Global aid programs grapple with U.S. funding freeze

During a daily morning assembly last week at the Mary Immaculate Hospital in Mapuordit, South Sudan, Dr. Clarke McIntosh learned about an immediate effect of suspended U.S. foreign aid.

The hospital’s Volunteer Counseling and Testing clinic, which cares for patients with HIV, AIDS, and tuberculosis, was going to close. “The head of the hospital had some HIV tests and drugs stored away if we really needed them,” he said.

McIntosh said that about half of similar clinics in surrounding communities shut down, while others continued functioning but did not take in new patients.

The Trump administration announced a 90-day freeze on foreign aid last month, saying the pause allows officials to review and ensure U.S. funds are not wasted or misappropriated. Secretary of State Marco Rubio later announced some waivers to the suspended foreign aid, but confusion and uncertainty have kept some shuttered services abroad from reopening.

The United States is the world’s single-largest provider of foreign aid and development assistance, disbursing $72 billion in foreign support in 2023. The pause affects programs such as a crisis hotline supporting veterans in Ukraine, and last week, an early warning system for predicting famine globally went offline. The International Rescue Committee said seven refugee hospitals it runs in Burma, also known as Myanmar, closed their doors. Some aid groups have said the exemptions don’t extend to funding for clean water, sanitation, and healthcare.

Rubio’s announced exemptions included military aid to Israel and Egypt and some humanitarian programs. The waiver also extended to the President’s Emergency Plan for AIDS Relief (PEPFAR), which has reportedly saved 25 million people.

PEPFAR already faced a possible cancellation ahead of its renewal in March. A review by the Centers for Disease Control and Prevention and the Ministry of Health in Mozambique found that four nurses with the program in Mozambique had carried out 21 abortions since January 2021. Their actions violated rules that prevent U.S. aid from subsidizing abortions. The investigation also revealed that some nurses did not receive training about the requirements of the foreign funding. Mozambique refunded the misused funds.

The waivers don’t extend to programs that cover abortion, family planning, or diversity, equity, and inclusion. The current administration says the freeze will end funding for so-called “woke programs” globally.

In South Sudan, McIntosh said the uncertainty over the funding waiver continued into this week. He initially expected to remain closed, but workers resumed operations by midmorning on Tuesday.

“We were able to get some newly diagnosed patients counseled and treated,” he said.

McIntosh said he hopes services will soon return to normal, given the urgent need of the patients. “The most concerning patients are the ones who have been on ART [antiretroviral therapy] for some months or years and then can no longer get the drugs,” he said. “A long absence could result in resistance, but even short stops in supplies can cause the patients to quit since their compliance with ART is iffy at best.”

Rep. Brian Mast, R-Fla., chairs the House Foreign Affairs Committee, which provides oversight of the State Department. Last weekend, Mast told CBS’ Face the Nation that 30 cents or less of every dollar given to USAID actually goes toward aid. He added that about $50,000 in U.S. funds went toward a transgender opera in Colombia and $20,000 for a drag show in Ecuador.

“You need to come to us and explain what it is you’re doing, why you’re doing it, and where it’s actually saving life,” he said.

It’s unclear how many programs will be reinstated after the 90-day pause or what the fate of the United States Agency for International Development will be. The USAID website went offline over the weekend. The Trump administration on Tuesday said it’s withdrawing the majority of all USAID workers globally.

Khataza Gondwe, the team leader for Africa and the Middle East at Christian Solidarity Worldwide, said the damage in the interim is also concerning. “There’s a very real chance that some of the people who are receiving this assistance prior to the 90 days will not be alive by the end of it because they depend on that to live,” she said.

The exemption for HIV and AIDS treatment also brought some relief to Nigeria, where PEPFAR funds about 90% of the country’s treatment needs. But Nigeria’s State Minister for Health, Dr. Iziaq Salako, said the paused aid serves as a wake-up call for the country to reorganize its healthcare sector, a sentiment echoed by many Nigerians.

“At the end of the day, we have a government that is supposed to take care of the HIV patients and all the other things that U.K. aid, USA, Canada aid are doing,” said Adeboro Odunlami, a Nigerian who also received a stopwork order for a U.S.-funded research project she was involved in. “We can create value in our own countries.”