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Funds from the world\u2019s richest nation once flowed from the largest global aid agency to an intricate network of small, medium and large organizations that delivered aid: H.I.V. medications for more than 20 million people; nutrition supplements for starving children; support for refugees, orphaned children and women battered by violence.<\/p>\n
Now, that network is unraveling. The Trump administration froze foreign aid for 90 days and has planned to gut the U.S. Agency for International Development to just 5 percent of its work force, although a federal judge paused the plan<\/a> on Friday. Given wars and strapped economies, other governments or philanthropies are unlikely to make up for the shortfall, and recipient nations are too hamstrung by debt to manage on their own.<\/p>\n Even the largest organizations are unlikely to emerge unscathed. In interviews, more than 25 aid workers, former U.S.A.I.D. employees and officials from aid organizations described a system thrown into mass confusion and chaos.<\/p>\n A tower of blocks may take hours to build, but \u201cyou pull one of those blocks out and it collapses,\u201d said Mitchell Warren, executive director of the H.I.V. prevention organization AVAC, which relied on U.S.A.I.D. for 38 percent of its funding.<\/p>\n<\/div>\n<\/div>\n \u201cYou\u2019ve gotten rid of all of the staff, all of the institutional memory, all of the trust and confidence, not only in the United States but in the dozens of countries in which U.S.A.I.D. works,\u201d Mr. Warren said. \u201cThose things have taken decades to build up but two weeks to destroy.\u201d<\/p>\n Small organizations, some with as few as 10 employees, have folded. Some midsize organizations have furloughed up to 80 percent of their employees. Even large organizations \u2014 including Catholic Relief Services and FHI 360, among the biggest recipients of U.S.A.I.D. funding \u2014 have announced large layoffs<\/a> or furloughs<\/a>.<\/p>\n In one survey<\/a>, about 1 in 4 nonprofits said they might last a month; more than half said they had enough reserves to survive for three months at most.<\/p>\n The damage is compounded by President Trump\u2019s announcement that the United States would withdraw from the World Health Organization<\/a>, forcing its leaders to announce cost-cutting measures of their own. <\/p>\n Global health experts said that the future suddenly looked uncertain, even dystopian, and struggled to articulate alternatives.<\/p>\n<\/div>\n<\/div>\n \u201cWe are quite clear that the future looks different,\u201d said Christine Stegling, a deputy executive director at UNAIDS, the United Nations\u2019 H.I.V. division. But \u201cnone of us yet has a real picture of what that means.\u201d<\/p>\n<\/div>\n<\/div>\n The damage extends not just to the health of people abroad but to Americans and American businesses. Along with the roughly 100,000 positions cut overseas, an estimated 52,000 Americans<\/a> in 42 states have lost their jobs.<\/p>\n The global health care supply chain market<\/a> was valued at nearly $3 billion in 2023 and was expected to grow. Each year, about $2 billion in American agricultural products<\/a> were purchased as food aid. The abrupt halt risks more than $450 million worth of corn, lentils, rice and other commodities that are in transit or in warehouses<\/a> and ports.<\/p>\n \u201cThe economic impact of this is going to be astounding to people\u2019s lives and businesses,\u201d said Lisa Hilmi, executive director of CORE group, a consortium of large global health practitioners.<\/p>\n<\/div>\n<\/div>\n Ms. Hilmi, who worked as a nurse in many conflict and disaster zones, said that a lack of health services could drive poor health, malnutrition, epidemics, civil unrest and \u201ca much broader meltdown of society across the world.\u201d<\/p>\n \u201cIf America is the biggest superpower, then we need to act like it,\u201d she said. \u201cAnd part of that is acting with humanity.\u201d<\/p>\n A week after the aid was paused, Secretary of State Marco Rubio issued a waiver for lifesaving humanitarian assistance and medications. But stop-work orders for some programs, including food assistance<\/a>, followed even after the waiver\u2019s announcement.<\/p>\n Last week, one large organization got the go-ahead for some of its programs. But later that same day the Trump administration placed dozens of U.S.A.I.D. officers<\/a> on leave, leaving the organization wondering whether the division that issued the waiver was still a viable entity and the officer who wrote the notice was still employed.<\/p>\n \u201cIt\u2019s another example of the dizzying chaos that this administration has inflicted on us,\u201d said a senior official at the organization.<\/p>\n<\/div>\n<\/div>\n The leaders of most organizations that depend on U.S.A.I.D. funding would not speak on the record, fearing retaliation from the Trump administration.<\/p>\n Even when organizations have received approvals to continue, no money has flowed. One large organization received less than 5 percent of its expected budget for the period, but others have received nothing.<\/p>\n \u201cI obviously welcome that the secretary approved a waiver and put a post on the internet, but we cannot pay our bills with the post,\u201d a senior official at a large organization said of Mr. Rubio.<\/p>\n Some groups feel morally obligated to continue to provide lifesaving services, hoping that they will eventually be reimbursed. But with dozens of small organizations shuttering by the day, damage to some of the world\u2019s most vulnerable groups is accruing, some experts warned.<\/p>\n<\/div>\n<\/div>\n The ecosystem of global health is so closely interwoven that the pause has frozen the work even of organizations that receive no money from the U.S. government.<\/p>\n<\/div>\n<\/div>\n The nonprofit IPAS works with hundreds of organizations in dozens of countries to provide access to contraception, abortion and other reproductive health services. Many of the clinics have shuttered, some permanently, said Anu Kumar, the organization\u2019s president.<\/p>\n The speed of the disruption did not allow clinics time to make contingency plans or taper their dependence on the funding, she said, adding, \u201cThis definitely has a ripple effect.\u201d<\/p>\n After one week of the freeze, more than 900,000 women and girls will have been denied reproductive care, a figure that will grow to 11.7 million<\/a> over the 90-day pause, according to the Guttmacher Institute. \u201cThat\u2019s more than the entire population of North Carolina,\u201d Dr. Kumar said.<\/p>\n As a result, the institute estimated, 4.2 million girls and women will experience unintended pregnancies, and 8,340 will die from complications during pregnancy and childbirth.<\/p>\n<\/div>\n<\/div>\n\u2018Dizzying chaos\u2019<\/h2>\n