The first World Humanitarian Summit opened Monday in Istanbul as the United Nations and key donors acknowledged that the current system for distributing humanitarian aid and responding to global crises is not working the way it should.

Some 125 million people, a "record number," are in need of aid around the world as we face the worst humanitarian crisis since World War II, UN Secretary General Ban Ki-moon said as he opened the two-day summit.

"Today we do not yet have a functioning humanitarian aid system," German Chancellor Angela Merkel said.  

Admitting that the international system for delivering aid is bloated, UN agencies and major donor countries agreed to a plan to cut 1 billion dollars in inefficiencies on an annual basis, freeing up more cash for people in need. 

Despite the pledges for reform, the event faced heavy criticism, with some aid groups accusing governments of blocking aid to people under siege and attacking schools and hospitals. Some groups charged that the summit would do little to hold those governments accountable. 

UN agencies and their partners need roughly 20 billion dollars this year, but only 18 per cent of that sum has been received so far.

"Very often pledges are made but the money does not reach where it is most needed," Merkel said. Some donors have admitted there are not enough funds to go around. 

Doctors Without Border (MSF) pulled out of the summit, saying it failed to address the most acute humanitarian crises, which cannot be fixed through aid alone.

The aid group wants states to do more to end conflicts, protect civilians, deliver assistance and respect international law. Last year, 75 hospitals managed by or supported by MSF were bombed, often by governments.

"In Syria and elsewhere, hospital and medical centres are being bombed, people are losing their lives," Merkel said. The German chancellor was the highest ranking official from major donor countries to attend the summit.

Russia and the United States are among key countries - both in terms of donations and influence - which have not sent high-level officials.

Some 60 million people are refugees or displaced, and that number is growing as national and international conflicts remain unresolved. 

As a result, tens of millions of children are unable to access education because of war. War Child, a charity, says only 1.4 per cent of humanitarian aid is spent on educating children who are trapped by conflicts.

As the crises mount, the size of UN and government agencies has grown to accommodate those in need, but officials admit this is not always in proportion.

"We need to shrink these bureaucracies down to size," said Kristalina Georgieva, the European Commissioner for budget.

Turkey, the host country, has more than 2 million Syrian refugees, with no sign of the civil war ending, letting them go home.

Despite often being touted as an example of generosity towards refugees, the country has come under fire from human rights groups, who contradict government claims that it has an open border policy and warn of growing authoritarianism.

Europe too is coming under criticism for its refugee policy, including a recent deal with Turkey to stem the flow of migrants and cut routes to the bloc.

"I don't think what the EU has come up with so far is a good solution. It is not sustainable," Salil Shetty, the head of Amnesty International, told dpa.

"The refugee crisis is not a one-off crisis. They are only dealing with the consequences not the causing factors," he said. 

Security is tight in Istanbul, which has been hit by terrorist attacks this year.

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