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I'm a bit uncomfortable with this. Who picks the people that get our help? Is it better to pick a few and fix their lives, or should we aim to slightly improve the lives of many?

Well, I can sort of understand what you're saying. But, it's like letting the perfect be the enemy of the good, which actually is a common theme in many of the criticisms. There are people with real problems that need help now or they could perish; I don't see how providing ways to help them could ever be a bad thing. The other alternative is to fund nebulous water projects that might get off the ground in 1-5 years or something like that -- no that there's anything wrong with that but I don't think it is a mutually exclusive thing.

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