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On Friday morning, staffers at a half-dozen US-funded medical facilities in Sudan caring for severely malnourished children faced a choice: defy President Donald Trump’s order to halt operations immediately or risk losing up to 100 babies and toddlers.
They chose the children.
Despite the order, three people with direct knowledge of the situation say they plan to keep their facilities open for as long as possible. The individuals requested anonymity for fear that the administration would target their group for reprisals. Trump’s order also prohibited them from receiving new, previously approved funds to cover salaries, IV bags, and other supplies. They said it would be days, not weeks, before they ran out.
American-funded aid organizations around the world, tasked with providing lifesaving care to the most desperate and vulnerable populations imaginable, have been forced to halt operations, turn away patients, and lay off employees for days as a result of the Trump administration’s abrupt stop-work orders. Despite an announcement earlier this week that ostensibly allowed lifesaving operations to continue, the previous orders have not been lifted.
Many groups doing such lifesaving work are either unaware of how to request an exemption to the order, known as a waiver, or are unsure of where their request stands. They have received little information from the US government, where humanitarian officials have recently been abruptly removed or barred from communicating with aid organizations.
Trump’s rapid assault on the international aid system is quickly becoming the most consequential and far-reaching shift in US humanitarian policy since the Marshall Plan to rebuild Europe after WWII, according to aid groups and government officials.
Emergency medical care for displaced Palestinians and Yemenis fleeing war, heat and electricity for Ukrainian refugees, and HIV treatment and polio surveillance in Africa are among the programs that remained operational as of Friday.
Experts inside and outside of government have been closely monitoring the evolving situation. “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 developing treatment plans for people with the most drug-resistant tuberculosis. She emphasized that infectious diseases have no borders. “It’s terrifying.”
Last Friday, Trump and Secretary of State Marco Rubio announced a freeze on aid operations, with limited exceptions. “The pause on all foreign assistance means a complete halt,” a senior adviser wrote in an internal memo to staff. (The order was separate from Trump’s now-seemingly rescinded moratorium on domestic US grants.)
Aid organizations around the world began receiving emails instructing them to immediately cease operations while the government conducted a 90-day review of their programs to ensure they were in line with the administration’s agenda.
Trump campaigned on a “America First” platform after failing to reduce the foreign assistance budget during his first term in office. The United States provides approximately $60 billion in nonmilitary humanitarian and development aid each year, accounting for less than 1% of the federal budget but far exceeding that of any other country. The State Department and the United States government manage the complex network of organizations that carry out the work. Agency for International Development.
Over the weekend, the system came to a halt. There was widespread chaos and confusion as contractors struggled to understand seemingly arbitrary orders from Washington and figure out how to obtain a waiver to continue working.
By Tuesday evening, Trump and Rubio appeared to have heeded international pressure and relaxed the order, stating that any “lifesaving” humanitarian efforts would be permitted to continue.
Aid organizations that specialize in saving lives were relieved, believing their stop-work orders would be reversed as quickly as they had arrived.
But that has not happened. Instead, additional stop-work orders have been issued. As of Thursday, contractors around the world were still bound by the original orders and unable to obtain waivers. Top Trump appointees halted additional funding and prohibited 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, USAID’s former deputy assistant administrator for humanitarian assistance.
Aid organizations that had already received US funds were told they couldn’t 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 would extend their suspension or cancel their contracts entirely.
As crucial days and hours pass, aid organizations claim Trump’s order has already caused irreparable harm. Many organizations, often without cash reserves or endowments, rely solely on US funding and have been forced to lay off employees and cancel vendor contracts.
According to trade publication Devex, one CEO predicts that up to 3,000 aid workers will lose their jobs in Washington alone. Some organizations may have to close entirely because they can’t afford to float their overhead costs without knowing when or if they’ll be reimbursed.
Critics argue that the past week has undermined Trump’s own stated goals of American prosperity and security by creating a vacuum for international adversaries to fill, putting millions of people 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 US. “There’s nothing that was left untouched.”
In response to ProPublica’s detailed list of questions for this article, the White House referred them to the State Department. The State Department stated that all questions about USAID should be directed to the agency itself. USAID did not respond to our emails. Many of its communications staff were laid off in the last week.
The State Department defended the foreign aid freezes in a public statement on Wednesday, claiming that the government had 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,” according to a statement. “We are eliminating waste. We are preventing woke programs. And we are exposing activities that are contrary to our national interests. None of this would be possible if these programs remained in autopilot mode.”
The dire international situation has been exacerbated by the turmoil in Washington. This week, the Trump administration furloughed 500 support staff contractors from USAID’s humanitarian assistance bureau, or roughly 40% of the unit, and fired 400 more from the global health bureau. Those employees were instructed to stop working and “please head home.”
The remaining officials in Washington are now attempting to navigate a perplexing waiver process and bring life-saving programs back online. Officials and diplomats told ProPublica that Trump’s new political appointees did not consult with USAID’s long-time humanitarian experts when developing the new policies. As a result, career civil servants say they are struggling to understand the policy and how to implement it.
According to meeting notes, one of USAID’s top Middle East officials told mission directors earlier this week that the bar for aid groups to qualify for an exemption from Trump’s freeze was high.
A government employee told ProPublica that it took the directors until Thursday to receive instructions on how to fill out a spreadsheet with the programs they believe should qualify for a waiver and why. “The waiver for humanitarian assistance has been a farce,” another USAID official stated.
“Like a Russian nesting doll of fuck-ups,” said Jeremy Konyndyk, who oversaw some of USAID’s largest programs under Presidents Obama and Biden. “It’s just astonishing.”
Fear of retaliation pervades the federal government’s foreign aid agencies, which have become some of Trump’s first targets in his campaign against diversity, equity, and inclusion programs. Earlier this week, the administration removed photographs of children and families from the agency’s hallways.
Many people are afraid of being disciplined or fired for doing their jobs. Officials in USAID’s humanitarian affairs bureau say they are not allowed to accept calendar invites from aid organizations or set up out-of-office email responses.
On Monday, USAID placed approximately 60 senior civil servants on administrative leave, citing unspecified efforts to “circumvent” the president’s agenda. The group received an email informing them of the decision with no explanation before being locked out of the agency’s systems and barred from entering the building.
“We’re civil servants,” one of the officials explained. “I should have been given notice and due process. Instead, an agency-wide notice accused people of undermining the president’s executive orders.”
Then, on Thursday, the agency’s labor relations director informed the group that he was withdrawing the agency’s decision because he discovered no evidence of misconduct, according to emails obtained by ProPublica.
Hours later, the director was placed on administrative leave himself. “The agency’s front office and DOGE instructed me to violate our employees’ due process by issuing immediate termination notices,” he wrote to colleagues, referring to Trump’s Department of Government Efficiency, which is led by Elon Musk. (Musk did not return a request for comment.)
Later that night, the original 60 officials were placed on leave again.
On Thursday, the United States. The director of labor relations at the Agency for International Development announced the reinstatement of approximately 60 senior civil servants who had been placed on administrative leave by the Trump administration. (ProPublica obtained and redacted this information.) Hours later, the labor relations director was placed on leave. He claimed that the agency’s front office and the Department of Government Efficiency had instructed him to fire his colleagues without due process. (ProPublica obtained the information and redacted it.)
Diplomats have long praised America’s humanitarian efforts abroad because they help build critical alliances around the world at a low cost.
When President John F. Kennedy established USAID in 1961, he described it as a historic opportunity to improve the developing world and prevent countries from falling into economic collapse. That, according to his testimony to Congress, “would be disastrous to our national security, harmful to our comparative prosperity and offensive to our conscience.”
USAID oversees the most successful international health program of the twenty-first century. President George W. Bush established the President’s Emergency Plan for AIDS Relief in 2003 to combat HIV around the world, and it is estimated that it has saved 26 million lives in the last 22 years. It currently provides HIV medications to 20 million people and funds HIV testing and employment for thousands of health-care workers, primarily in Africa.
That all came to a halt this week. Since receiving the US government’s stop-work orders, contractors managing the program say they have received little communication about what work they will be allowed to continue or when. They are not allowed to distribute medicines that have already been purchased and are sitting on shelves.
If the exemption waivers are not granted, policy analysts and HIV advocates warn that the full 90-day suspension of those programs will have disastrous consequences. According to an analysis by amFAR, a nonprofit dedicated to AIDS research and advocacy, over 222,000 people receive HIV treatment through the program each day. Three people with direct knowledge said that as of Friday morning, those orders had not been lifted.
Up until last week, PEPFAR provided HIV treatment to an estimated 680,000 pregnant women, the majority of whom lived in Africa. According to the amfAR analysis, a 90-day stoppage could result in an estimated 136,000 babies acquiring HIV. Because HIV testing services are also suspended, many of them may go undiagnosed.
The chaos has spread to war zones and foreign governments, posing a risk of disease outbreaks and straining long-standing international relationships.
Government officials were concerned about contract personnel who were unexpectedly stranded in remote locations. Camp managers in Syria were ordered to abandon their site at al-Hawl refugee camp, which also serves as a prison for ISIS sympathizers. This left the refugees inside with nowhere to go for basic necessities such as food and gas.
According to a company official, the State Department ordered security guards protecting an arms depot from insurgents in Mogadishu, Somalia, to simply walk away. When the guards inquired about what would happen to the armory, their government contacts informed them that they had no answers. Concerns about the armory were first reported by The Wall Street Journal.
Contractors in Syria and Somalia have been allowed to return to their work sites.
An executive at a health-care nonprofit told ProPublica he hasn’t been as fortunate. His organization is still under a stop-work order and is unable to fund medical operations in Gaza, where Hamas and Israel have reached a fragile cease-fire agreement that is contingent on the free flow of humanitarian aid.
“People will die,” the executive stated. “This is bad news for organizations that rely solely or primarily on government funding in the United States. That may be part of the message. But there would be less drastic methods to send it.”
In response to criticism, the Trump administration spread misinformation. During a press conference, White House press secretary Karoline Leavitt touted the initiative’s success thus far, saying 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 on to say Hamas fighters were using the condoms to make explosives.
They did not name the contractor, but the State Department later cited $100 million in canceled aid packages destined for the International Medical Corps.
In response, IMC stated that no funds from the US government were used for condoms or other family planning services. The organization treats more than 33,000 Palestinians per month, according to the statement. It also runs one of the few centers in Gaza for severely malnourished children.
“If the stop-work order remains in place,” said IMC, “we will be unable to sustain these activities beyond the next week or so.”
There have also been new outbreaks of Ebola in Uganda’s capital and the disease’s cousin, the Marburg virus, in Tanzania. The United States has long been a major funder of biosecurity measures around the world, including high-security labs. That funding is currently on hold.
According to three officials familiar with the situation, groups in Ukraine that provide critical humanitarian aid to civilians and soldiers fighting Russia have been told to stand down after receiving no meaningful updates in days. The services that have been halted include first responders, hospital fuel, 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,” one of the organizations’ leaders said, adding that they may have to lay off 20% of their staff. “And we are taking away these very basic services that they need to survive.”
A contractor for the United States in Yemen claimed her entire team was told to stop working last weekend, which ProPublica confirmed with contemporaneous emails. “One of my tasks was summarizing how many people had been directly saved by our health programs every week,” she recalled. “It was usually 80 to 100.”
The stop-work order has not been lifted. It’ll be a week on Sunday.