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REPORTAGE |...

REPORTAGE | The End of U.S. Foreign Aid: Condemning Millions to Die in Silence

Jul 14, 2026 | written by: Tommaso Ciuffoletti

Foreword

I was born in Italy in 1979. When I was a child, my mother would often try to persuade me to finish my meals by reminding me that there were children who would have given anything to have the food I stubbornly refused to eat. It was her way of making me understand how fortunate I was. Without realizing it, I began to form a very clear image in my mind: that of the "African child" with nothing to eat.

I was a sensitive child. I remember the campaigns against world hunger, the appeals from the Pope and the Catholic Church, the fundraising drives, the concerts, the television broadcasts. It was one of the few major international issues that managed to reach even someone my age. Despite my mother's efforts, I remained remarkably thin. More than once I was told, "You look like one of the children from Biafra." I had no idea where Biafra was. I knew nothing about its history. Yet that single word immediately brought to mind images I had already seen: children with skeletal limbs, swollen bellies and eyes that seemed too large for their faces.

Those images had entered the Western collective imagination long before I was born. The famine caused by the blockade imposed by the Nigerian government during the Biafran War (1967–1970) became the first humanitarian catastrophe to be broadcast into homes around the world through television. Millions of people in Europe and North America discovered that famine was not an abstract concept. It had a face.

As I grew older, those images never disappeared. They were gradually accompanied by another narrative: one of international cooperation. Not because hunger or humanitarian crises had been defeated—that would be untrue—but because there was a collective effort, however imperfect, to prevent those images from becoming ordinary. That is what now seems to be changing.
The dismantling of a significant part of the international aid system risks bringing those images back—not suddenly, not through the shock of war or an earthquake, but through thousands of almost invisible interruptions: a health programme suspended, a vaccination campaign cancelled, a rural clinic closed, an agricultural project deprived of funding.

It is a slow process. And it is precisely its silence that makes it so dangerous.
That is why I felt compelled to write this article. Not because I believe it can change the course of events, but because the first step toward accepting a tragedy is to stop talking about it. And I refuse to watch, in silence, the return of images I had hoped belonged to the past.

biafra

International cooperation has spent decades being forced to justify every dollar it received. Today, for the first time, scientific research is trying to measure the human cost of making it disappear. From the dismantling of USAID to the estimates published in The Lancet, this report reconstructs a story that affects millions of people—and one that, far too often, continues to unfold in silence.

The Beginning of the End

International cooperation has spent decades being forced to justify every dollar it received. Today, for the first time, we are being forced to ask a different question: what is the cost of making it disappear?
This is not a rhetorical question. It is one that emerges directly from recent events.
During the first months of Donald Trump's second administration, USAID—the United States Agency for International Development—became the target of one of the most sweeping dismantling processes in its history.

Through the actions of the Department of Government Efficiency (DOGE), the body created by the Trump administration and initially led by Elon Musk, thousands of employees were suspended or dismissed, most programmes were frozen, offices were closed and contracts were terminated. Health, food security, agricultural and humanitarian programmes operating across dozens of countries were brought to a halt within a matter of weeks.

Those events gave rise to an entirely new question. If we already understand the impact that decades of international cooperation have had on public health, food security and the development of millions of people, can we also estimate the consequences of bringing that cooperation to an abrupt end?

That is the question epidemiologists, public health researchers and some of the world's leading scientific institutions have begun to answer—not to determine whether those political decisions were justified, but to measure the human cost they are likely to carry.

Sixty Years Erased in a Matter of Weeks

Founded by the Kennedy administration in 1961, USAID served for more than six decades as the cornerstone of American international development assistance.

Its history is inseparable from the Cold War, decolonization, global vaccination campaigns, the fight against HIV/AIDS, humanitarian emergencies and, more recently, efforts to help vulnerable communities adapt to climate change. Over those six decades, its priorities evolved with successive administrations. One thing, however, remained unchanged: its ability to support—directly or through thousands of partner organizations—some of the world's most fragile health and agricultural systems.

By 2024, USAID programmes were operating in around 130 countries, making the agency one of the central pillars of the global aid architecture.

Reducing USAID to an agency that simply distributes aid misses its true nature.

Every year, billions of dollars flowed through its programmes to strengthen hospitals, finance vaccination campaigns, combat HIV, malaria and tuberculosis, improve child nutrition, respond to humanitarian emergencies, help smallholder farmers adopt more resilient agricultural practices and reinforce food security for entire communities. In many countries, those resources were not merely a supplement to public services—they had become an essential part of them.

That is why the dismantling that began in early 2025 extends far beyond the boundaries of American domestic politics.

Following President Trump's executive order suspending foreign assistance pending review, USAID underwent an unprecedented institutional upheaval. According to official figures later confirmed by the U.S. State Department, approximately 83% of the agency's programmes were terminated, while around 94% of its workforce was affected by layoffs, administrative leave or separation from the agency. Billions of dollars in contracts were cancelled, and hundreds of humanitarian and development projects were abruptly brought to an end.

USAID

For many partner organizations, the consequences were immediate. Hospitals lost funding. Vaccination campaigns were suspended. Food assistance programmes stalled. Agricultural extension services disappeared. Local NGOs were forced to dismiss staff or shut down field offices altogether. For those watching events unfold on the ground, the question was never whether there would be consequences.
The only question was how profound they would be. The answer was unlikely to come from politics.

It could only come from research

For decades, epidemiologists and public health researchers have measured the effects of international cooperation by asking which interventions reduce mortality, improve nutrition, strengthen health systems and increase the resilience of vulnerable communities.

The dismantling of USAID forced them to ask a different question. If we already know the value of these programmes while they are operating, can we also estimate what happens when they disappear?
This is not an unfamiliar approach in public health. It is the same methodology used to measure the effects of smoking, air pollution, heatwaves or pandemics. Researchers compare populations, analyse long-term data and observe how the probability of illness or death changes in the presence—or absence—of a given intervention.

It is through this approach that we know how many lives a vaccination campaign saves. And, conversely, how many may be lost when that campaign is interrupted. For the first time, the same methodology was applied to the dismantling of USAID.

In June 2026, an international team of researchers published in The Lancet what is likely to become a landmark study in the debate over international development assistance. Their objective was not to determine whether the cuts were politically justified. It was far more concrete: to measure how the disappearance of one of the largest international development and global health infrastructures ever created could affect human survival.

Science Starts Counting the Cost

The findings are striking. By analysing two decades of USAID interventions, researchers estimated that, between 2001 and 2021, programmes funded by the agency helped prevent approximately 92 million deaths across low- and middle-income countries. Nearly 30 million of those lives were children under the age of five.

Few statistics convey the scale of international cooperation more clearly than these. The study then asks a second question.
If we know what these programmes achieve while they are operating, can we also estimate what happens when they disappear?

Using established epidemiological models, the researchers projected the consequences of the funding cuts initiated in 2025. Their conclusion is stark: if the dismantling of USAID becomes permanent, more than 14 million additional deaths could occur by 2030, roughly one third of them among children younger than five.

These figures deserve a clarification. They are not a count of deaths that have already occurred, nor are they speculative guesses. They are projections based on the same epidemiological methods routinely used to estimate the impact of smoking, air pollution, heatwaves or pandemics on population health.

Public health rarely has the luxury of waiting for a tragedy to unfold before assessing its consequences. Its purpose is precisely the opposite: to identify risks early enough that they can still be prevented. That is why epidemiologists build models.
Not to predict the future with certainty, but to estimate how different political decisions are likely to affect human life.

The dismantling of USAID has now become one of those decisions. The study published in The Lancet has already attracted significant attention across the global health community.
Researchers at the Harvard T.H. Chan School of Public Health have highlighted its implications, arguing that the abrupt interruption of long-standing health programmes is likely to generate consequences extending far beyond today's headlines.

New Yorker

Among the most authoritative voices is Atul Gawande—surgeon, writer, professor at Harvard and former Assistant Administrator for Global Health at USAID. In an interview with The New Yorker, Gawande observes that public debate has focused overwhelmingly on the savings generated by the cuts, while paying far less attention to the human consequences they are likely to produce.

The emerging scientific evidence now gives empirical weight to that concern. The central question is no longer how much money has been saved. It is what those savings will ultimately cost in human lives.

The Numbers Have Faces

A woman carries an infant in the town of Shire,Ethiopia, March 15, 2021. © Baz Ratner, Reuters

Epidemiological models describe a scenario. The news tells us how that scenario is already beginning to unfold.

In the months following the first wave of funding cuts, international organisations started reporting the consequences of programmes abruptly brought to a halt. These are not projections but documented events: clinics reducing their services because funding has disappeared, healthcare workers being laid off, medical supplies no longer reaching remote communities, and long-established programmes shutting down after years of continuous operation.

One of the clearest examples concerns HIV/AIDS. According to UNAIDS, the suspension of U.S. funding has already forced numerous HIV clinics to close or drastically reduce their services, leaving thousands of healthcare workers without jobs. Winnie Byanyima, Executive Director of UNAIDS, warned that if the current situation persists, the world could face 2,000 new HIV infections every single day, reversing decades of progress in the global fight against AIDS. Reuters has documented similar disruptions across programmes addressing HIV, tuberculosis and malaria, where contracts were cancelled within days, forcing local organisations and international NGOs to dismiss staff, suspend outreach activities and interrupt services that had become essential to the communities they served.

The effects extend far beyond HIV. USAID supported programmes combating malaria and tuberculosis, strengthening maternal and child health, financing vaccination campaigns, supplying therapeutic foods to treat acute malnutrition and maintaining disease surveillance systems capable of detecting outbreaks before they became epidemics. When that infrastructure begins to disappear, the consequences do not arrive as a single catastrophe. They spread gradually through health systems that, in many countries, were already operating at the limits of their capacity.

Researchers at the Harvard T.H. Chan School of Public Health have stressed precisely this point. The consequences of dismantling long-established programmes are unlikely to appear all at once. They accumulate over time as prevention weakens, access to treatment becomes more difficult, diseases once brought under control begin to spread again, childhood malnutrition increases and communities become less resilient to the next emergency, whatever form it may take.

Perhaps this is the most difficult aspect of the story to convey. Major humanitarian disasters usually produce an image that captures the world's attention: an earthquake, a flooded city, a column of refugees crossing a border. The dismantling of international cooperation offers no equivalent. It advances through thousands of seemingly ordinary interruptions—a laboratory that stops monitoring infectious diseases, a vaccination campaign that quietly ends, a nutrition programme that no longer receives therapeutic food, an agricultural extension office that closes its doors. Each of these events may appear insignificant in isolation. Together, they describe exactly what epidemiologists are now trying to measure.

That is why the studies published over the past year matter so much. They do more than estimate mortality. They represent the first serious attempt to assign a human cost to political decisions that have too often been discussed only in terms of budgets, administrative reform or ideological priorities.

Breaking the Silence

The studies published over the past year add a new dimension to a debate that, until recently, had been framed almost exclusively in political terms. Thanks to the work of epidemiologists, public health researchers and leading scientific institutions, we are now beginning to measure the human consequences of dismantling one of the pillars of international development assistance.

Statistics alone cannot tell the whole story. No study will ever capture the experience of every patient who loses access to treatment, every child who misses a vaccination, or every community left with a weaker health system and fewer resources to face the next climate shock or humanitarian crisis. Yet those numbers matter because they make visible a process that has remained largely absent from public debate.

That is one of the reasons why we decided to write this report.

For years, Treedom has worked alongside rural communities across Africa, Latin America and Asia. We meet farmers, cooperatives, agronomists and local organisations whose work is rooted in places where climate change, poverty and economic vulnerability are deeply interconnected. From that perspective, international cooperation is neither an abstract principle nor an ideological banner. It is a network of relationships, expertise and long-term commitments that enables millions of people to build more resilient futures under extraordinarily difficult conditions.

Over the past months, we have tried to document those realities. We wrote about Madagascar, where climate change is intensifying food insecurity and economic fragility. We examined how Donald Trump's return to the White House could reshape international cooperation and global climate policy, because it was already clear that decisions taken in Washington would reverberate far beyond the United States. Today, scientific research gives us something we did not yet have when those articles were published: a way of measuring the consequences. It does not change the nature of the problem. It reveals its scale.

International cooperation will continue to be debated, criticised and reformed. It should be. But from this point forward, one question can no longer be ignored. The debate cannot stop at asking how much development assistance costs. It must also ask what the cost of abandoning it will be.

Those who pay that price rarely have a voice in the discussion. They do not vote in the elections that shape these policies. They do not sit in the parliaments where these decisions are made. They are not invited onto television panels or quoted in political debates. In most cases, they will never have the opportunity to describe what these choices have meant for their lives.

Breaking that silence will not reopen a clinic, restore a cancelled programme or rebuild a dismantled system of international cooperation. But it is the first step towards ensuring that the people who bear the consequences of these decisions do not disappear from view.

For us, today, that is also what doing our job means.

Sources and Further Reading

Scientific Literature

The Lancet

Evaluating the Impact of Two Decades of USAID Interventions and Projecting the Effects of Defunding on Mortality up to 2030: A Retrospective Impact Evaluation and Forecasting Analysis

https://www.sciencedirect.com/science/article/pii/S0140673625011869