The book investigates how economic policies imposed by international institutions can exacerbate humanitarian crises. Peter Griffiths, an insider at the intersection of government and the Bank, chronicles his mission in Sierra Leone through his diary. He details the pressures on officials to ignore developing problems and the World Bank's imposition of a secret agreement that banned government food imports and subsidies, driven by an obsession with the free market. This policy, enacted when the private sector failed to import, directly contributed to the looming famine, leaving ministries and state organizations powerless to intervene.

The book offers a critical, insider's perspective on the devastating impact of international economic policies during humanitarian crises. It highlights the internal conflicts and pressures faced by officials caught between institutional mandates and on-the-ground realities. The narrative is grounded in personal diary entries, providing a granular, day-by-day account of events. The work serves as a case study illustrating how adherence to free market principles by institutions like the World Bank can, in certain contexts, lead to severe famine.