(FILES) Health official takes blood sample of a woman for malaria testing at Ajah in Eti Osa East district of Lagos, on April 21, 2016. The sudden dismantling of USAID, the country’s main foreign development arm, is unraveling health care systems across Africa that were built from a complicated web of national health ministries, the private sector, nonprofits and foreign aid. As the effects of the cuts compound, the resulting damage, and deaths, are unlikely to end anytime soon: malaria cases will peak around the end of the rainy season, while threatened American cuts to global vaccine funding would likely be felt later in the year. (Photo by PIUS UTOMI EKPEI / AFP)

As clouds gather and humidity rises across west Africa, whose annual rains bring an uptick of deadly, malaria-carrying mosquitoes, Musa Adamu Ibrahim, a nurse, is sitting at home, unemployed.

In Nigeria — home to 30 percent of the world’s annual 600,000 malaria deaths — clinics that once served 300 people a day in the conflict-hit Borno state have abruptly shut down, Ibrahim and other laid-off workers told AFP, following the withdrawal of American funding by President Donald Trump.

“The clinics have been closed and (there are) no more free drugs or mosquito nets,” said Ibrahim.

The sudden dismantling of USAID — the country’s main foreign development arm — is unravelling health care systems across Africa that were built from a complicated web of national health ministries, the private sector, nonprofits and foreign aid.

As the effects of the cuts compound, the resulting damage — and deaths — are unlikely to end anytime soon: malaria cases will peak around the end of the rainy season, while threatened American cuts to global vaccine funding would likely be felt later in the year.

In the meantime, the ripple effects continue to spread: alongside laid-off workers, malnutrition clinics have shuttered doors in Nigeria.

Rattled supply chains mean drugs are at risk of being stuck in warehouses in Mali. Children are walking miles to reach care in South Sudan for cholera care and dying along the way, and refugee camps in Kenya are facing medicine shortages.

“People with resources will be able to go and get drugs… but the poorest of the poor, out in remote areas of Nigeria and other parts of sub-Saharan Africa, they’re the ones who will be cut off,” said Lawrence Barat, a former senior technical advisor for the US President’s Malaria Initiative (PMI).

“They’re the ones whose children will die.”

– Malaria forecasts upended –

During malaria’s seasonal peak, Ibrahim once saw clinics he worked at treat 300 patients a week. Fatima Kunduli, another laid-off aid worker in Borno, said her clinic was seeing 60 children per day for malnutrition and malaria care before it shut down.

As downpours progressively cascade across west Africa — Nigeria’s have just started, while Senegal’s rains won’t arrive until May — countries that have made in some cases significant progress in stamping out malaria in recent decades will now be doing so without a major financial backer.

Forecasts developed by ministries of health across the continent to plan for the rainy season have deep holes blown in them, said Saschveen Singh, an infectious disease specialist with Doctors Without Borders in France.

The complex mix of funding sources in each nation — from local governments to internationalnonprofits — means US programmes worked differently in every country.

In Mali, seasonal malaria chemoprevention drugs given to young children won’t have an issue coming into the country — but American funds were crucial for coordinating their distribution, Singh told AFP.

Meanwhile, in the Democratic Republic of Congo, the USAID-supported PMI was the primary malaria drug and test provider to government health facilities in nine provinces.

“Suddenly, they’ll just not have drugs, and it’s going to be very difficult for other actors to step in,” said Singh, adding her co-workers are “scrambling” to map out where gaps may arise.

– Cholera treatment scaled back –

In South Sudan, USAID-funded clinics have closed amid a cholera outbreak. Children are walking hours to the next closest treatment centre, with at least five dying along the way in the country’s eastern Jonglei state, British charity Save the Children reported earlier this month.

In neighbouring Kenya’s Kakuma refugee camp, which hosts more than 300,000 people, protests broke out in March when it was announced rations would be lowered, and doctors are running out of medicine.

“All the clinics around, you can get paracetamol. But all other drugs, no,” one camp elder, who asked to remain anonymous, told AFP during a recent visit.

At Kinkole General Hospital, in Kinshasa, doctors were recently treating 23 mpox patients isolated in tents free of charge thanks to American support. But workers have no idea if that funding will continue, despite an outbreak that has infected 16,000 and killed 1,600.

“We’re thinking a disaster is coming,” said Yvonne Walo, an epidemiologist at the centre.

– Potential vaccine funding gap –

The hits to health care systems are set to keep coming.

Washington is reportedly considering pulling back its funding to Gavi, the organisation that procures vaccinations for the world’s poorest countries.

Cuts would be almost guaranteed, with Gavi chief executive Sania Nishtar telling AFP that “this is too big a hole to be filled.”

If confirmed, John Johnson, a vaccination and epidemic response advisor with Doctors Without Borders, expects programmes to start coming under strain later this year.

In Borno, whose governor recently warned of a resurgence of the Boko Haram jihadist group, Kunduli, the laid-off aid worker, said even with US funding the work was “overwhelming.”

Now, “I could only imagine.”

One of the first acts of the first 100 days of President Trump’s Administration was an executive order that led to a large-scale cutback in American spending on foreign aid. Through the United States Agency for International Development (USAID), which is now on the verge of dissolution, the U.S. had funded 40% of the world’s foreign assistance, including programs designed to combat disease, malnutrition, maternal mortality, totalitarianism, and climate change. According to analysis by KFF, 80% of all the U.S.’s global health awards were terminated, including those to the jewel in the America’s foreign aid crown, the President’s Emergency Plan for AIDS Relief (PEPFAR). Medecins Sans Frontieres (MSF), also known as Doctors Without Borders, an organization that provides emergency medical help almost anywhere in the world during times of crisis, does not rely on any U.S. government funding. But its fieldworkers have front-row seats to the consequences of the loss of aid across the globe. Avril Benoît, the CEO of MSF in the U.S., spoke to TIME about the ripple effects the organization is seeing—and where the cuts are hurting most.

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This interview has been condensed and edited for clarity. MSF is an emergency-response organization that takes no government funding. Was it immediately affected by the pullback of U.S. foreign aid after election of Donald Trump? We’re not directly financially affected, but we’re indirectly affected. We’re on the ground in humanitarian crisis zones, providing independent and impartial medical humanitarian aid. And all around us, we are seeing a collapse of various services that were subsidized by U.S. government. Groups that we work alongside have been left scrambling to carry out lifesaving services without money, staff, or any certainty about what comes next. We are already seeing life-threatening implications. Programs for HIV, AIDS, and tuberculosis treatment, sexual and reproductive health care, disease-outbreak response, and malnutrition are the most dramatic ones. People have shown up to clinics in South Africa, for example, clinics where they’ve received care for years, just to see “closed” signs hanging on the door. Ready-to-use therapeutic food in many places is now sitting in warehouses out of reach of children with severe acute malnutrition, because the implementing partners whose job it was to distribute it have been fired. We are seeing more patients coming into hospitals that are already over capacity.

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Can you give me a specific example of what changes MSF workers are noticing? Our nutrition programs in Baidoa, Somalia, have reported an increase in malnutrition admissions since the funding cuts. We admitted, all of a sudden, 195 children with severe acute malnutrition in March alone. Severe acute malnutrition means that if the children don’t receive therapy, they could die within weeks. The MSF-supported Bay Regional Hospital in Baidoa has received patients, especially women, who have come from as far as 120 miles away. When the wider network of health-care services shuts down, it means people have to travel that much further to where our programs are located, and that time, that distance, you can imagine for somebody who’s sick or carrying a severely malnourished child, could mean life or death. It’s one of the reasons that community health programs are so important. One of the predictions was the spread of infectious diseases. Has that happened?

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In the border regions of South Sudan and Ethiopia, there’s a rampant cholera outbreak amid escalating violence. Our teams say that a number of organizations, including Save the Children, have suspended mobile clinic activities in Akobo County due to the USAID cuts. Save the Children reported earlier this month that at least five children and three adults with cholera died while making a long arduous trek in the heat to seek treatment. So local health authorities are now facing significant limitations in their ability to respond effectively and cholera cases are rising in many other parts of South Sudan. It’s worrying because people are on the move in a conflict. They bring diseases with them to new locations, new camps for displaced people, where there are very few resources available. From October 2024 until now, we treated more than 7,800 cholera patients and were supporting local health systems, local clinics and health posts. Normally you would have other organizations chipping in, helping out, supporting oral-vaccination campaigns or oral-rehydration sites, and when those are taken out of commission very suddenly, it increases the risk of the spread of cholera.

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MSF is essentially an emergency organization. You go where the emergencies are. Are you seeing less of an American presence during these crises, or is that still something America can respond to? In the initial weeks following the aid freeze, we saw several organizations stop the distribution of drinking water for displaced people in various conflict-affected areas, including Darfur in Sudan, Tigray in Ethiopia, and the capital of Haiti, Port-au-Prince, where you’ve got levels of criminality that rival any war zone in terms of violence. We have quite a large presence in Port-au-Prince: trauma, hospitals, emergencies, and so forth. We had to pick up some of the cut programming in terms of running a water-distribution system via tanker trucks to provide for all these displaced people, 13,000 or so living in encampments in the capital. People are trying to flee violent clashes between armed groups and the police, and they end up in these encampments, where there’s absolutely no resources, no water for them. So we had to add water in addition to our focus on medical care for victims of violence. But there is absolutely no way for an organization even as large as ours to cover these gaps, it’s too enormous. No organization can do this work alone.

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Has anything that happened in these last 100 days just completely taken you by surprise? Prior to the election, every aid organization working internationally understood that there was likely to be a policy shift and a reduction in the availability of U.S. government funding for humanitarian aid. What we didn’t expect is this wrecking ball just completely destroying the infrastructure, the capacity to follow up, the availability of resources to the world’s most vulnerable in one swoop. We thought maybe there will be a review that will be 90 days, and then things will come back online. What we’ve seen, though, is nothing. And we just can’t accept nothing in terms of U.S. government contribution to humanitarian aid as the new normal. That would be dangerous for the world. Have you seen any fresh new emergencies arise, or has it mostly been an exacerbation of existing crises? The earthquake in Myanmar would be the latest natural disaster. And of course, as it was reported, USAID emergency responders on the ground received orders to pack up and go home amid all the chaos. Myanmar is not an easy place to work, so those organizations already inside with good, credible activities and some sort of relationship with the local population, would be the ones to focus on. Instead, there was no response from the U.S.

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The U.S. now no longer has the kind of infrastructure that would make it even possible to quickly reset in an emergency. If you have fired all the people who normally would do the quick assessments, the monitoring and evaluation and push the buttons for the money to flow, even if you wanted to activate an urgent humanitarian response, the capacity has been obliterated. Almost everybody I’ve interviewed about the U.S. foreign aid situation has said that USAID was an imperfect system that required reform. Would you agree with that? MSF is funded largely by the generosity of individual Americans. One third of our global operational budget is coming from people in the U.S.—there’s a huge commitment to this issue from the American people. And honestly, we always had very healthy, productive dialogue with the folks in the Bureau of Humanitarian Affairs at USAID, where we were able to alert them to what we were seeing on the ground, as the first responders in crisis zones. We have expressed, at different times, our frustration with the sluggishness, and non-responsiveness of the aid system to emergencies. So for sure, there are things to be improved, and we would welcome that discussion, because it’s absolutely urgent to get on with it.

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USAID has been called inefficient and wasteful. What does MSF do to be more efficient? What does efficiency look like in the aid sector? Efficiency and effectiveness for us relies very much on, frankly, having the kind of independent, unrestricted funding that allows us to go where the needs are greatest, where our assessments determine that we can have an added value and where we can design the programs with the communities in mind, as opposed to geopolitical or economic drivers. I think there’s also just baked into our DNA, a sense of urgency—that we don’t have time for bureaucracy. We’re looked at with some envy right now, of course, because of our independent funding, and yet we’re deeply worried because we can’t do this alone. We can’t carry the burden with organizations that have lost up to 80% of their funding. We are looking at how we organize ourselves, because we know that the dollars need to stretch further now. We’re going to have to try to fill the gaps as best we can.

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Is there a loss you personally particularly mourn? In contexts with already high levels of maternal and infant mortality, these cuts are heartbreaking. In Cox’s Bazar in Bangladesh, which is home to the world’s largest refugee camps with the Rohingya, MSF teams report that other health providers aren’t able to provide the supplies like emergency birth kits and contraceptives. Post-exposure prophylaxis after sexual violence and referrals for medical emergencies like post-abortion care have also been disrupted, so that’s increasing the urgent needs and a lot of people are going to die as a result. Why aren’t the local governments stepping up in some of these situations? Why does it have to come from the American government? Whatever capacity local governments had in the past is so much less right now. Vaccination is one of the greatest public-health measures you can take. Worldwide, more than half of the vaccines that we use in our programs come from local ministries of health and are procured through GAVI, the vaccine alliance. We partner with the ministries of health, because they maybe don’t have the implementation capacity, or they don’t have the budgets to be able to pay the nurses and the health-care providers to do a vaccination campaign, so we pay for it. The decision by the U.S. government [GAVI’s third largest donor] to cut funding to GAVI could have disastrous consequences for children around the globe. There have been projections that if you deny vaccines to the approximately 75 million children that were benefiting from that program you could have 1.2 million children potentially dying as a result. We can see the impacts already in Democratic Republic of Congo (DRC) where we do the most vaccination of children against diseases like measles and cholera and the early immunization programs. Could the DRC government do this? Does the DRC government have skilled staff? Yes. Do they have their resources and the political will to really step up into some of the regions of the country that are more conflict-prone, such as the Kivus? That remains to be seen.

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If you could wave your magic wand, what would you restore?

It’s interesting, we thought [Secretary of State] Marco Rubio was going to be a champion of PEPFAR. Cuts to PEPFAR and USAID have led to suspensions and closures of HIV programs in many countries, including South Africa, Uganda, Zimbabwe, and this is threatening the lives of people receiving antiretroviral treatment. We’ve seen a 70% increase in pre-exposure prophylaxis tablet distribution from January to March, compared to the previous quarter, and an increase of 30% in consultations for health services. People have fewer places to go so they’re coming to us—a 30% increase in patients. Can you imagine what that’s like as we anticipate our budgetary pressures, our staffing pressures, our supply pressures over the coming months and years? We thought PEPFAR would be one that there was a commitment to preserve. And here we are.

Watching the news and all the executive orders and what the reaction is in the United States, one gets the impression that there are no votes in this, that there are so many things going on, there’s not going to be a specific outcry about cuts to foreign aid. That is a shattering reality for those around the world whose lives depend on it.

Children playing with kites on the Sudan-Chad border, where hundreds of thousands of refugees have fled the war in Sudan. Staffers at a half dozen U.S.-funded medical facilities in Sudan who treat children defied President Donald Trump’s orders to stop their work.

Series: The End of Aid: Trump Destroyed USAID. What Happens Now? More in this series Caret

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On Friday morning, the staffers at a half dozen U.S.-funded medical facilities in Sudan who care for severely malnourished children had a choice to make: Defy President Donald Trump’s order to immediately stop their operations or let up to 100 babies and toddlers die.

They chose the children.

In spite of the order, they will keep their facilities open for as long as they can, according to three people with direct knowledge of the situation. The people requested anonymity for fear that the administration might target their group for reprisals. Trump’s order also meant they would stop receiving new, previously approved funds to cover salaries, IV bags and other supplies. They said it’s a matter of days, not weeks, before they run out.

American-funded aid organizations around the globe, charged with providing lifesaving care for the most desperate and vulnerable populations imaginable, have for days been forced to completely halt their operations, turn away patients and lay off staff following a series of sudden stop-work demands from the Trump administration. Despite an announcement earlier this week ostensibly allowing lifesaving operations to continue, those earlier orders have not been rescinded.

Many groups doing such lifesaving work either don’t know the right way to request an exemption to the order, known as a waiver, or have no sense of where their request stands. They’ve received little information from the U.S. government, where, in recent days, humanitarian officials have been summarily ousted or prohibited from communicating with the aid organizations.

Trump’s rapid assault on the international aid system is quickly becoming the most consequential and far-reaching shift in U.S. humanitarian policy since the Marshall Plan to rebuild Europe after World War II, aid groups and government officials warned.

Among the programs that remain grounded as of Friday: emergency medical care for displaced Palestinians and Yemenis fleeing war, heat and electricity for Ukrainian refugees and HIV treatment and mpox surveillance in Africa.

Experts in and out of government have anxiously watched the fluid situation develop. “I’ve been an infectious disease doctor for 30 years, and I’ve never seen anything that scares me as much as this,” said Dr. Jennifer Furin, a Harvard Medical School physician who received a stop-work order for a program designing treatment plans for people with the most drug-resistant forms of tuberculosis. Infectious diseases do not know borders, she pointed out. “It’s terrifying.”

Trump and Secretary of State Marco Rubio first issued the freeze on aid operations last Friday, which included limited exemptions. “The pause on all foreign assistance means a complete halt,” a top adviser wrote in an internal memo to staff. (The order was separate from Trump’s now-seemingly rescinded moratorium on domestic U.S. grants.) Aid groups across the globe began receiving emails that instructed them to immediately stop working while the government conducted a 90-day review of their programs to make sure they aligned with the administration’s agenda.

Trump campaigned on an “America First” platform after unsuccessfully trying to slash the foreign assistance budget during his first term in office. The U.S. provides about $60 billion in nonmilitary humanitarian and development aid annually — less than 1% of the federal budget, but far more than any other country. The complex network of organizations who carry out the work is managed by the State Department and U.S. Agency for International Development.

Over the weekend, that system came to a standstill. There was widespread chaos and confusion as contractors scrambled to understand seemingly arbitrary orders from Washington and figure out how to get a waiver to continue working. By Tuesday evening, Trump and Rubio appeared to heed the international pressure and scale back the order by announcing that any “lifesaving” humanitarian efforts would be allowed to continue.

Aid groups that specialize in saving lives were relieved and thought their stop-work orders would be reversed just as swiftly as they had arrived.

But that hasn’t happened. Instead, more stop-work orders have been issued. As of Thursday, contractors worldwide were still grounded under the original orders and unable to secure waivers. Top Trump appointees arrested further funding and banned new projects for at least three months.

“We need to correct the impression that the waiver was self-executing by virtue of the announcement,” said Marcia Wong, the former deputy assistant administrator of USAID’s humanitarian assistance bureau.

Aid groups that had already received U.S. money were told they could not spend it or do any previously approved work. The contractors quoted in this article spoke on the condition of anonymity because they feared the administration might prolong their suspension or cancel their contracts completely.

As crucial days and hours pass, aid groups say Trump’s order has already caused irreparable harm. Often without cash reserves or endowments, many organizations depend on U.S. funding entirely and have been forced to lay off staff and cancel contracts with vendors. One CEO said he expects up to 3,000 aid workers to lose their jobs in Washington alone, according to the trade publication Devex. Some groups may have to shutter altogether because they can’t afford to float their overhead costs without knowing if or when they’d get reimbursed.

Critics say the past week has also undermined Trump’s own stated goals of American prosperity and security by opening a vacuum for international adversaries to fill, while putting millions at immediate and long-term risk.

“A chaotic, unexplained and abrupt pause with no guidance has left all our partners around the world high and dry and America looking like a severely unreliable actor to do business with,” a USAID official told ProPublica, adding that other countries will now have good reason to look to China or Russia for the help they’re no longer getting from the U.S. “There’s nothing that was left untouched.”

Preparation for the launch of the mpox vaccination campaign at the General Hospital of Goma, in the Democratic Republic of Congo, in October 2024. The federal aid standstill could affect mpox supplies for patients across Africa. Credit: Aubin Mukoni/AFP/Getty Images

In response to a detailed list of questions for this article, the White House referred ProPublica to the State Department. The State Department said to direct all questions about USAID to the agency itself. USAID did not reply to our emails. Much of its communications staff was let go in the last week.

In a public statement Wednesday, the State Department defended the foreign aid freezes and said the government has issued dozens of exemption waivers in recent days.

“The previously announced 90-day pause and review of U.S. foreign aid is already paying dividends to our country and our people,” the statement said. “We are rooting out waste. We are blocking woke programs. And we are exposing activities that run contrary to our national interests. None of this would be possible if these programs remained on autopilot.”

The dire international situation has been exacerbated by upheaval in Washington. This week, the Trump administration furloughed 500 support staff contractors from USAID’s humanitarian assistance bureau, about 40% of the unit, and fired 400 more from the global health bureau. Those workers were told to stop working and “please head home.”

The remaining officials in Washington are now attempting to navigate a confounding waiver process and get lifesaving programs back online. Officials and diplomats told ProPublica that Trump’s new political appointees have not consulted USAID’s longtime humanitarian experts when crafting the new policies. As a result, career civil servants said they are struggling to understand the policy or how to carry it out.

During an internal meeting early in the week, one of USAID’s top Middle East officials told mission directors that the bar for aid groups to qualify for an exemption to Trump’s freeze was high, according to meeting notes. It took until Thursday for the directors to receive instructions for how to fill out a spreadsheet with the programs they think should qualify for a waiver and why, a government employee told ProPublica. “The waiver for humanitarian assistance has been a farce,” another USAID official said.

“Like a Russian nesting doll of fuck-ups,” said Jeremy Konyndyk, who ran some of USAID’s largest programs under Presidents Barack Obama and Joe Biden. “It’s just astonishing.”

Fear of retaliation is permeating the government’s foreign aid agencies, which have become some of Trump’s first targets in his campaign against diversity, equity and inclusion initiatives. Earlier this week, the administration pulled down photographs of children and families from the agency’s hallways.

Many are afraid of being punished or fired for doing their jobs. Officials in USAID’s humanitarian affairs bureau say they have been prohibited from even accepting calendar invites from aid organizations or setting up out-of-office email replies.

On Monday, USAID placed about 60 senior civil servants on administrative leave, citing unspecified attempts to “circumvent” the president’s agenda. The group received an email informing them of the decision without an explanation before they were locked out of the agency’s systems and banned from the building.

“We’re civil servants,” one of the officials said. “I should have been given notice, due process. Instead there was an agencywide notice accusing people of subverting the president’s executive orders.”

Then, on Thursday, the agency’s labor relations director told the group that he was withdrawing the agency’s decision because he found no evidence of misconduct, according to emails obtained by ProPublica.

Hours later, the director was put on administrative leave himself. “The agency’s front office and DOGE instructed me to violate the due process of our employees by issuing immediate termination notices,” he wrote to colleagues, referring to Trump’s Department of Government Efficiency run by Elon Musk. (Musk did not respond to a request for comment.)

Later that night, the original 60 officials were placed back on leave again.

On Thursday, the U.S. Agency for International Development’s director of labor relations told about 60 senior civil servants placed on administrative leave by the Trump administration that he had reinstated them. Credit: Obtained by ProPublica. Redacted by ProPublica.

Hours later, the labor relations director himself was put on leave. He said the agency’s front office and the Department of Government Efficiency had instructed him to fire his colleagues without due process. Credit: Obtained by ProPublica. Redacted by ProPublica.

Diplomats have long lauded American humanitarian efforts overseas because they help build crucial alliances around the world with relatively little cost.

When he created USAID in 1961, President John F. Kennedy called it a historic opportunity to improve the developing world so that countries don’t fall into economic collapse. That, he told Congress, “would be disastrous to our national security, harmful to our comparative prosperity and offensive to our conscience.”

USAID is responsible for the most successful international health program of the 21st century. The President’s Emergency Plan for AIDS Relief, created in 2003 by President George W. Bush to combat HIV globally, has saved an estimated 26 million lives over the past 22 years. It currently helps supply HIV medicines to 20 million people, and it funds HIV testing and jobs for thousands of health care workers, mainly in Africa.

That all ground to a halt this week. Since receiving the U.S. government’s stop-work orders, contractors who manage the program say they have so far received little communication about what work they will be allowed to continue, or when. They are not allowed to hand out medicines already bought and sitting on shelves.

If the exemption waivers don’t come through, policy analysts and HIV advocates say the full 90-day suspension of those programs would have disastrous consequences. More than 222,000 people pick up HIV treatment every day through the program, according to an analysis by amFAR, a nonprofit dedicated to AIDS research and advocacy. As of Friday morning, those orders had not been lifted, according to three people with direct knowledge.

Up through last week, PEPFAR was providing HIV treatment to an estimated 680,000 pregnant women, the majority of whom are in Africa. A 90-day stoppage could lead to an estimated 136,000 babies acquiring HIV, according to the amfAR analysis. Since HIV testing services are also suspended, many of those could go undiagnosed.

The disarray has also reached warzones and foreign governments, risking disease outbreaks and straining international relationships forged over decades.

Government officials worried about contract personnel who were suddenly stranded in remote locations. In Syria, camp managers were told to abandon their site at al-Hawl refugee camp, which is also a prison for ISIS sympathizers. That left the refugees inside with nowhere to turn for basic supplies like food and gas.

In Mogadishu, Somalia, the State Department instructed security guards who were protecting an arms depot from insurgents to simply walk off the site, according to a company official. When the guards asked what would happen to the armory, their government contacts told them they didn’t have any answers. (Concerns about the armory were first reported by The Wall Street Journal.)

The contractors in Syria and Somalia have since been allowed to return to their sites.

An executive at a health care nonprofit told ProPublica he has not been so lucky. His group is still under the stop-work order and can’t fund medical operations in Gaza, where there is a fragile ceasefire deal between Hamas and Israel that depends in part on the free flow of humanitarian aid.

“People will die,” the executive said. “For organizations that rely solely or largely on U.S. government funding, this hurts. That may be part of the message. But there would be less drastic ways to send it.”

In response to criticism, the Trump administration has offered misinformation. During a press conference, Karoline Leavitt, the White House press secretary, touted the initiative’s success so far and said the government “found that there was about to be $50 million taxpayer dollars that went out the door to fund condoms in Gaza.” Trump later went further, saying Hamas fighters were using the condoms to make explosives.

They didn’t name the contractor, but the State Department later cited $100 million in canceled aid packages slated for the International Medical Corps.

IMC said in a response that no U.S. government funding was used for condoms or any other family-planning services. The organization has treated more than 33,000 Palestinians a month, according to the statement. It also operates one of the only centers in Gaza for severely malnourished children.

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“If the stop-work order remains in place,” IMC said, “we will be unable to sustain these activities beyond the next week or so.”

There are also new outbreaks of Ebola in Uganda’s capital and of the disease’s cousin, the Marburg virus, in Tanzania. The U.S. has long been a key funder of biosecurity measures internationally, including at high-security labs. That funding is now on hold.

In Ukraine, groups that provide vital humanitarian aid for civilians and soldiers fighting Russia have been told to stand down without any meaningful updates in days, according to three officials familiar with the situation. The halted services include first responders, fuel for hospitals and evacuation routes for refugees fleeing the front lines.

“These are people who have been living in a war zone for three years this month,” the head of one of the organizations said, adding that they may have to lay off 20% of its staff. “And we are taking away these very basic services that they need to survive.”

Concrete electrical poles provided by USAID replace some that were damaged by fighting in Ukraine as Russia targets electrical infrastructure across the country. Credit: Scott Peterson/Getty Images

A contractor for the U.S. in Yemen said her entire team had been told to stop their work last weekend, which ProPublica corroborated with contemporaneous emails. “One of my tasks was summarizing how many people had been directly saved by our health programs every week,” she said. “It was usually 80 to 100.”

Their stop-work order has not been lifted. It will be a week on Sunday.

QUAZ NAFISA, Sudan — The 3-year-old boy darted among the mourners, his giggles rising above the soft cadence of condolences. Women with somber faces and bright scarves hugged his weeping mother, patting her shoulders as she stooped to pick up her remaining son. Marwan didn’t yet know that his twin brother was dead.

Omran shouldn’t have died, doctors said. The physician at his clinic outside the Sudanese capital said basic antibiotics probably would have cured his chest infection. The International Rescue Committee, which received a large amount of its funding from the United States, had been scheduled to deliver the medicines in February. Then the new U.S. administration froze foreign aid programs, and a stop-work order came down from Washington.

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Omran died at the end of May. As his health declined, his frantic mother had carried him in ever-widening circles to 11 health facilities. None had the medicine he needed.

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“He was just in my arms whimpering, ‘I’m so sick, Mom,’” said 24-year-old Islam al Mubarak Ibrahim. “I was holding him and trying to comfort him, and I prayed to God to save him.”

Her boys were inseparable. Marwan thinks Omran is still in the hospital. “One day, I will just tell him, ‘Your brother went to Paradise,’” she said.

After more than two years of ferocious civil war, Sudan is home to the world’s largest humanitarian crisis, the United Nations says. Both sides have attacked hospitals. The military often delays or denies aid access; the paramilitary it is fighting has kidnapped relief workers and looted aid facilities.

Disease and famine are spreading unchecked. More than half the population, some 30 million people, need aid. More than 12 million have fled their homes. For so many families barely hanging on, programs funded by the U.S. Agency for International Development (USAID) were a lifeline — providing food to the hungry and medical care for the sick.

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While the Trump administration’s cuts to USAID this year have been felt deeply across the world, their impact in Sudan was especially deadly, according to more than two dozen Washington Post interviews with civilians, clinicians and aid officials in the capital, Khartoum, and surrounding villages.

When U.S.-supported soup kitchens were forced to close, babies starved quietly, their mothers said, while older siblings died begging for food. Funding stoppages meant that critical medical supplies were never delivered, doctors said. The lack of U.S.-funded disease response teams has made it harder to contain cholera outbreaks, which are claiming the lives of those already weakened by hunger.

The World Health Organization says an estimated 5 million Sudanese people may lose access to lifesaving health services as a result of the U.S. cuts.

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In a response to questions from The Post, the State Department press office said it was “reorienting our foreign assistance programs to align directly with what is best for the United States. … We are continuing lifesaving programs and making strategic investments that strengthen other nations and our own country.”

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“Americans are the most charitable and humanitarian-minded people in the world,” the statement continued. “It’s time for other countries to step up in providing lifesaving aid.”

For now, no one has filled the void left by Washington. European countries, including Germany, France and Britain, have also slashed funding for international relief or announced their intention to do so. Russia and China rarely fund humanitarian work; wealthy Persian Gulf countries tend to work outside established foreign aid systems. On the ground in Sudan, volunteers are appealing to members of the diaspora, many of whom lost their homes and savings when they fled the war.

As Tom Fletcher, a top U.N. relief coordinator, put it this month: “We have been forced into a triage of human survival.”

Empty shelves

The health center in Omran’s village of Quaz Nafisa, about 35 miles north of Khartoum, is supposed to serve 60,000 people, physician Amira El Sadig said, but its entire stock of medicines now fits on a single shelf of a filing cabinet, with room to spare.

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Sadig, 41, was delighted last year when the International Rescue Committee announced it would provide the clinic with medications, solar panels to cool vaccines, oxygen tanks, simple medical devices, and lab tests for malaria and other diseases. A referrals system set up by the IRC would help patients needing more-specialized care.

When President Donald Trump took office in mid-January, he signed an executive order calling for an immediate freeze to foreign aid programs and vowing no further assistance “that is not fully aligned with the foreign policy of the President of the United States.” In February, billionaire Elon Musk proclaimed that his newly created U.S. DOGE Service was “feeding USAID into the wood chipper.” Sweeping global cuts soon followed.

As the fatal consequences became clear, and political backlash intensified, the administration said it would restore funding for essential, lifesaving programs. But in many places, including Sudan, vital staffers had already been fired and payment systems disabled, aid workers said.

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Initially, the IRC project in Quaz Nafisa was frozen by the stop-work order. Then it was terminated on Feb. 27, the organization said. It was partly reactivated March 3, but the disbursement of funds was delayed. Five months later, the clinic is due to begin receiving the help it was promised at the beginning of the year.

Sadig listed a handful of what she said were preventable deaths between February, when the medications were due to arrive, and the end of May. They included a man with a scorpion bite. A woman with cholera. A diabetic who needed insulin. And Omran, the dimpled 3-year-old.

“There are other deaths in the villages around here that we don’t even know about,” Sadig said. “Most people don’t bother to come here because it is not equipped.”

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Sadig wishes that she could solve the problem with her “own hands,” that her country could stand on its own.

“We say thank you to the American people for helping with our suffering,” she said.

Kitchens closed

In the desert outside the city of Omdurman, just to the northwest of the capital, Fatma Swak Fadul lives in a sweltering adobe slum. She used to have seven children; now she has five.

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For more than a year, they survived on a single daily meal from local soup kitchens. They were run by volunteers from the local Emergency Response Rooms, which formed in 2019 during the pro-democracy protests that helped topple military dictator Omar Hassan al-Bashir. The two years following his ouster were a heady era of hope, until two generals — the head of the military and the leader of the Rapid Support Forces paramilitary — joined forces to overthrow the fledgling government.

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Two years later, their rivalry spilled into all-out war, and the young demonstrators mobilized again. They smuggled food and medicine across front lines and cooked provisions donated by charities in vast pots, trying to keep the hungriest alive.

Last year, USAID gave the Emergency Response Rooms $12 million, which accounted for 77 percent of the soup kitchens’ funding, said Mohamed Elobaid, who manages the group’s finances. When the stop-work order came in January, Fadul said, almost all the soup kitchens in her neighborhood shut down overnight. So her children starved.

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Her daughter Nada, only 18 months old, starved to death in February, she said, and was often too weak to cry. Three-year-old Omer, who loved to wrestle with his siblings and dreamed of owning a bike, lingered longer.

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First, his mother said, he began to lose his vision, which can be a side effect of malnutrition. Then he began asking fretfully for an absent brother. In his last days in March, he curled up on a mat, she said, begging her for porridge.

“I told him we don’t have any wheat to make that,” Fadul said. “He was suffering a lot and then he died around midnight.” His mother wept, she recalled, then asked the neighbors to help bury him.

She had done her best to keep them alive, she said, walking 10 hours each day to collect small bundles of firewood she could sell for about a dollar. Sometimes it was enough to buy wheat to boil in water; never enough for all the children, but the older ones could live on less.

The daily meal from the soup kitchen was a godsend, she said. Often the family would share a single bowl.

“You can’t ask your neighbors for anything because we are all in the same situation,” Fadul said. “We have nothing.”

In mid-May, the soup kitchen reopened, buoyed by funds from the Sudanese diaspora and the U.N. World Food Program. But many children are now so malnourished, doctors say, their stomachs cannot handle normal food. To survive, they need a special high-calorie supplement, and that, too, is hard to find.

Stuck in the warehouse

Hundreds of thousands of doses of the lifesaving supplement — a peanut paste called Plumpy’Nut — have been paid for by the U.S. government and are sitting in a warehouse in Rhode Island, said Navyn Salem, the founder and CEO of Edesia Nutrition, which manufactures the paste.

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About 122,000 doses were due to go out in February to the U.N. Children’s Fund (UNICEF) in Sudan, Salem said, but their shipping contract was canceled amid the wave of USAID cuts. The supplies began moving again at the beginning of June, she said, but it will take more than a month to ship them all out.

Now, more stocks are piling up — 185,000 doses from the past fiscal year — but Salem said her factory has received no new orders.

“No business can survive this amount of uncertainty, and many children will not survive either,” she said. “The financial losses and the losses of human life are unimaginable and unacceptable.”

The small nutritional packets are desperately needed at the Almanar feeding center in the Mayo Mandela district of Khartoum, where mothers lined up last month carrying their starving children. Rahma Kaki Jubarra’s 9-month-old son, Farah, weighs just 12 pounds. Her other son, 3½-year-old Jabr, is down to just 21 pounds. The tape the medics wrap around their arms to measure their body fat slides far into the red, signaling an emergency.

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Before the war, Jubarra said, she scraped by, selling falafel while her husband was a trader at the local market. When RSF fighters took over their neighborhood, they burned 200 homes, including hers, she said, and beat her husband, brother and eldest son so badly they fled. Jubarra and her two children now live in the ruins of their former home; a blanket draped over the charred walls is all that shields them from the merciless sun.

Jubarra scavenged fish bones from restaurants and boiled them to feed her children. Her elderly father, who was also beaten, was too ill to flee and stayed with her, which meant another mouth to feed. But the soup kitchens were closed, she said, and the price of wheat had quadrupled.

“Sometimes I boiled water on the fire and told them I am cooking and just to wait,” she said. She’d continue poking at the pot, she recounted, hoping her children would fall asleep before they realized no meal was coming.

She rattled off the names of children she knew who didn’t make it. Old people died. Her uncle died. Her father died. People went to Bashair, the nearest hospital, but Doctors Without Borders had pulled out after the facility was shot up by the RSF. As the fighting raged, no aid made it in.

Last month, UNICEF was able to deliver peanut paste to the Almanar feeding center. Liana Ashot Chuol, just 7 years old, showed up by herself on a recent morning. She was carrying her starving 3-year-old sister and pushing her 5-year-old brother. Her mother had disappeared, she whispered, her father was dead and her grandmother had gone looking for firewood to sell. None of the children had eaten for two days, Liana said.

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Almanar director Amna Kornlues said that deaths have skyrocketed since the soup kitchens closed but that there is no way to know the true toll. Many children died at home, she said, and families stopped coming when the center ran out of aid to distribute.

She asked for the U.S. to continue its support: “All we need is a little, and we will share together,” Kornlues said.

If U.S. funding is not preserved, UNICEF could run out of Plumpy’Nut within a few months, it says, with dire consequences for those who depend on the nearly 2,000 feeding centers the agency supports across Sudan.

The U.S. cuts “force us to make extremely difficult decisions,” said Kristine Hambrouck, the acting U.N. representative in Sudan. Aid workers must choose between buying vaccines for babies or nutrition products for starving children, she said, and all could die without help.

Cholera spreads

Sickness here is just as dangerous as hunger.

Cholera, a waterborne disease that can kill within hours, swept across the capital in the past month after RSF drones attacked the filtration plant and electricity grid, knocking out the city’s water pumps. People are drinking from polluted rivers or contaminated wells, along streets where charred and bloated bodies have decomposed.

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Soup kitchen manager Waleed Elshaikh Edris told The Post that dozens of people had died of cholera in a single day last month in his neighborhood of Al Fitehab, including his uncle and his cousin, who he said died only eight hours after she began to show symptoms.

“When artillery shelling was intense, we had solutions — we would go under buildings,” he said. “But this infection suddenly sneaks into your body without your knowledge.”

The World Health Organization said that its partner organizations are missing 60 percent of their medical supplies and that tracking and containing the outbreak have become all but impossible.

“Supplies for cholera response were largely funded by USAID,” said Loza Mesfin Tesfaye, a WHO spokeswoman, adding that “the cuts have reduced the number of disease surveillance teams [and] reduced our ability to distribute water-purifying supplies.”

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At a mobile health clinic run by volunteers in the Salha district of Omdurman, elderly men were treated with bags of intravenous fluids hung from a mosque window. In what was once an upmarket restaurant in Omdurman, a young man curled up on a table, an intravenous tube sticking out from his hand.

Much of the cholera response has fallen to locals like Momen, a dreadlocked 33-year-old who slips out his front door on a bike every day at 5 a.m., carrying chlorine tablets — the most common way to disinfect water supplies — along with information leaflets and dreams of a different Sudan.

Momen gives the tablets to the tea ladies fanning battered pots on charcoal fires, to mothers with jerricans lining up at water wells, and drops them in the round blue communal tanks. As a pro-democracy activist during the 2019 uprising, he was arrested more than 40 times and shot in the arm, he said. Momen spoke to The Post on the condition he be identified by his first name for fear of being targeted by armed groups.

“When support was coming from USAID, we were able to respond and carry out emergency interventions much more quickly,” he said. Now, the volunteers have to design their own solutions and fundraise online, he said, which slows their work.

But he said nothing will stop them.