About €950 per death averted. Here is the calculation.

Four reasons to distrust it

An estimate at this level would place us among the most effective documented interventions. We do not claim that, because four things can distort it, and we would rather name them ourselves.

1. Neither of our two parameters comes from a trial on our population. The 6 % annual mortality is a working assumption. The 70 % reduction comes from the hydroxyurea literature, not from following our own cohorts.
2. The calculation assumes perfect adherence. A three-month stock-out removes a quarter of the year's effect. We have had them, and they are on the record.
3. The €40 covers the medicine only. The biological monitoring the treatment requires is not funded by us. A full cost would be higher.
4. Our overheads are real, even though donations do not pay them. The founding family does. That is true in the accounts, and it does not make them vanish from an honest effectiveness calculation.

One thing cuts the other way, and we flag it too: our 6 % assumption is probably twice too low. Half of affected children die before the age of five in low-resource settings, which corresponds to roughly 13 % a year. At that rate the cost would fall to €440 per death averted. We keep the conservative figure.

Counterfactual impact

The question that matters is not what we do, but what would not have happened without us.

• Where we still work, hydroxyurea is not available in a pharmacy. Without us these children have no treatment. Not a worse treatment: none.
• The other organisations working on sickle cell fund screening and therapeutic education, not the medicine. We are complementary, not redundant.
• We did not merely pay the price, we brought it down. Work on a locally produced generic cut the cost threefold, for us and for everyone who buys after us. That effect reaches beyond our own cohorts.
• And we leave where the handover has happened. In Senegal the generic is now sold in pharmacies and covered up to the age of five, so we are preparing our exit rather than settling in. The consequence is uncomfortable and we would rather say it: three quarters of our published figure are in the country we are leaving.

The leverage, in figures

Two reductions obtained, both verifiable against invoices and bank statements: the capsule went from 27 to 9 cents by working on a locally produced generic rather than importing from Europe, and shipping a consignment from €800 to €84 by sending it from within the region. A child-year of treatment therefore went from €120 to €40.

What we do not know

We publish this list because an organisation without one is an organisation that does not measure.

• Retention. How many children who start in one year are still treated the next. It is the figure that would make our promise of continuity credible, and we do not have it.
• The breakdown of our cohorts by partner, with a date against each count.
• The biological monitoring actually carried out for the children we treat.
• An independent evaluation. No external evaluator has examined us. Our figures are our own — verifiable, but not audited.

What one more euro would fund

We treat a child into adulthood, roughly ten years. We do not reserve the full ten: our working assumption is three years reserved per child, or €120. At that rate, €3,000 commits a cohort of 25 children — which is exactly the extension pending with our main partner in Burkina Faso.

We hold no institutional funding. Our latest application was unsuccessful, and our fundraising is event-driven: it depends on a handful of gifts a year. That, not the field's capacity to take children on, is what currently limits how many we can commit to.

The accounts, and what they say

The 2025 financial year was rebuilt from the twelve bank statements, line by line, and reconciles to the cent. €6,952 received, €12,949 spent: we drew nearly six thousand euros from our reserve, which comes mostly from a gift by the founding family. 97 % of outflows were medicine and its shipping.

We do not present that 97 % as evidence of effectiveness. The overhead ratio says nothing about impact per euro, and an organisation can be very frugal and very useless. We mention it because it is verifiable, not because it is an argument.

Our three commitments

• Every figure carries its date and its source. A figure without a date is not published.
• We revise downwards when we must. In August 2026 we replaced “more than 300 children”, published for months, with 200, because we could no longer obtain real counts from one of our partners. We did it ourselves, unprompted.
• When a figure is uncertain, it is shown as uncertain. Including the one at the top of this page.