What has happened in a year of US foreign aid cuts?
Just over a year since the Trump administration introduced massive cuts to the US Agency for International Development (USAID), the global effects have been both devastating and preventable.
What began as a 90-day freeze on foreign assistance has turned into an almost complete dismantling of American humanitarian efforts. By July last year, USAID had been entirely closed and its functions transferred to the State Department.
The potentially deadly consequences for the most vulnerable, often children, were raised. “No children are dying on my watch,” Secretary of State Marco Rubio insisted several months into the cost-saving programme. A year on, this has inevitably been shown to be untrue.
Atul Gawande, who served in the Biden administration as assistant administrator for global health in USAID, warned early on that with such large-scale cuts, “you’re talking hundreds of thousands [of deaths] in year one at a minimum. Just on the reduction in immunisations, you’re talking about more than a million”.
The Center for Global Development (CGD) found that US cuts to the world’s largest funder of humanitarian aid could contribute to as many as 700,000 deaths per year.
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The effects are likely to worsen in the years to come.
A study in The Lancet Global Health reported that severe funding cuts by the US and the UK could result in as many as 22.6 million additional preventable deaths globally by 2030, including 5.4 million children under the age of five.
Doomed from the start
When the US announced its policy, it did so under the banner of an “America First” foreign policy and enforced efficiency.
Rubio said the cuts would draw a line under an “era of government-sanctioned inefficiency”.
The changes were introduced quickly despite their projected risks and vehement opposition from many, including Barack Obama, who called it “a colossal mistake”.
By March 2025, just weeks into the dismantling, 86 percent of foreign aid programmes had been terminated and a similar proportion of department staff laid off.
Notably, the pattern of the cuts over the past year has suggested that those aligned with or serving the administration’s interests were largely spared.
Meanwhile, millions of people in countries that did not meet US criteria, regardless of vulnerability, had lifelines cut.
As a result, some countries fared far better than others, while millions of vulnerable people were left without support.
The US signed a deal donating $1.7 billion to Kenya’s health system after the country led a United Nations peacekeeping mission in Haiti.
Jordan, a close US ally that regularly collaborates with its intelligence agencies, was one of the few countries to have a water infrastructure project reinstated.
By contrast, despite severe humanitarian needs, Yemen and Afghanistan remained largely excluded from assistance.
Millions left without critical aid
In Afghanistan, where the US maintained a military presence for decades until 2021, child malnutrition has risen to its highest level in 25 years, and 450 health centres have closed due to cuts in foreign aid.
Occupied Palestine does not figure in any foreign assistance plans either, with President Donald Trump claiming the area will be addressed under his Gaza peace plan.
In Syria, where 16 million people remain dependent on humanitarian aid, $237m was cut. Although US sanctions were lifted in June and some aid was reportedly reinstated, aid agencies said they still have not received funds.
USAID money helped build field hospitals that treated civilians during Syria’s war.
In Yemen, the CGD found that the cuts had ended food assistance for 2.4 million people and stopped nutritional care for 100,000 children.
Women have been disproportionately affected. Many of Yemen’s emergency obstetric services were reliant on funding from the US government through the UN Population Fund.
When the cuts were implemented, 1.5 million women abruptly lost access to services and 300,000 were left without prevention and treatment for gender-based violence.
Meanwhile, despite being the world’s largest humanitarian crisis, Sudan's 30 million people have also been excluded from US foreign assistance.
The sudden removal of outside support led to the closure of more than 1,700 communal kitchens, affecting nearly three million people.
'We're not prepared'
Critics of the aid cuts have emphasised that any potential savings are minimal - USAID accounts for less than 1 percent of the federal budget - while the risks to everyone have increased dramatically.
Despite the administration’s insistence that it was not in the US’ interest for the money to be spent abroad, many of the problems aid would have addressed are not confined by borders.
Many scientists tasked with preventing the spread of infectious diseases were also removed during the cuts.
One former USAID employee, who led a team tackling an Ebola outbreak in Uganda in 2022, told The New York Times that the next infectious outbreak “is getting closer”, but added, “we’re just not prepared”.
Similarly, George W Bush’s 2003 policy, the US President's Emergency Plan for AIDS Relief (Pepfar), which led the effort to tackle the HIV epidemic, was also dismantled. When Trump signed off on the 90-day freeze, more than 20 million people were receiving treatment through the programme, including half a million children.
Many have described the aid cuts as “cruel” and warned that hundreds of thousands of people worldwide could die unnecessarily.
The reduction in US aid appears to be part of a broader trend: global aid is thought to have declined by almost a third since 2023, with France, Germany, and the UK all scaling back their commitments, potentially with dangerous global consequences.
A report by Chatham House in November found cuts could also undermine future efforts in “conflict prevention, peacebuilding and responding to humanitarian emergencies. This may have effects on international security”.
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