by Funds from the world’s richest nation ever flowed from the largest worldwide auxiliary agency to a complicated network of small, medium -sized and large organizations that provide help: HIV drugs for more than 20 million people; Nutritional supplements for starving children; Support for refugees, orphans and women damaged by violence.
Now that network is unraveling. The Trump government is freezing for 90 days of foreign aid and plans to intestine the American agency for international development to only 5 percent of its workforce, although a federal judge paused the plan on Friday. Given wars and tied economies, it is unlikely that other governments or philanthropies will compensate for the deficit, and reception countries can be obstructed by debts to manage themselves.
Even the largest organizations will probably not appear unscathed. In interviews, more than 25 care providers, former USAID employees and officials from aid organizations, described a system that was thrown into mass confusion and chaos.
A tower of blocks can take hours to build, but “you pull one of those blocks out and collapses,” said Mitchell Warren, executive director of the HIV prevention organization AVAC, who trusted on USAID for 38 percent of the financing.
“You are of all employees, all the institutional memory, all trust and trust, not only lost in the United States, but in the dozens of countries in which USAID works,” Warren said. “Those things took decades to build themselves up, but two weeks to destroy.”
Small organizations, some with only 10 employees, have folded. Some medium -sized organizations have redeemed up to 80 percent of their employees. Even large organizations – including Catholic emergency services and FHI 360, one of the largest recipients of USAID financing – have announced large dismissals or leave.
In one survey, about 1 in 4 non -profit organizations said that they might take a month; More than half said they had enough reserves to survive for a maximum of three months.
The damage is exacerbated by President Trump’s announcement that the United States would withdraw from the World Health Organization, forcing its leaders to announce their own cost -saving measures.
Worldwide health experts said that the future suddenly looked insecure, even dystopically and struggled to articulate alternatives.
“We are quite clear that the future looks different,” said Christine Stuilgeling, a deputy executive director at UNAIDS, the HIV division of the United Nations. But “nobody has a real picture of what that means.”
The damage does not only extend to the health of people abroad, but also for Americans and American companies. Together with the approximately 100,000 positions that have been cut abroad, an estimated 52,000 Americans have lost their jobs in 42 states.
The worldwide market for Supply Chain for Healthcare was appreciated at almost $ 3 billion in 2023 and is expected to grow. Every year around $ 2 billion in American agricultural products were purchased as food aid. The abrupt Halt risks more than $ 450 million in corn, lentils, rice and other raw materials that are on the road or in warehouses and ports.
“The economic impact of this will be amazing for people’s life and companies,” said Lisa Hilmi, executive director of Core Group, a consortium of large global health workers.
Mrs. Hilmi, who worked as a nurse in many conflict and disaster zones, said that a lack of health services could stimulate poor health, malnutrition, epidemics, civil unrest and “a much broader collision of society around the world.”
“If America is the biggest super power, then we have to act like that,” she said. “And part of it is acting with humanity.”
‘Dizzy Chaos’
A week after the aid was paused, Foreign Minister Marco Rubio gave an exemption for life -saving humanitarian aid and medicines. But stop-work orders for some programs, including food aid, even followed after the announcement of the exemption.
Last week a large organization received the Go-Ahead for some of its programs. But later the same day, the Trump administration placed dozens of USAID officers on leave, so that the organization wondered whether the division issued the exemption was still a viable entity and the officer who wrote the notification was still employed.
“It is another example of the dizzying chaos that this administration has inflicted on us,” said a senior official at the organization.
The leaders of most organizations that depend on USAID financing would not speak in the record, for fear of retribution of the Trump government.
Even when organizations have received approvals to continue, no money has been streamed. A large organization received less than 5 percent of the expected budget for the period, but others have received nothing.
“I clearly welcome that the secretary has approved an exemption and posted a position on the internet, but we cannot pay our bills with the position,” said a senior official at a large organization of Mr Rubio.
Some groups feel morally obliged to continue to provide life -saving services, in the hope that they will eventually be reimbursed. But with dozens of small organizations that closed every day, the damage to some of the most vulnerable groups in the world is built up, some experts warned.
The ecosystem of global health is so closely intertwined that the break has even frozen the work from organizations that do not receive money from the US government.
The non -profit IPAs work with hundreds of organizations in dozens of countries to provide access to contraception, abortion and other reproductive health services. Many of the clinics have closed, some permanent, said Anu Kumar, the president of the organization.
The speed of the disruption does not allow clinics time to make unforeseen plans or to tap their dependence on financing, she said, and added: “This definitely has a wrinkle effect.”
After a week of freezing, more than 900,000 women and girls will be denied reproductive care, a figure that will grow to 11.7 million during the 90-day break, according to the Guttmacher Institute. “That is more than the entire population of North Carolina,” said Dr. Kumar.
As a result, the institute estimates, 4.2 million girls and women will experience unintended pregnancies, and 8,340 will die from complications during pregnancy and the birth.
Many HIV programs were aimed at “important populations” with the highest risk, including transgender people and men who have sex with men who marginalized and even criminalized in some countries.
In Uganda, for example, where a hard anti-gay can bear the death penalty for consensual homosexual activity for people with HIV, there are non-profit organizations that are funded by the United States crucial sources of financial and medical support.
“It is something that every American should be proud of, but I don’t think they know,” says Kenneth Mwehonge, executive director of the Coalition for Health Promotion and Social Development, which monitors the quality of other HIV programs in Uganda.
“I don’t think they know how much they have contributed and the lives they have saved, and they don’t celebrate enough,” he said. His organization has had to let go of 140 full -time employees and community workers.
Immunisations in children, malaria prevention and treatment and malnutrition programs are also stuck. This also applies to programs on education, economic empowerment, preventive health services and family planning.
“This is a perfect storm for poor health results, not to circumvent it,” said Elisha Dunn-Georgiou, executive director of the Global Health Council, a membership organization of health groups.
Some organizations funded by the USAID provided clean water and sanitary facilities, in particular for refugee populations. Others helped to protect governments against diseases such as polio and measles in conflict zones and among nomadic groups. Still others offered expertise in containing outbreaks of dangerous pathogens such as Ebola and Marburg, Die Smolden in Uganda and Tanzania.
Each of these threats, if not included, can easily cross boundaries and countries on the American coasts, said Rebecca Wolfe, who worked for 15 years at the non-profit Mercy Corps funded by USAID and is now a development expert at the University of Chicago.
The world “is so interconnected and to try to divide it in ‘America first’ and the rest no longer works in the age of today,” she said.
“It feels like sadness”
Some USAID employees and aid organizations said that decoupling of financing in contrast to the goal was: helping countries to become independent enough to take care of their own citizens.
In recent years, USAID has worked on training midwives, nurses, doctors, laboratories and hospitals to transfer responsibility.
Self-supply would require small non-profit organizations at the local level to provide services, but the smallest organizations are also the least likely to endure the current storm.
“The irony is that their priority in Project 2025 locates and leaves large partners,” said Jeremiah Centella, former general counselor of Mercy Corps. “But large international partners are the only ones with access to private donors and strong enough balance to endure this.”
It is unclear what will happen to the tens of thousands of employees who suddenly have no jobs and no industry to find one.
In Kenya, Mercy Githinji took care of 100 households in the Kayole -Wijk Nairobi when the clinic where she worked, run by the USAID Tumukia Mtoto project, abruptly closed. Now Mrs. Githinji, a 52-year-old single mother of four daughters, is not sure how she will pay rent or school fees.
The clinic offered medical care but also helped residents with rent, food and sanitary pads. “Now there is no check, there is nothing,” said Mrs. Githinji. “It’s very bad. People suffer. “
Even if the help were resumed next week, clinics and offices were already closed, people have moved and his confidence has been broken, some former USAID employees said.
Others said they were desperately sad – not for themselves, but for the people they had promised to serve.
“The only way I was able to describe it is, it feels like sadness,” said a former USAID employee.
“Our mission is to save lives and to relieve suffering,” she said. “It is not the opportunity to contribute to it and have it removed at night, randomly, without notification or reason, called a criminal or radical madman, has just been deep heartbreaking.”
Stephanie Nolen contributed reporting.
