation. Famously, Red Cross officials knew about the widespread abuse – and sometimes torture – of prisoners in the U.S.-run Abu Ghraib prison in Iraq. However, the organization did not publicize those findings, instead working directly with the U.S. government in hopes of negotiating change.

Neutrality, of course, raises its own ethical questions. During World War II, the German Red Cross was accused of aiding the slaughter of Jews, with one historian calling it an “S-S riddled ambulance corps.”

Maurer, the Red Cross president, defended his organization’s approach.

“Neutral, impartial, @ICRC is mandated to speak with all sides of a conflict to advocate respect for the laws of war that protect civilian life,” Maurer tweeted after his visit to Russia in March.

While Project Victory isn’t providing any sort of military aid, defensive or otherwise, Malone admits he’s pro-Ukrainian and jokes that he’s probably on a couple “Russian lists.” Still, he’s asked members of Project Victory to avoid scathing anti-Russian social media posts and tries to stay out of the politics of the war.

Drawing the line in the midst of war between humanitarian and military aid is murky. The fact that U.S. military veteran Malone works closely with the Ukrainian government, limits where and who he helps. If a Ukrainian is freezing to death – and happens to be a soldier – does providing him a jacket mean you’re providing military aid? This isn’t a new question, but the shift from large, centralized aid groups to smaller ones means the response to that question has more variability. In the case of Ukraine, where Russian forces have committed numerous documented atrocities, few are willing to criticize groups for aligning themselves closely with the Ukrainian military cause.

“Nobody is going to lecture these volunteer groups that are providing both helmets and baby food,” Stoddard said. “In fact, many of them will preferentially fulfill the requests of the local military group before they will help civilians.”

Still, it’s a question worth considering. One with potentially deadly ramifications.

“We’re lucky we haven’t seen any major security incidents so far,” she said. “It’s pretty ad hoc and a little bit scary, but clearly there is a gap (small organizations) are filling.”

• • •

That gap isn’t unique to Ukraine, said Alison Thompson, a full-time aid worker since 2001, when she volunteered at Ground Zero in New York City. There, she saw the systemic failings of large aid organizations and, shortly after, founded Third Wave Volunteers, an organization focused on “teaming with local grassroots groups already in place on the ground.” This year, she was awarded the U.S. Presidential Lifetime Service Award, an honor made more remarkable because she’s an Australian citizen.

“The old disaster manuals don’t work anymore,” she said. “The Federal Emergency Management Agency fails every disaster.”

Since 9/11, she’s worked all over the world, including in Ukraine. She’s seen large aid organizations refuse to work in an area where smaller organizations are already present, despite overwhelming need. This, she said, is tied up with the politics of raising money and marketing.

“The big ones, they have to raise $100 million before they even walk out the door,” she said. “The aid business is quite a dirty business … when you’re really out there and in it.”

Although she doesn’t know anything about Malone’s organization, she said efforts like his represent a new “bottom-up” approach.

Similarly, Helena Krajewska, a spokeswoman for the Polish Humanitarian Action, the country’s largest aid group, said she’s seen many small, newly formed aid groups like Malone’s. In the best-case scenario, they can provide targeted and efficient help. She’s also seen the dark side: aid workers with few useful skills, bumbling through cultures and countries they don’t understand or showing up temporarily and then leaving. This is where large organizations are useful, she argues. They have the resources and procedures for the long haul.

“We have to find a middle there,” she said.

This dynamic of smaller aid organizations providing localized support isn’t unique to Ukraine. Recent disasters such as Nepal’s 2015 Earthquake or this year’s flooding in Pakistan have seen the same dynamic. However, according to an analysis by Humanitarian Outcomes, Ukraine is unique because of the sheer number of small, recently formed aid groups. “Virtually all humanitarian aid” inside Ukraine was undertaken by local groups, including 150 pre-existing groups and 1,700 new local aid groups, the May analysis states.

Still, the May study, whose lead author was Stoddard, concluded that only $6.4 million of the more than $2.6 billion donated to the Ukraine humanitarian response since February went to local organizations, despite the fact these organizations were providing nearly all of the assistance inside the country, the report states.

“I don’t think the (large) humanitarian organizations have acquitted themselves that well in terms of meeting people’s needs,” she said.

• • •

Part of the reason larger organizations haven’t “acquitted themselves” well is because of rigorous internal policies, both about financial oversight and acceptable levels of risk. In the early days of the war, the vast majority of international aid was concentrated in western Ukraine, far from the front lines and the most acute need. At the same time, most disbursement systems for monetary aid require some sort of grant application, a tough ask for people living in an active war zone.

Project Victory, one of the 1,700 newly formed aid groups, had no such restrictions, although Malone has worked hard to assure donors that their money isn’t being misspent.

A Ukrainian member of Project Victory will escort the washers and dryers to the hospitals, and take photos and videos documenting their delivery, a chain-of-custody procedure Malone implements for all donated items. In December, Project Victory was vetted by Blue Check Ukraine, a New York-based organization that helps fund small nonprofits working in Ukraine and was founded in response to the proliferation of small groups in a country known for corruption.

“If we are going to continue to get supplies over there, we want to make sure they’re going through trusted supply routes,” Malone said.

• • •

Dave Nelson wasn’t thinking about financial oversight and neutrality when he stepped into a bone-white Ukrainian church in November. Instead, he was wrestling with his own personal reasons for joining Project Victory.

Inside the church, he saw images of terror. Photos of dead women, men and children lined the walls of the Church of St. Andrew in Bucha, Ukraine. Clear and obvious signs of torture; corpses’ hands tied behind backs and worse. Bucha, which was occupied by Russian soldiers, has become synonymous with atrocity since its liberation by Ukrainian forces in April. By November, the bodies had been buried. But the documentary photos remained as a ghastly memorial.

Nelson, a former U.S. Marine who served two combat tours, is Project Victory’s director of development and served with Malone in Iraq. He’d already spent three days training Ukrainian police officers on the basics of trauma care, and now he was touring Bucha before heading back to Colorado.

Standing in the church, he wondered about his motivations. Was he here for atonement? To pay off an ethical debt? Simply to help? It’s an open question, one with which he’s still grappling, and representative of the diverse motivations of small aid organizations.

“I wonder if this whole Project Victory thing is absolution for being a participant in warfare. I don’t know how to describe it,” he said. “When we were in the military, we had to do lot of terrible things.”

He paused, struggling to articulate it all. The thing he is sure of? While the photos fill him with rage, he’s done with violence.

“I definitely don’t want to hurt people anymore,” he said. “I had to do that for a long time, and I don’t think that’s the right way to go about things.”

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