World War I transformed humanitarian relief. The magnitude of the conflict, the extent of civilian suffering, particularly in occupied areas, and the destruction and consequences after the end of hostilities accelerated the rationalization of humanitarian relief. Organizations, both temporary and permanent, embraced the challenge of alleviating human suffering, creating new precedents for international cooperation. Among the new organizations was one that would have a long legacy in foreign assistance, the American Friends Service Committee (AFSC), an association of Quakers. Spontaneous organizations such as the American Committee for Armenian and Syrian Relief, the American Jewish Relief Committee, Christian Science Relief, and the Smith College Relief Unit sprang up. Established organizations like the Rockefeller Foundation, which set up a War Relief Commission, and the YMCA and the Salvation Army participated. In all, 130 U.S. agencies involved themselves in war relief. The ARC, the oldest and most organized relief group in 1914, had less than 150 chapters and twenty thousand members. The agency had a new national headquarters in Washington, D.C., signifying its arrival as part of the American establishment. When World War I began in Europe, the ARC offered war relief only to sick and wounded combatants. It sent medical and hospital supplies, and at first even established hospital units. Soon it was obvious that civilians were in dire straits, particularly in occupied nations like Belgium. Under the leadership of Henry P. Davison, chair of the War Council of the ARC, the organization engaged in intensive fund-raising and publicity. The ARC raised $400 million during the war and immediate postwar for relief. Membership grew from 250,000 in early 1917 to 21 million at the start of 1919.
An individual whose reputation took on heroic proportions emerged as the most important figure in the history of American humanitarian assistance and relief, with the singular exception of Barton. Herbert C. Hoover, Quaker, Stanford-trained engineer, and millionaire had spent his early career in international mining endeavors, primarily in Australia and China. His first experience at providing relief came in Tientsin, when he and his wife, Lou, helped distribute food and supplies to anti-Boxer Chinese. Appalled by the devastating effects of German occupation, American diplomats called for relief for Belgium. They asked Hoover, who was in Europe, to head what became the American Commission for Relief in Belgium (CRB) and was later transformed into an international undertaking. The primary goals of the CRB were to provide food to prevent starvation and, by its neutral presence, to offer protection to the population. It was the start of almost a decade of American relief efforts in Europe.
Efforts to provide relief required close cooperation with the belligerents. The image of starving Belgians swayed British officials to reject the seemingly callous position of those like Winston Churchill, who believed that feeding Belgians helped Germany and impeded Britain's war goals. Conflicts with the belligerents emerged, yet Hoover cajoled and manipulated German and British officials throughout the war to keep the relief program going.
Hoover attempted to distribute relief assistance in ways that kept the Belgian economy functioning. Although some food was handed out freely, Hoover purchased wheat (mostly from the United States) and sold it at fixed prices to millers, who then sold flour at fixed prices to bakers, and so on to consumers. Belgian town leaders also helped distribute food in an equitable manner. While Hoover favored voluntary efforts, he sought public funds since the CRB required more resources than the organization could raise through private donations. Voluntary contributions totaled $52 million to the CRB. But the organization spent about $1 billion between November 1914 and August 1919. Much of it was Belgian money in banks outside of Belgium, British and French government funds, and U.S. government loans, which came after 1917.
The CRB also coordinated relief in northern France after 1915, and made some effort to provide relief in other parts of Europe. Suffering in Poland and Serbia in particular gained American attention. The CRB cooperated in a limited way with the Rockefeller Foundation to extend relief to Poland, but Britain opposed Polish relief. Talk of starving Poles bolstered public support for the war. Despite U.S. diplomatic pressure on Britain to permit food for Poland and on Germany to stop requisitioning Polish food, both countries remained intransigent and little was accomplished, except for some food shipments for children. These relief attempts, however, spurred later support for Polish independence, in part by promoting the organization of Polish American lobbies, which along with Polish constituents in other countries rallied to press for Polish interests. Also, while President Wilson was already moving toward support for Polish independence, the failure of relief to Poland helped stimulate sympathy and thus domestic political support for an independent Poland. Efforts to provide relief to Serbia won more support from Britain than the United States. Hoover thought Serbian relief too complicated and he resented British efforts to tie Polish relief to relief in the Balkans.
When the United States entered the war, Belgian relief was turned over to the Comité Hispanico-Hollandais, with figureheads at the helm in the persons of the king of Spain and the queen of Holland. Hoover still ran the show, but now he did so from Washington. The CBR ended its activities in 1919. According to auditors, its overhead costs came to only about one-half of one percent. Some 2.5 million tons of food at a value of $300 million fed nine million people in France and Belgium. As David Burner concludes in his biography Herbert Hoover: A Public Life (1979), these projects "constituted a superb accomplishment, technically, morally, and practically."