One year later: How US policies are reshaping global health and humanitarian aid
Bearing witness to the abandonment of aid guided by public health needs
One year ago, the Trump administration issued a series of executive actions that upended global health and humanitarian programmes around the world and severely damaged global cooperation and solidarity on these issues. Clinics shut their doors. Lifesaving medicines were stranded at ports. Health workers lost their jobs. The human costs have been catastrophic. Throughout 2025, Doctors Without Borders (MSF) witnessed the immense toll of these actions. As we mark this moment and remember those who have been affected, we warn that the harmful consequences of the administration's drive to reshape US foreign assistance have only just started to unfold.
“While the world is still reeling from these cuts to aid, it's already clear that they were merely the Trump administration's opening salvo in reshaping global health and humanitarian assistance," said Mihir Mankad, Global Health Advocacy and Policy Director at MSF USA. "Different administrations have always had varying priorities and agendas when it comes to global health, but what we are seeing now is a startling turn away from the fundamental principle that providing basic humanitarian care, fighting epidemics, malnutrition, and vaccine-preventable diseases and supporting the world’s most marginalised communities are worthy causes."
Though MSF does not accept US government funding, over the course of 2025 our teams saw the devastating impact of the US government's retreat from the communities we serve.
In Somalia, aid disruptions caused shipments of therapeutic milk to stop for months. The number of severely malnourished children admitted to MSF-supported facilities rose from 1,937 in the first nine months of 2024 to 3,355 in the same period in 2025. In Baidoa Bay Regional Hospital alone, deaths among severely malnourished children increased by 44 percent in the first half of 2025, compared to the same period in 2024, with 47 percent of deaths occurring within two days of a child's arrival due to the severity of their condition.
At Renk County Hospital in South Sudan, funding cuts abruptly forced an aid organisation to stop supporting 54 hospital staff in June, leaving severe gaps in maternity care. The hospital's MSF-run paediatric ward saw a rise in critical neonatal cases—typically newborns with sepsis, partly due to a lack of adequate hygiene and infection prevention and control at the hospital. In response, MSF began supporting the maternity ward in September 2025.
In the Democratic Republic of Congo, the dismantling of USAID led to the cancellation of an order for 100,000 post-rape kits, which included medication for preventing HIV and other sexually transmitted infections. MSF teams see extremely high levels of sexual violence in DRC—we provided care to 28,000 survivors in the first half of 2025 alone—and made unplanned purchases of post-exposure prophylaxis (PEP) for HIV in response to supply gaps in North Kivu.
These examples—and countless others over the past year—signify more than budgetary cuts; they represent a fundamental shift in how the United States engages with and imagines its role in the world. Last September, the Trump administration released its America First Global Health Strategy, which positions the US to play a dramatically diminished role in global health. The strategy is narrow and shortsighted, pivoting US policy toward a misguided and likely ineffective approach to outbreak response. On key areas where the US has long been a global leader—sexual and reproductive health, nutrition, and non-communicable diseases—the strategy is silent. To begin implementing the America First Global Health Strategy, the administration has been rapidly negotiating a series of bilateral agreements with governments receiving US foreign health assistance. These agreements will form the backbone of a new approach to global health—one that is openly transactional and negotiated behind closed doors, without input from civil society or the communities whose health and wellbeing are most at stake.
The administration claims this approach encourages country ownership and strengthens sovereignty. Yet the US government has simultaneously been pressuring recipient governments to restrict access to services along ideological lines—particularly for marginalised populations and in sexual and reproductive health.
“The claim that these agreements advance national ownership rings hollow when, at the same time, you have State Department officials openly telling countries that global health assistance is contingent on their willingness to strike a minerals deal with the US,” said Mankad. “Global health assistance should be guided by public health need, sound medical evidence, and epidemiology—not crude political calculations, economic extraction, or ideological coercion.”
The cuts of 2025 were devastating, but what is emerging now is a wholesale reimagining of why and how the US provides aid and engages with the world at large on health and humanitarian issues.
MSF midwife supervisor organises medicines given to sexual violence survivors at their first medical appointment, Turunga Health Centre, Goma, DRC. She holds post-exposure prophylaxis for HIV, administered to survivors within 72 hours of the assault. Photographer: Laora Vigourt | Date: 25/03/2025 | Location: Democratic Republic of Congo
Suado Hassan Mohamed, 22, holds her 11-month-old son, Abdirahman Abdilatif, in the paediatric ward of MSF supported Bay Regional Hospital. A resident of Baidoa, Suado brought her son for treatment, as he is currently receiving care for malnutrition. Photographer: Mohamed Ali Adan | Date: 03/06/2024 | Location: SomaliaOne year later - How US policies are reshaping aid - PR EN.docx
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Jane Rabothata
About Doctors Without Borders (MSF)
Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.
In South Africa, we currently run a non-communicable diseases (NCDs) project in Butterworth, Eastern Cape province, where we support the Department of Health (DoH) in improving care for patients with diabetes and hypertension. The project focuses on improving screening, diagnosis, management, and prevention of NCDs through advocacy, research, health promotion, training, and mentorship of Community Healthcare Workers.
MSF is also recognised as one of the pioneers in providing antiretroviral treatment (ART) in the public sector. It started the first HIV programme in South Africa in 1999. The organisation's earlier interventions in the country have primarily been on developing new testing and treatment strategies for HIV/AIDS and Tuberculosis (TB) in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape). The Eshowe project was handed over to DoH in 2023 after 12 years of operations. The Khayelitsha project was closed in 2020 after 22 years of activities and campaigning for improved HIV and TB treatment.
Other projects we have been involved in include our Migrant Project in the country's capital, Tshwane, which was handed over to authorities and a local Community-Based Organisation after building the capacity to work with undocumented populations. We also previously offered free, high-quality, and confidential medical care to survivors of sexual and gender-based violence in Rustenburg, North West province.
To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work:
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