The leading medical journal The Lancet on Friday accused major aid organisations of corporate preening and self-interest that had contributed to bedlam in the effort to help Haiti.
"International organisations, national governments and non-governmental organisations are rightly mobilising, but also jostling for position, each claiming that they are doing the best for earthquake survivors," it said in an editorial.
"Some agencies even claim that they are 'spearheading' the relief effort. In fact, as we only too clearly see, the situation in Haiti is chaotic, devastating, and anything but coordinated."
The Lancet did not name names and gave credit to "exceptional work in difficult circumstances" by aid workers.
But, the British journal said, "the aid sector (is) undoubtedly an industry in its own right" and, unpalatable as it might seem, scrutiny of motives and performance was justified.
"Large aid agencies and humanitarian organisations are often highly competitive with each other," The Lancet said.
"Polluted by the internal power politics and unsavoury characteristics seen in many big corporations, large aid agencies can be obsessed with raising money through their own appeal efforts.
"Media coverage as an end in itself is too often an aim of their activities. Marketing and branding have too high a profile.
"Perhaps worse of all, relief efforts in the field are sometimes competitive with little collaboration between agencies, including smaller, grass-roots charities that may have better networks in affected countries and so are well placed to immediately implement disaster relief."