US-funded projects worldwide, including those providing lifesaving care for millions of people around the world from Sudan to South Africa, have received termination notices sending shockwaves around the global aid community.
The latest cancellations came on Thursday as US President Donald Trump's administration nears completion of a review to ensure that grants are aligned with his "America First" agenda after ordering a 90-day pause on all foreign aid in January to assess whether projects were consistent with his policy aims.
US Secretary of State Marco Rubio had dismissed concerns that Washington was ending foreign aid, saying waivers had been provided to life-saving services.
Only weeks later, the Trump administration decided to terminate more than 90 percent of the programmes globally, according to a February 25 court document, including many that were initially covered by waivers such as work addressing HIV as well as wider health programmes. It is unclear whether the projects can be reinstated.
Major United Nations health programmes were among those to get termination notices, including UNAIDS, the Stop TB Partnership and Scaling Up Nutrition as well as projects helping millions of forcibly displaced people.
"We are hit, but we will continue to be there," Lucica Ditiu, Stop TB's executive director, said.
Ditiu said that the group has different sources of funding it would use for procuring TB tests and treatments, but that it would have to terminate contracts with 140 partners around the world, many of which provide services including helping TB patients get diagnosed and stay on treatment.
'US funding cuts are dismantling the system'
Some 10,000 USAID contracts with NGOs and others were terminated in the Trump administration's move, InterAction said, "effectively crippling American foreign assistance."
Charlotte Slente, secretary general of the Danish Refugee Council, said she was appalled after receiving more than 20 termination notices for projects across a range of countries including Sudan, Yemen and Colombia.
"Not only are these terminations egregious breaches of contracts, but they endanger the lives of millions of the world's most vulnerable people," Slente said, adding that the decision would hit forcibly displaced people in conflict zones.
A global non-profit with projects on malaria and newborn health, among other areas, said the majority of its contracts had been cancelled. Smaller organisations were also hit, such as Khana in Cambodia, a TB and HIV organisation and many organisations working on HIV and AIDs in South Africa.
It is unclear how many organisations worldwide were affected, or exactly what the criteria were for termination.
"Secretary Rubio and (US Agency for International Development) Deputy Administrator (Peter) Marocco have determined your award is not aligned with Agency priorities and made a determination that continuing this programme is not in the national interest," said the notice received by organisations.
For some groups, USAID represents the majority of their funding, and they will struggle to survive, while for others it is only one of many donors.
International AIDS Society President Beatriz Grinsztejn, referring to cuts worldwide, said: "The US funding cuts are dismantling the system. HIV treatment is crumbling. TB services are collapsing."
South Africa could lose 500,000 lives in 10 years
In South Africa, which has the world's largest number of people living with HIV at around 8 million, health experts said the cuts could roll back years of progress on the epidemic.
The head of the Desmond Tutu HIV Foundation said it could lead to more than 500,000 deaths over 10 years.
"We will see lives lost," the foundation's chief operating officer Linda-Gail Bekker told reporters after South African groups were notified that their USAID grants had been cancelled.
"In excess of half a million unnecessary deaths will occur because of the loss of the funding, and up to a half a million new infections," Bekker said, citing studies modelling the potential impact of the funding cuts.
"We haven't heard of anybody not getting a termination," said Lynne Wilkinson, a public health expert in South Africa, referring to USAID-funded programmes.
The United States provides about 17 percent of South Africa's HIV/AIDS budget, and health experts said this funding was crucial for providing testing and getting new patients on treatment.
"The programmes who received their termination letters this morning were among the most efficient, effective health delivery programmes in the country," said Francois Venter, executive director of the Ezintsha Research Centre in Johannesburg, which is not funded by USAID, calling it a "devastating blow" for South Africa's HIV response.
Trump ordered what he said would be a three-month review of which foreign assistance programmes deserved to continue in his first day back in office on January 20, and cut off all foreign assistance funds almost overnight.
The administration and Elon Musk's Department of Government Efficiency teams have also pulled the majority of USAID staff off the job through forced leave and firings. Thousands of USAID workers were being given a 15-minute window on Thursday and Friday to clear out their workspaces.
