FEBRUARY 4, 2025, 7:44 PM <\/p>\n\n\n\n It took the Trump administration\u2014and, really, Elon Musk\u2014all of 10 days to dismantle USAID, the world\u2019s single largest humanitarian donor. On January 24, a memo from the State Department ordered virtually every foreign-assistance program funded by the United States government to halt work for 90 days. Four days later, the State Department said that lifesaving humanitarian assistance should continue, and that special waivers could be granted to select programs. Nevertheless, soup kitchens stopped handing out food, clinics suspended care, and truckers paid through aid programs stopped delivering medicine.<\/p>\n\n\n\n Then came the purge. Early yesterday morning, the Department of Government Efficiency, a Musk-led group that has been announcing what stays and goes in Washington, told employees not to come to work. Musk posted on X an hour later, \u201cWe spent the weekend feeding USAID into the wood chipper.\u201d More than 1,000 employees\u2014including some in war zones\u2014were locked out of their work accounts. Earlier today, Politico <\/em>reported<\/a> that nearly all of USAID\u2019s Washington-based staff will soon be placed on leave, and ABC News reported<\/a> that staff on foreign assignments are being evacuated.<\/p>\n\n\n\n USAID, which has distributed aid to hundreds of millions of people around the world for 60 years, estimates<\/a> that it has extended children\u2019s life expectancies by six years in many of the countries it works in. But its $40 billion in annual spending\u2014about 0.7 percent of the U.S. budget\u2014has been criticized for inefficiencies, and many Americans accuse<\/a> the government of spending too much on foreign aid. Some of those critiques are arguably fair. In 2022, for example, USAID spent more than $100,000 on theatrical productions in Ireland and Colombia. (That said, Americans also tend to drastically overestimate<\/a> the amount we spend on foreign aid.) USAID was established by Congress as an independent agency, and by law, only Congress can dissolve it. The White House, though, seems determined to do away with it as an independent agency; yesterday, Secretary of State Marco Rubio announced that he is now the acting head of USAID. If the agency is successfully subsumed by the State Department, it could, in theory, continue in a slightly diminished form\u2014or be totally gutted. When reached for comment, a State Department spokesperson referred me to Rubio\u2019s recent statements to the media. One of them read: \u201cUSAID may move, reorganize, and integrate certain missions, bureaus, and offices into the Department of State, and the remainder of the Agency may be abolished consistent with applicable law.\u201d<\/p>\n\n\n\n So far, the administration has framed the foreign-aid pause as temporary. But even if much of USAID\u2019s work is allowed to resume in a few months, the intricate global-health ecosystem being torn apart will not be easily repaired. Famine and disease\u2014two of the issues against which USAID has made the most progress\u2014don\u2019t stop when funding does, and can spread disastrously in even a short window. Prior to the stop-work order, at least 220,000 people worldwide got their HIV medication every day at clinics supported by the U.S. government. Juli Duvall-Jones, who oversees an HIV clinic in eastern Ivory Coast, told me that the pregnant women her clinic serves are no longer receiving their daily treatment, meaning that some children will almost certainly contract HIV during birth or through breastfeeding. People who are exposed to HIV have only 72 hours\u2014less than the amount of time many clinics have now been closed\u2014to begin a medication regimen called post-exposure prophylaxis that can help prevent infection. A pause of any length in USAID-funded anti-HIV efforts will cause more people to contract the disease. Missing doses of treatment can make it less effective<\/a>. Without treatment, the disease kills<\/a> young people in about 12 years, and older adults even faster.<\/p>\n\n\n\n Read: Melinda Gates on why foreign aid still matters<\/a><\/p>\n\n\n\n The head of one aid group, who, like several aid workers I spoke with, asked that neither she nor the group be named for fear of permanently losing their USAID funding, told me that her organization\u2014which, among other projects, treats severely malnourished children and babies in Sudan\u2014is now scraping by on money diverted from other projects. Most aid efforts operate on extremely thin margins, so any pause in funding is felt almost immediately. \u201cWe can sort of keep it going for a few days,\u201d she said. But once the money runs out, these children will lose the supplemental oxygen, fortified foods, and 24\/7 medical supervision they need. Many, she said, will die in two to six hours.<\/p>\n\n\n\n As the 90-day pause drags on, longer-term consequences will start to become clear. In Uganda, the national government has stopped spraying insecticide and distributing bed nets to pregnant women and young kids; during the country\u2019s next rainy season, which spans from March to May, malaria cases and deaths may spike. The Center for Victims of Torture, a global nonprofit, has furloughed most of its staff and stopped rehabilitation programs in Jordan, Uganda, and Ethiopia, including one for women among the estimated 100,000 raped<\/a> in a recent war in Tigray, Ethiopia. Scott Roehm, CVT\u2019s director of global policy and advocacy, told me that many of the center\u2019s clients attempted suicide prior to getting help. He fears what will happen to people who have to stop their treatment\u2014and those who never get help at all.<\/p>\n\n\n\n Right now, it seems unlikely that all or even most of USAID\u2019s programs will resume at the end of April. Yesterday, Donald Trump said Ukraine should give America its lithium<\/a> in exchange for aid, suggesting that programs that don\u2019t give the U.S. an immediate win may be cut for good. The longer the pause lasts, the more devastating the effects will be, not just for aid recipients but also for Americans. The Famine Early Warning Systems Network<\/a>, a monitoring tool funded by USAID, has been offline since Friday. Without it, aid workers may struggle to intervene early enough to prevent mass starvation, and farmers have lost a major tool for anticipating agricultural shocks. Michael VanRooyen, an emergency physician who has led humanitarian work in Darfur, Rwanda, and Ukraine, estimates that an extended pause in food aid could kill hundreds of thousands of people, many of them children. USAID workers leading the agency\u2019s response to an active Ebola outbreak in Uganda were among those locked out of work systems. Without their involvement, the U.S. could miss signs that the outbreak is growing or changing\u2014or even that a new pandemic is brewing.<\/p>\n\n\n\n Democratic lawmakers have started pushing back on the demolition of USAID. Yesterday, Brian Schatz, a Democratic senator from Hawaii, said in a statement that \u201cdismantling USAID is illegal and makes us less safe,\u201d and placed a blanket hold on nominees for State Department positions until USAID is back up and running.<\/p>\n\n\n\n Read: The constitutional crisis is here<\/a><\/p>\n\n\n\n But if the agency is restored\u2014next week, next month, or years from now\u2014restarting its work won\u2019t be as simple as turning the flow of cash back on. After the week USAID has had, staff might be hard to come by. According to one group of development workers tracking<\/a> the fallout, the aid freeze has caused nearly 9,000 Americans and far more people around the world to lose their jobs. Many may decide to pursue work outside the humanitarian sector, which typically offers low pay and benefits. Even if the pause ends quickly, the federal government has given workers little incentive to return. Musk has called USAID \u201ca criminal organization,\u201d \u201ca ball of worms,\u201d and a \u201cviper\u2019s nest of radical-left Marxists who hate America.\u201d<\/p>\n\n\n\n Whoever does come back to work will need to get back in touch with the people who lead local organizations (many of which have or will have gone defunct), the world leaders with whom they once partnered, and the people who shuttle supplies around the world. Susan Reichle, a foreign-assistance expert who served in every presidential administration from George H. W. Bush\u2019s to Trump\u2019s first term, told me that the pause has already broken trust that could take years to repair. \u201cUSAID staff are having to meet with ministers of health, ministers of power, ministers of education\u201d to tell them that work has stopped, Reichle said. \u201cAnd they can\u2019t tell them if or when those partnerships will ever continue.\u201d<\/p>\n\n\n\n Having a measured, humane debate about the way the U.S. distributes humanitarian aid is possible. It is in the country\u2019s interest to spend aid money effectively. And the way the United States distributes global aid could certainly be improved. But the instant retraction of much of the world\u2019s food and health-care infrastructure will create damage that cannot be undone. After three months, \u201cmany of those people will be dead, or so severely harmed and malnourished that it causes them irreversible and deep suffering,\u201d Lawrence Gostin, the faculty director of Georgetown\u2019s O\u2019Neill Institute for National and Global Health Law, told me. A pause on saving lives means exactly that.<\/p>\n\n\n\n![\"People](\"https:\/\/cdn.theatlantic.com\/thumbor\/ZDDdmsZLcW5aO4l-CjLhfoVgB9I=\/0x0:2700x1519\/960x540\/media\/img\/mt\/2025\/02\/2025_02_04_usaid_\/original.jpg\")
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