The US Agency for International Development (USAID) has recalled nearly all overseas staff and placed thousands on administrative leave starting Friday, leaving critical aid programmes in disarray and millions at risk, aid workers and activists say.
The move follows a 90-day foreign aid freeze ordered by US President Donald Trump in his first month in office, which has already led to thousands of layoffs and the shutdown of USAID's website and social media accounts.
Aid groups warn that halting USAID's $50 billion annual budget, which supports everything from HIV treatment to food aid in more than 100 countries, could cause a humanitarian catastrophe.
The agency, established in 1961 by President John F Kennedy, has about 10,000 employees and works in more than 60 countries directly, funding many more programmes through partner organisations.
“We are talking about countless refugees and other displaced persons, children threatened by malaria, and people who need HIV and tuberculosis treatment, whose care risks being stopped,” said Avril Benoît, CEO of Doctors Without Borders USA. “Already we are hearing from local organisations who have closed their doors and are unsure when or if they will be able to reopen.”
The US government said “lifesaving” work was exempted from the cuts, and the President's Emergency Plan for AIDS Relief, a programme launched in 2003 that has saved 26 million lives in 55 countries since, has been granted an emergency humanitarian waiver. But HIV/AIDs workers and NGOs told The National that AIDs patients are at risk in the confusion over funding and status.
“We are currently doing a situational analysis,” Faith Muperi, an HIV activist in Zimbabwe, where 1.2 million people live with the virus, told The National. “The freeze will reduce access to antiretroviral therapy, which is crucial for HIV management. People living with HIV are facing treatment interruptions, leading to increased viral loads and decreased health outcomes.”
Ms Muperi warned that without consistent access to medication, progress made in reducing transmission could be lost and an increase in infections is a very likely outcome.
“We are also looking at increased stigma and discrimination as the freeze has led to the halt of community outreach programmes that have been helping in reducing stigma. As social services diminish, people living with HIV face greater isolation and discrimination.”
There are 25.6 million people living with HIV in sub-Saharan Africa, according to WHO figures. Complications from AIDs, caused by the HIV virus, killed about 380,000 people in 2022.
In Sudan, which is experiencing a devastating civil war since April 2023 during which about 150,000 people have died from violence, starvation and preventable diseases and left tens of millions displaced, the cuts to funding could be disastrous.
The country's medical system is barely functioning as NGOs struggle to access patients. One of the main concerns is USAID funding to health programmes that limit the spread of HIV, malaria and tuberculosis, with infection rates expected to increase as “millions contend with the closures this week of healthcare units across the country that rely on foreign funding”, said Ahmed Abdullah Ismail, the head of Mashad, a Paris-based Sudanese NGO.
He warned that the freezing of USAID funds will have far-reaching consequences.
“Millions of Sudanese families rely on food and medical assistance supported by USAID, and suspending this aid will increase rates of hunger and malnutrition, especially among the most vulnerable groups,” Mr Ismail said.
“The humanitarian situation will worsen,” he said, adding that “the absence of this funding will limit the ability of many humanitarian organisations working in the fields of health, education, and reconstruction to provide essential services”.
The aid freeze could also have political implications on Sudan’s continuing civil war.
“The US might use this move as a means of pressure on the parties to end the conflict,” Mr Ismail said. However, he warned that this could be unsuccessful and that “Sudan may be pushed towards strengthening its relations with other powers such as Russia or China in search of financial and diplomatic alternatives”.
Not all who use USAID funding are concerned. A doctor employed in the Egyptian health ministry's HIV programme told The National that the number of people infected with the virus in Egypt is about 40,000, a small fraction of the infections in many African countries.
The doctor, who spoke on condition of anonymity, said that while the Egyptian programme has stockpiles of antiviral medication to cover patients for another two months, the government could easily cover the costs even if supplies run out.
“We are not worried yet,” she added.
Food aid also threatened
In Kenya, nutritionist Joshua Dena Katembo, who has worked on several USAID food programmes in his country, said drought-stricken mothers and children risk losing vital food aid.
“With this freeze, it greatly affects response efforts,” he told The National. “We are likely to experience a worse humanitarian crisis, generational impact for the children under five and pregnant women caught in the freeze before they were healed since there is no guarantee that the commodity supply will be consistent.”
Still, Mr Katembo said he understood the US administration's logic, believing countries should ultimately rely on themselves.
“America does not and will not exist in a vacuum. I understand the line of reasoning by the American leadership but my only reservation it is they didn't undertake the freeze in a transitional manner,” he said.
The UN, which relies on the US for a third of its humanitarian budget, said 18 countries could lose aid worth more than 1 per cent of GDP, with war-torn states like Afghanistan and Syria hit hardest.
According to a UN survey, the US provided 34 per cent of the $35 billion spent on humanitarian aid in 2022, but only 15 per cent of the $20 billion for development work.
Elon Musk, who leads the new Department of Government Efficiency (DOGE) tasked with slashing federal spending, has labelled USAID a “criminal organisation”. In an X Spaces discussion, he claimed Mr Trump agreed it should be shut down.
On Monday, Secretary of State Marco Rubio said he is now the acting director of the agency, though he has “delegated that authority to someone”. Mr Rubio, who was speaking from El Salvador, said that many of the agency's functions are going to continue, but they “must be aligned with American foreign policy”.
He added that USAID has strayed from US interests. “These are taxpayer dollars,” he said, vowing to evaluate every programme as the agency is subsumed into the State Department, which aid workers say requires Congressional approval.
The freeze has also dealt a blow to scientific research around the globe, disrupting projects funded through USAID's global health and environmental programmes. Projects affected include clinical trials of vaccines, studies of emerging diseases, and efforts to predict climate change impacts.
On Wednesday, protesters rallied in Washington against the USAID cuts, accusing the administration of imperilling lives to wage war on an agency linked to Mr Trump's predecessors.
Democrats call the moves an illegal power grab, but many Republicans have embraced Mr Trump's hard line on foreign aid.
For Africa's vulnerable, there is little time to adapt before health systems buckle and food pipelines dry up. Aid groups are racing to map funding gaps and appeal for help, but experts say replacing America's outsized role is unrealistic.
