What Happened to Foreign Aid?

After the cataclysm

After the end of DOGE, USAID, the administrative agency primarily concerned with delivering foreign aid, has receded from the headlines. But what has happened to USAID since those days when it seemed like it might be dismantled entirely? The short answer is that most of the aid programs have chugged on but with seriously diminished capacity and funding, leaving lots of innocent people dead.

The picture a lot of people have is that USAID has been destroyed entirely, so that the United States is no longer really in the foreign aid business. That’s not right. USAID has been officially shut down, but many of its remaining operations are carried out by the Department of State. The result has been more transfer than wholesale destruction.

However, many operations have ceased. USAID spending in 2025 was 23% lower than in 2024. There was a 43% decline in obligations—commitments to future spending. Foreign aid tends to save about 3 million lives yearly, so a 43% reduction will likely cost more than a million lives annually. Other earlier estimates put the death toll from USAID cuts north of 14 million by 2040. There was another cut of 16% between 2025 and 2026.

The best estimate is that the number of lives lost from the 2025 spending cuts is between 500,000 and 700,000. The reduction in obligations likely cost between 670,000 and 1,600,000 lives. These cuts affected many different areas:

Cholera deaths nearly doubled, with cuts being a plausible contributor. While PEPFAR treatment grew 30% between 2023 and 2024, it remained constant between 2024 and 2025. PEPFAR HIV testing collapsed. Remember: PEPFAR is the single most effective foreign aid program that’s probably saved north of 20 million lives. So a very conservative estimate puts the number dead from the foreign aid cuts much higher than the number dead from the war in Iraq. One report on the damages described:

cuts to PEPFAR, credited with saving 25 million lives since 2003, had resulted in more than 159,000 adult deaths and 16,000 child deaths. The termination of other USAID health programs contributed to an estimated 53,577 additional child deaths from malaria and 62,699 from tuberculosis.

But the sectoral damage has extended far beyond health. Agricultural sector cuts are predicted to affect roughly 735 million people who could now face hunger.

The cancellation of education programs has affected 44 million learners. UNICEF predicts that 6 million additional children will be out of school by the end of 2026 due to a US$3.2 billion education aid shortfall.

Now, many of those defending USAID cuts hoped other countries would fill in. The opposite happened. As Lydia Gichuki notes “2025 was the first time in nearly 30 years that the U.S., the UK, France, and Germany cut their aid contributions at the same time.” This produced a roughly 17% decline in total global aid. So taking into account the follow-on from other countries, America’s actions may have an even larger death toll, perhaps in the millions annually.

And the cuts aren’t the only way that foreign aid functionality has been diminished. Trump attempted to rapidly reconfigure foreign aid without forewarning or careful planning. Most employees were quickly fired. The result was an unpredictable and chaotic mess, with purchased food rotting in warehouses.

In many cases, treatment was shut off abruptly. People had no time to transfer to a new provider or to adjust. Treatment simply vanished overnight, and lots of people died. As Nicholas Kristof put it:

Elon Musk says that no one has died because he slashed humanitarian aid. I went to South Sudan to check if that’s true. It’s not. Within an hour of starting interviews, I had the names of a 10-year-old boy and an 8-year-old girl who had died because of decisions by wealthy men in Washington

While the health and humanitarian cuts caused the most death, cuts also rolled back progress on human rights. The apparatus investigating human rights abuses was systematically dismantled, emboldening autocrats globally. Human Rights Watch concluded, “US aid cuts have diminished protection for people at risk of rights violations, constrained local efforts to gather evidence to one day hold abusive actors accountable, and weakened civil society organizations more broadly.”

This is very likely the worst thing a president has done in my lifetime. If Trump had simply done nothing, rather than slashing foreign aid, many fewer people would be dead. Despite foreign aid saving millions of lives annually while taking up less than 1% of the federal budget, Washington bureaucrats made a deliberate political decision to gut it, very likely with full foreknowledge that the result would be more dead children.

And these haven’t even benefitted America. Setting the global economy on fire, letting diseases ravage whole continents, and decimating American soft power isn’t in our interest. America is not an island. What happens to the rest of the world affects Americans. Additionally, see here for my objection to the claim that a nation should only serve its own interest.

It is a very bad thing when a single child dies.

Multiply that by several million, and you have the horror of the USAID cuts.

This was profoundly evil, and we should all hope that the cuts are reversed soon. While Trump’s popularity has recently sunk low due to the ill-fated war with Iran, I wish voters would attend more fully to the planes full of child death doled out by the monster in the White House.