Only a few hours after becoming President, Trump issued an executive order pausing all USAID support for 90 days. The legality of this order is subject to ongoing challenges in the US courts.[i] Nevertheless, Elon Musk, Trump’s top election donor, has implemented the order, including his team firing USAID security who tried to deny them entry to confidential information systems.[ii] Almost all USAID work has stopped.[iii] 83% of programmes have now been permanently eliminated.[iv] People are already dying as a result. On the Myanmar Thai border, Wah K’Ler Paw, a 30-year-old Myanmar refugee had been receiving dialysis. Pe Kha Lau, 71, another refugee from Myanmar, had been receiving oxygen for her lung problems. Both were treated by USAID supported facilities until Trump ordered immediate suspension of USAID at the end of January. Both have now died due to their illnesses remaining untreated.[v]
Mike Elvis Tusubira, a motorcycle taxi rider with HIV in Uganda, says his USAID funded anti-retroviral medicines, which can keep you healthy and prevent transmission, have now been stopped. He fears death. [vi] In Ethiopia, a fifteen-year-old boy living with HIV has also run out of his USAID funded medicine. He has stopped going to school and is scared he will die of AIDS like his parents did.[vii] Programmes have closed in Lesotho, Eswatini and Tanzania which provide medicine to 10,000 women living with HIV who need these drugs for their own survival as well as to prevent their babies being born with HIV.[viii] Cuts to funding for HIV, Tuberculosis, Malaria, and polio are predicted to cause a huge rise in disease and deaths. Until this year, the US provided over half of funding to tackle HIV in children in lower- and middle-income countries.[ix] Now these programmes are in disarray.
In Sudan around 2 million people struggling to survive have been affected by the closure of food kitchens previously supported by USAID.[x] With climate crises and civil unrest, nearly 16 million people in Ethiopia rely on donated food. The US was the biggest food donor, as well as providing health and other support to the country, all of which has been disrupted. “We are in complete shock,” said Dawit Melese, manager of a local NGO supported by USAID, “The impact has been devastating.”[xi]
The State Department stated that waivers are enabling life-saving humanitarian assistance to continue.[xii] However, intentional and unintentional bureaucratic obstacles, the slashing of USAID staff and of implementing organisations, and dismantling USAID payment systems, has meant that most waivers are not taking effect.[xiii] Even money owed by USAID for work previously completed is not being paid.
Why does USAID’s closure have such a huge impact? Total US foreign assistance amounted to a lower percentage of Gross National Income (GNI) than any other country of the G7 – only 0.24% of GNI.[xiv] However, because the US has the highest GNI in the world, USAID support constituted 40% of aid worldwide.[xv] Musk claimed only 10% of USAID funds actually reached communities. In fact, 10% of USAID funds went directly to organisations in the developing world. The remaining 90% included costs for goods and services like medicines, food, mosquito nets, treatment for malnutrition, and the services delivered by multilateral and American organisations and companies.[xvi] USAID certainly had its inefficiencies, but the stop-work orders and ineffective waiver system do not distinguish between work which is impactful, efficient, and lifesaving and that which is not.
Trump inherited around 500Million USD (in today’s value) from his father.[xvii] Musk’s wealth jumped after Trump won the election (which Musk helped swing with his donations).[xviii] Oxfam reports that since 2020, the world’s five richest men more than doubled their wealth while the poorest 60% of the world have got poorer.[xix] One of these five men is Elon Musk. In fact, money is flowing from the poorest to the richest, and debt service payments from south to north outpace aid flows.[xx] Do Trump and Musk care more about increasing their fortunes than helping the poor? This may be part of the reason USAID has been dismantled. But Trump and Musk say they are shutting it down because it doesn’t promote US interests, and it’s a “viper’s nest of radical-left Marxists who hate America”.[xxi]
In fact, USAID did promote US interests, whether through promoting US soft power, or purchase of surplus produce from US farmers. And giving aid is often in the broader interest of the donor. Climate crises, conflicts, and disease cross borders. We have seen how Covid spread around the world. USAID and the US Centre for Disease Control were helping tackle a recent Ebola outbreak in Uganda and now they are hampered from doing so.[xxii] USAID cuts may result in an Ebola epidemic or HIV resurgence in the US.[xxiii]
Unfortunately, instead of stepping in to help fill the gap, the UK government has echoed Trump, saying they will cut aid by almost 50%, to the lowest percentage of GDP since the 1960s, in order to increase the defence budget.[xxiv] But cutting aid makes the world less safe. Sarah Champion, chair of the UK parliament’s international development committee argues “Cutting the aid budget to fund defence spending is a false economy that will only make the world less safe. Conflict is often an outcome of desperation, climate and insecurity; our finances should be spent on preventing this, not the deadly consequences.”[xxv]
When countries depend on aid, particularly from a single donor, they are vulnerable to the donor’s power. ‘He who feeds you also controls you’ warned Burkina Faso’s former president.[xxvi] In the longer term, the global inequalities and systems which block equity and justice must be reset, so aid is no longer needed. Debt relief, as well as more domestic funding in health and other areas are part of the solution.[xxvii] In the shorter-term Chinese support could help save lives.
China, in 2018, established the China International Development Cooperation Agency, a specific agency with professional expertise dedicated to international development and cooperation.[xxviii] The US is now moving in the opposite direction, with the remaining USAID programmes now put under the administration of the Secretary of State. Much international media discusses if China will step in to the void left by the destruction of USAID. China has already agreed to take over a 4.4million USD de-mining project in Cambodia abandoned by USAID.[xxix] Recently on Phoenix TV CIDCA vice-chairman Hu Zhangliang said: “We will not behave like some countries that leave aid recipients feeling helpless, caught off guard, or unprepared for such situations” and that China would increase investment in international development.[xxx] Health is one of the priorities of Chinese international cooperation.[xxxi] Chinese biotech is making great strides developing new medicines.[xxxii] Can China provide health and other support where the US has withdrawn? For the fifteen-year-old Ethiopian living with HIV and many others abandoned by USAID this cannot happen fast enough.
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[i] https://www.devex.com/news/aid-groups-present-case-to-supreme-court-as-decision-looms-109539
[ii] https://www.nbcnews.com/politics/national-security/usaid-security-leaders-removed-refusing-elon-musks-doge-employees-acce-rcna190357
[iii] https://www.reuters.com/business/healthcare-pharmaceuticals/services-collapsing-usaid-cuts-health-contracts-worldwide-2025-02-27/
[iv] https://www.theguardian.com/us-news/2025/mar/10/marco-rubio-usaid-funding
[v] https://www.theguardian.com/us-news/2025/feb/26/along-thai-myanmar-border-trumps-decision-to-suspend-foreign-aid-is-deadly-ntwnfb
[vi] https://www.bbc.co.uk/news/articles/cy8xlxx58l4o
[vii] https://www.npr.org/sections/goats-and-soda/2025/02/26/nx-s1-5307352/hiv-usaid-ethiopia-waivers
[viii] https://www.theguardian.com/global-development/2025/feb/28/usaid-funding-health-development-hiv-aids-antiretroviral-mothers-lgbt-sex-workers-south-africa
[ix] Expenditures and resource needs to support children and adolescents affected by HIV and AIDS. The Coalition for Children Affected by HIV; 2024 (https://www.youtube.com/watch?v=oKa1Mk8iddo)
[x] https://www.bbc.co.uk/news/articles/cy7x87ev5jyo#:~:text=It%20is%20estimated%20that%20nearly,it%20erupted%20in%20April%202023
[xi] https://www.theguardian.com/global-development/ng-interactive/2025/feb/21/the-impact-has-been-devastating-how-usaid-freeze-sent-shockwaves-through-ethiopia
[xii] https://www.state.gov/emergency-humanitarian-waiver-to-foreign-assistance-pause/
[xiii] https://www.devex.com/news/usaid-official-dismissed-after-detailing-failure-to-give-lifesaving-aid-109543?skip_optional_steps=true
[xiv] https://www.theguardian.com/global-development/2025/feb/20/how-will-trump-and-musk-freeze-on-usaid-affect-millions-around-world
[xv] https://www.telegraph.co.uk/global-health/climate-and-people/usaid-america-foreign-aid-spending-donanld-trump-elon-musk/
[xvi] https://www.theguardian.com/commentisfree/2025/feb/07/donald-trump-elon-musk-usaid-poverty-america
[xvii] https://www.theguardian.com/books/2024/sep/26/lucky-loser-review-how-donald-trump-squandered-his-wealth
[xviii] https://www.brasildefato.com.br/2024/12/30/why-did-elon-musk-gain-even-more-money-with-trump-s-comeback-to-the-us-presidency/
[xix] https://www.oxfam.org.uk/media/press-releases/wealth-of-five-richest-men-doubles-since-2020-as-wealth-of-five-billion-people-falls/
[xx] https://www.one.org/us/press/debt-service-payments-outpacing-aid-investments-in-developing-countries/
[xxi] https://www.theguardian.com/commentisfree/2025/feb/07/donald-trump-elon-musk-usaid-poverty-america
[xxii] https://www.npr.org/2025/03/02/nx-s1-5313045/he-led-the-2014-us-response-to-ebola-he-says-usaid-cuts-will-impact-future-readiness
[xxiii] https://www.npr.org/2025/03/02/nx-s1-5313045/he-led-the-2014-us-response-to-ebola-he-says-usaid-cuts-will-impact-future-readiness
[xxiv] https://www.theguardian.com/politics/2025/feb/28/anneliese-dodds-resigns-keir-starmer-cut-aid-budget
[xxv] https://committees.parliament.uk/committee/98/international-development-committee/news/205432/international-development-committee-chairs-responds-to-aid-cuts/
[xxvi] https://www.theguardian.com/global-development/2025/mar/03/those-of-us-who-rely-on-aid-must-accept-the-new-reality-and-shape-our-own-destiny
[xxvii] https://www.nature.com/articles/d41591-025-00009-9
[xxviii] http://en.cidca.gov.cn/
[xxix] https://www.aljazeera.com/news/2025/2/13/for-china-usaids-demise-could-be-a-soft-power-win-in-southeast-asia
[xxx] https://www.scmp.com/news/china/politics/article/3298824/could-usaids-closure-open-door-greater-chinese-soft-power-global-south
[xxxi] https://www.focac.org/eng/zywx_1/zywj/202409/t20240926_11497783.htm
[xxxii] https://www.economist.com/business/2025/02/16/its-not-just-ai-chinas-medicines-are-surprising-the-world-too
