What Is The Full Cost Of Dismantling Usaid?

It took the Trump administration—and, really, Elon Musk—all of 10 days to dismantle USAID, the world’s 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.

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, “We spent the weekend feeding USAID into the wood chipper.” More than 1,000 employees—including some in war zones—were locked out of their work accounts. Earlier today, Politico reported that nearly all of USAID’s Washington-based staff will soon be placed on leave, and ABC News reported that staff on foreign assignments are being evacuated.

USAID, which has distributed aid to hundreds of millions of people around the world for 60 years, estimates that it has extended children’s life expectancies by six years in many of the countries it works in. But its $40 billion in annual spending—about 0.7 percent of the U.S. budget—has been criticized for inefficiencies, and many Americans accuse 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 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—or be totally gutted. When reached for comment, a State Department spokesperson referred me to Rubio’s recent statements to the media. One of them read: “USAID 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.”

So far, the administration has framed the foreign-aid pause as temporary. But even if much of USAID’s 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—two of the issues against which USAID has made the most progress—don’t 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—less than the amount of time many clinics have now been closed—to 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. Without treatment, the disease kills young people in about 12 years, and older adults even faster.

[Read: Melinda Gates on why foreign aid still matters]

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—which, among other projects, treats severely malnourished children and babies in Sudan—is 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. “We can sort of keep it going for a few days,” 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.

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’s 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 in a recent war in Tigray, Ethiopia. Scott Roehm, CVT’s director of global policy and advocacy, told me that many of the center’s clients attempted suicide prior to getting help. He fears what will happen to people who have to stop their treatment—and those who never get help at all.

Right now, it seems unlikely that all or even most of USAID’s programs will resume at the end of April. Yesterday, Donald Trump said Ukraine should give America its lithium in exchange for aid, suggesting that programs that don’t 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 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’s 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—or even that a new pandemic is brewing.

Democratic lawmakers have started pushing back on the demolition of USAID. Yesterday, Brian Schatz, a Democratic senator from Hawaii, said in a statement that “dismantling USAID is illegal and makes us less safe,” and placed a blanket hold on nominees for State Department positions until USAID is back up and running.

[Read: The constitutional crisis is here]

But if the agency is restored—next week, next month, or years from now—restarting its work won’t 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 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 “a criminal organization,” “a ball of worms,” and a “viper’s nest of radical-left Marxists who hate America.”

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’s to Trump’s first term, told me that the pause has already broken trust that could take years to repair. “USAID staff are having to meet with ministers of health, ministers of power, ministers of education” to tell them that work has stopped, Reichle said. “And they can’t tell them if or when those partnerships will ever continue.”

Having a measured, humane debate about the way the U.S. distributes humanitarian aid is possible. It is in the country’s 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’s food and health-care infrastructure will create damage that cannot be undone. After three months, “many of those people will be dead, or so severely harmed and malnourished that it causes them irreversible and deep suffering,” Lawrence Gostin, the faculty director of Georgetown’s O’Neill Institute for National and Global Health Law, told me. A pause on saving lives means exactly that.