Clinics in Uganda are scrambling to find new sources for vital HIV drugs, aid workers in Bangladesh fear refugee camp infrastructure will crumble, and mobile health units may have to stop treating civilians near the frontline in Ukraine.
Services worldwide have been thrown into disarray by President Donald Trump’s executive order, signed on Monday 20 January and published on Friday halting US foreign aid funding flows for 90 days for review.
A few exemptions include military aid to Israel and emergency humanitarian food assistance, but charities said the sudden announcement – which included instructions for any US-funded work already in progress to stop immediately – had put lives at risk.
The US president’s Emergency Plan for Aids Relief (Pepfar) is included in the order. It provides antiretrovirals to 20 million people with HIV globally, and funds test kits and preventive medicine supplies for millions more.
Already, clinics worldwide are reporting that supplies have been halted.
“This is a matter of life or death,” said Beatriz Grinsztejn, president of the International Aids Society, adding that stopping Pepfar would be disastrous. “If that happens, people are going to die and HIV will resurge.”
Brian Aliganyira runs a health clinic for the LGBT+ community in Kampala, Uganda. He said the presidential order had brought supplies to a standstill. Ark Wellness Hub relies on Pepfar for testing kits, medication to prevent and treat HIV and running costs.
“Today is crazy,” he said on Monday. “We are worried. As I’m chatting with you now, I’m amid lots of emails and trying to find who can stock up our supplies and drugs. Supply chains [are] all affected.”
Asia Russell, executive director of Health Gap, an advocacy group for HIV patients, said clinics worldwide were facing the same situation.
A stop work order was not needed to carry out a review of aid, she said. “This is wasteful, inefficient and doesn’t keep America safe or make it more prosperous or secure – whereas Pepfar actually does all of those things. This was a deliberate decision to sow chaos and confusion, no matter the human cost.”
She said any prolonged shutdown would mean “halting service delivery, firing staff, shutting down clinics, rolling back outreach”. “You don’t recover from that kind of whiplash overnight,” she added.
A community HIV testing service in Malawi. A prolonged freeze of US foreign aid will cause many such clinics to close, said experts. Photograph: USAid Office of HIV/AidsThe US is the largest single aid donor globally, and disbursed $72bn (£58bn) in the 2023 financial year.
The humanitarian sector had been braced for the impact of Trump policies such as the reintroduction of the global gag rule and threatened defunding of UN agencies, but the stoppage of currently funded projects came as a shock. Many aid sector organisations said on Monday they were still assessing whether their programmes were affected.
Andriy Klepikov, executive director of the Alliance for Public Health in Ukraine, said: “Mobile integrated medical services to people in remote locations closely located to the frontline are impacted. We provide mobile medical services to people in the areas where there are no clinics, doctors or nurses. This is a very demanded and effective programme.
“I hope Ukraine – being amid the war – will receive a waiver to continue such critical services. Or at least the review will be done in a priority order.”
Abby Maxman, president of Oxfam America, said the future looked grim “for US foreign assistance and the people around the world who rely on it, who are living through humanitarian disasters and struggling simply to survive”.
“We will see life or death consequences for millions around the globe, as programmes that depend on this funding grind to a halt without any plan or safety net. Aid experts are unable to operate or plan if they don’t know when funding will arrive, or how much,” she said.
“Funding for emergency food has been carved out as one exception, but funding for clean water, sanitation, healthcare and more has not been and are just as vital to survival for people living through crisis. We need to see these programmes allowed to proceed.”
The World Food Programme, a USAid partner, distributes food to people in South Sudan. Funding for emergency food is not affected. Photograph: Gabriela Vivacqua/WFP/USAidThere has been concern about the impacts of the cuts on hundreds of refugee camps globally – from Chad to Nigeria – where displaced people are especially reliant on aid.
A million people live in sprawling camps in Bangladesh, where the US provided 55% of funding for the Rohingya humanitarian response and which had already seen a drop in funding last year. An aid worker there, who wished to remain anonymous, said they were assessing “what are the most critical life-saving activities to prioritise”.
Dr Atul Gawande, who was assistant administrator for global health at USAid under the Biden administration, said the order had done “serious damage to the world and the US”. As well as hitting HIV programmes, it would stop work fighting a deadly Marburg outbreak in Tanzania and an mpox variant killing children in west Africa, he said.
It will also affect programmes monitoring the spread of bird flu, and working to eradicate polio and tropical diseases such as river blindness and lymphatic filariasis, he said, as well as services providing healthcare for pregnant women and childhood vaccinations.
Students receive Covid vaccinations at a school in Liberia. Many childhood vaccination programmes depend on USAid. Photograph: Ahmed Jallanzo/EPA-EFEIn a social media post, Gawande said: “Make no mistake – these essential, lifesaving activities are being halted right now. Clinics are shuttering. Workers sent home. Partners including US small businesses face being unable to meet payroll.”
Asked about potential waivers allowing Pepfar and other programmes to continue, and how services were being prioritised for review, a US state department spokesperson said it was “judiciously reviewing all the waivers submitted”.
The One campaign, co-founded in 2004 by the U2 singer Bono, estimated that nearly 3 million children could be at higher risk of malaria if the president’s malaria initiative paused work for 90 days.
Thomas Byrnes, who runs a consulting firm specialising in the humanitarian sector, said the sudden stop-work orders would have a harsh, far-reaching impact because of the extent the global system relies on US funding. The US provides 42.3% of global aid funding, according to the UN, and as much as 54% of the World Food Programme’s funding.
Byrnes said the “unprecedented” freeze was “forcing organisations to halt programmes abruptly, leading to job losses and reduction in essential services to vulnerable populations”.
“They are so abrupt, there’s no cool-down period – it’s not in 30 days or 60 days. You have to stop now.”