New York — Three months since the Trump administration first suspended all international assistance pending review, the United States (US) has terminated much of its funding for global health and humanitarian programmes, dismantled the federal government architecture for oversight of these activities, and fired many of the key staff responsible for implementation. Patients around the world are scrambling to understand how they can continue treatment, medical providers are struggling to maintain essential services, and aid groups are sounding the alarm about exploding needs in countries with existing emergencies.

“These sudden cuts by the Trump administration are a human-made disaster for the millions of people struggling to survive amid wars, disease outbreaks, and other emergencies,” says Avril Benoît, CEO of Médecins Sans Frontières (MSF) in the US. “We are an emergency response organisation, but we have never seen anything like this massive disruption to global health and humanitarian programmes. The risks are catastrophic, especially since people who rely on foreign assistance are already among the most vulnerable in the world.”

The US has long been the leading supporter of global health and humanitarian programmes, responsible for around 40% of all related funding. These US investments have helped improve the health and well-being of communities around the globe — and totalled less than 1% of the annual federal budget.

Abruptly ending this huge proportion of support is already having devastating consequences for people who rely on aid, including those at risk of malnutrition and infectious diseases, and those who are trapped in humanitarian crises around the world. These major cuts to US funding and staffing are part of a broader policy agenda that has far-reaching impacts for people whose access to care is already limited by persecution and discrimination, such as refugees and migrants, civilians caught in conflict, LGBTQI+ people, and anyone who can become pregnant.

The status of even the much-reduced number of remaining US-funded programmes is highly uncertain. The administration now plans to extend the initial 90-day review period for foreign aid, which was due to conclude on 20 April, by an additional 30 days, according to an internal email from the State Department obtained by the media.

MSF does not accept US government funding, so we are not directly affected by these sweeping changes to international assistance as most other aid organisations are. We remain committed to providing medical care and humanitarian support in more than 70 countries across the world. However, no organisation can do this work alone. We work closely with other health and humanitarian organisations to deliver vital services, and many of our activities involve programmes that have been disrupted due to funding cuts.

It will be much more difficult and costly to provide care when so many ministries of health have been affected globally and there are fewer community partners overall. We will also be facing fewer places to refer patients for specialised services, as well as shortages and stockouts due to hamstrung supply chains.

Amid ongoing chaos and confusion, our teams are already witnessing some of the life-threatening consequences of the administration’s actions to date. Most recently, the US administration cancelled nearly all humanitarian assistance programmes in Yemen and Afghanistan, two countries facing some of the most severe humanitarian needs in the world. After years of conflict and compounding crises, an estimated 19.5 million people in Yemen — over half the population — are dependent on aid. The decision to punish civilians caught in these two conflicts undermines the principles of humanitarian assistance.

Across the world, MSF teams have witnessed US-funded organisations reducing or cancelling other vital activities –including vaccination campaigns, protection and care for people caught in areas of conflict, sexual and reproductive health services, the provision of clean water, and adequate sanitation services.

“It’s shocking to see the US abandon its leadership role in advancing global health and humanitarian efforts,” says Benoît. “US assistance has been a lifeline for millions of people–while yanking this support will lead to more preventable deaths and untold suffering around the world. We can’t accept this dangerous new normal. We urge the administration and Congress to maintain commitments to support critical global health and humanitarian aid.”

Snapshot: How US aid cuts are impacting people worldwide

Malnutrition: US funding cuts are severely impacting people in areas of Somalia affected by chronic drought, food insecurity, and displacement due to conflict. In the Baidoa and Mudug regions, the scaling down of operations by aid organisations — driven by US funding cuts and a broader lack of humanitarian aid — is making a shortage of health services and nutrition programmes even more critical. For example, the closure of maternal and child health clinics and a therapeutic feeding centre in Baidoa cut off monthly care to hundreds of malnourished children. MSF nutrition programmes in Baidoa have reported an increase in severe acute malnutrition admissions since the funding cuts. The MSF-supported Bay Regional hospital has received patients traveling as far as 190 kilometres for care due to facility closures elsewhere.

HIV: Cuts to PEPFAR and USAID have led to suspensions and closures of HIV programmes in countries including South Africa, Uganda, and Zimbabwe — threatening the lives of people receiving antiretroviral (ARV) therapy. South Africa's pioneering Treatment Action Campaign — which helped transform the country’s response to HIV/AIDS — has had to drastically reduce its community-led monitoring system that helps ensure that people stay on treatment. The monitoring is now only happening at a small scale at clinics. In MSF’s programme in San Pedro Sula, Honduras, there has been a 70% increase in pre-exposure prophylaxis (PrEP) tablet distribution from January to March compared to the previous quarter, as well as an increase of 30% in consultations for health services, including for HIV — highlighting the growing demand as USAID funding cuts reduce access to other HIV prevention services.

Outbreaks: In the border regions across South Sudan and Ethiopia, MSF teams are responding to a rampant cholera outbreak amid escalating violence — while other organisations have scaled down their presence. According to our teams, a number of organisations, including Save the Children, have suspended mobile clinic activities in South Sudan’s Akobo County due to US aid cuts. Save the Children reported earlier this month that at least five children and three adults with cholera died while making the long, hot trek to seek treatment in this part of South Sudan. With the withdrawal of these organisations, local health authorities are now facing significant limitations in their ability to respond effectively to the outbreak. MSF has warned that the disruption of mobile services, combined with the reduced capacity of other actors to support oral vaccination campaigns, increases the risk of preventable deaths and the continued spread of this highly infectious disease.

Sexual and reproductive healthcare: MSF teams in more than 20 countries have reported concerns with disrupted or suspended sexual and reproductive health programmes, which MSF relies on for referrals for medical emergencies, supplies, and technical partnerships. These include contexts with already high levels of maternal and infant mortality. In Cox’s Bazar, Bangladesh — home to one of the world’s largest refugee camps — MSF teams report that other implementers are not able to provide supplies, like emergency birth kits and contraceptives. Referrals for medical emergencies, like post-abortion care, have also been disrupted, increasing urgent needs for sexual and reproductive care in the region.

Migration: Essential protection services — including shelters for women and children, legal aid, and support for survivors of violence — have been shuttered or severely reduced as needs increase due to changes in US immigration policy. For patients and MSF teams along the Central American migration route in areas like Danlí, San Pedro Sula, Tapachula, and Mexico City, referral networks have all but disappeared. This has left many migrants without safe places to sleep, access to food, or legal and psychosocial support.

Access to clean water: In the initial weeks following the aid freeze, our teams saw several organisations stop the distribution of drinking water for displaced people in conflict-affected areas, including in Sudan’s Darfur region, Ethiopia's Tigray region, and Haiti's capital, Port-au-Prince. In response to the crisis in Port-au-Prince, in March, MSF stepped in to run a water distribution system via tanker trucks to provide for more than 13,000 people living in four camps for communities displaced by violent clashes between armed groups and police. This was in addition to our regular activities focused on providing medical care for victims of violence. Ensuring access to clean drinking water is essential for health and preventing the spread of waterborne diseases like cholera.

Vaccination: The reported decision by the US to cut funding to Gavi (The Vaccine Alliance) could have disastrous consequences for children across the globe. The organisation estimated that the loss of US support is projected to deny approximately 75 million children routine vaccinations in the next five years, with more than 1.2 million children potentially dying as a result. Worldwide, more than half of the vaccines MSF uses come from local ministries of health and are procured through Gavi. We could see the impacts in places like the Democratic Republic of the Congo (DRC), where MSF vaccinates more children than anywhere else in the world. In 2023 alone, MSF vaccinated more than 2 million people in DRC against diseases like measles and cholera.

Mental health: In Ethiopia’s Kule refugee camp, where MSF teams run a health centre for more than 50,000 South Sudanese refugees, a US-funded organisation abruptly halted mental health and social services for victims and survivors of sexual violence and withdrew their staff. MSF teams provide other medical care but cannot currently cover the mental health and social services these patients need.

Non-communicable diseases: In Zimbabwe, US funding cuts have forced a local provider to stop its community outreach activities to identify women to be screened for cervical cancer. Cervical cancer is the leading cause of cancer-related death in Zimbabwe, even though it is preventable. Many women and girls — especially in rural areas — cannot afford or do not have access to diagnosis and treatment, which makes outreach, screening, and prevention activities vital.