On January 20 2025, President Trump signed Executive Order 14169, suspending all US foreign aids pending a 90-day review. The review’s findings were never publicly realized. The programs it targeted, however, never really came back. Sixteen months later, the consequences of that decision are becoming quantifiable, and the numbers are extraordinary in a way that has barely registered in any domestic political discourse.
Analysts at the Center for Global Development estimate that the decline in the US aid outlays was linked to between 500.000 and one million deaths globally in 2025 alone. A study published in The Lancet projects that if current funding trends continue, more than 9.4 million additional deaths will occur by 2030. Another study published there and written by few researchers in the US, Spain, Brazil, and Mozambique estimated an even greater impact, projecting between 8-19 million deaths, including approximately 4.5 million children under the age of 5.
Methodological cautions are warranted. Estimating deaths linked to aid cuts necessarily involves a series of assumptions; which programs were ended, how recipient governments reacted, and whether other donors stepped in to cover the shortfall. The researches themselves recognizes the uncertainty of it. Based on the Lee Crawfurd of the Center for Global Development observed, even the lowest estimate points to a humanitarian cost of historic scale.
The Architecture of American Generosity and Its Dismantling
To understand the scale of what has been unwound, it is necessary to understand the U.S. foreign assistance apparatus actually did to the people. USAID was the world’s largest single funder of humanitarian and development aid born out of frustration at the inefficiency of multiple government agencies carrying out foreign assistance in 1961 by President John F. Kennedy. It has never been merely a charity, rather, it has been the architecture of power, development, and global management. The system was vast and very often fragmented, spreading across as many as 25 government agencies and roughly 50 programs, from USAID and PEPFAR to the Millennium Challenge Corporation and the Dept. of State, Defense, Agriculture, and Health & Human Services. By 2024, the US remained the world’s largest provider of official development fundings, contributing $63.3 billion or around 30% of total DAC ODA. This funding subsidized HIV treatment programs in sub-Saharan Africa, tuberculosis control in the South of Asia, malaria prevention across the Sahel, as well as food security interventions in conflict zones, such as from Yemen to Tigray region of Ethiopia. It wasn’t just symbolic.
To understand the scale of what has been unwound, it is necessary to understand the U.S. foreign assistance. According to the Lancet’s retrospective analysis covering 133 countries from 2001 to 2021, United States of America’s development aid is estimated to have prevented approximately 91 million deaths over two decades. And so for decades, reform debates focused on how to make the assistance more coherent, accountable, and effective. However, Trump’s foreign aid cuts reverse that. By 2025, Trump ended billions in life savings foreign assistance. Total official assistance in 2025 amounted to just $174.3 billions, a sharp decline from $214.6 billions last year, making it the largest annual decrease according to OECD (Organisation for Economic Co-operation and Development) data.
The Cascade Effect
The damage did not stop at the U.S. border. When Washington retreats, others often follow. The UK, Germany, Canada, and France have all announced reductions in their own aid commitments. The total assistance for 2025 totaled only $174.3bn, down from $214.6bn the year before, representing the largest annual drop since the OECD began recording the data. This is partly a fiscal response, and partly a political signal: if the world’s largest donor had reframed aid as waste of their economy, the domestic politics of maintaining it elsewhere become more difficult. Sub-Saharan Africa, already the region most dependent on external development finance, is projected to face a 16 to 28 percent deadline in net bilateral assistance.
The human consequences are no longer political. They are already being well documented. In Uganda, the global acute malnutrition rate among refugees rose from 5.5% to 7.7% between late 2024 and late 2025. In Kenya, the UN reduced the minimum food basket by 40% for nearly 800.000 refugees, triggering protests and documented deaths. In northern Ethiopia, reports from Tigray describe worsening malnutrition in communities still recovering from war. In Afghanistan, medical programs were terminated outright.
The UN was pushed into humanitarian officials described as “hyper-prioritization”, a bureaucratic term for the brutal task of deciding who would be left without aid. Its original 2025 plan aimed to reach 192 million people, but that target was cut to 88 million. And even then, the reduced appeal remained more than $3 billion short.
The Strategic Incoherence of the “Trade Over Aid” Doctrine
The Trump administration has framed the cuts more explicitly through Secretary of State Marco Rubio’s argument for shifting from “aid” to “trade”, from dependency toward investment, and from assistance toward opportunity. It is indeed a coherent philosophy, in the abstract. In practice, however, the trade flows haven’t materialized to replace the withdrawn assistance. The space left by USAID isn’t being occupied by American commercial engagement, but increasingly by Chinese investment.
Beijing has positioned itself as the stable alternative to an erratic Washington. Where USAID once built clinics, Chinese state-affiliated entities are building ports, railways, and data infrastructure through Belt and Road Initiative. The ideological valence of that infrastructure is not neutral. Research from the University of Sydney further suggests that the reduction in U.S. aid has corresponded with an increase in armed conflict in Africa, a state resources contract and governance capacity erodes.
This lies at the heart of the current approach’s strategic error. Foreign assistance was never fully a simple act of generosity, it also served as a tool for sustaining the kind of stable and interconnected international order that advances American trade and security interests. Dismantling that mechanism in the name of efficiency may reduce line items in the federal budget, but it doesn’t eliminate the instability those programs were meant to contain. It simply reduce the cost to somewhere else, such as onto fragile governments, overburdened UN agencies, and ultimately, to the people that may die from preventable diseases that could be cured in those closed clinics.
The Problem of Invisibility
Wars generate images. Sanctions generate headlines. The deaths attributable to foreign aid cuts, a child in Ethiopia who does not receive measles vaccine, an HIV-positive adult in Malawi whose antiretroviral supply is discontinued, generate almost nothing. They happen quietly, in dispersed locations, without a single event that a news cycle can anchor to. This invisibility is politically convenient. A policy that might be politically untenable if its human cost were concentrated is instead rendered painless in the domestic political imagination by the virtue of its diffusion.
That diffusion, however, does not make the deaths any less real. During the most acute stage of the aid freeze, UN Human Rights experts estimated that nearly 100 people were dying every hour as a result of the suspension. The figure of 350.000 deaths, including more than 200.000 children did not originate from advocacy organizations, but from official UNHR mechanisms. The Trump administration rejects these numbers, but the methodology behind them remains open to examination.
A Question of Accounting
The debate over foreign aid has long been framed in terms of money: of how much the U.S. spends, what it gets in return, and whether the investment is efficient. These are the legitimate questions. However, efficiency is a metric that only makes sense if the costs of the alternatives are also counted. The 2024 foreign aid budget amounted to less than 1% of total U.S. federal spending, while the national security budget for fiscal year 2026 rises beyond one trillion dollars. The hierarchy of American priorities is therefore easy to read. What is less legible is the arithmetic of what the cuts cost. Not in dollars, but in the metric that foreign assistance was always, ultimately, measured in.
The exact death toll may be questioned, its trajectory is not.
