One year later: How US policies are reshaping global health and humanitarian aid

One year ago today, the Trump administration issued a series of executive actions that upended global health and humanitarian programs 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 per cent in the first half of 2025, compared to the same period in 2024, with 47 per cent 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 pediatric ward received more newborns with critically low birthweights and other needs due to a lack of medical care during pregnancy and childbirth. 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.