Report
The Lancet: Trump will kill 14 million people through cuts to USAID
Prolonged gaps freeze medicine and food pipelines, push qualified personnel out of work and compromise the effectiveness of the interventions.
According to a Lancet study released at the end of June, the United States’ decision to slash official development assistance (ODA) could translate into more than 14 million additional deaths by 2030. The U.S. decision has triggered a shock wave across the humanitarian system: analysts foresee a funding hole of at least $31 billion in 2025, magnified by other donors following Washington’s lead. The collapse exposes how deeply international aid depends on a handful of actors – and how brittle that architecture really is.
At the start of 2025 the Trump administration imposed a 90-day freeze on virtually all foreign-aid programs, sparing only emergency food relief and military assistance. More than $40 billion earmarked for the U.S. Agency for International Development (USAID) went on hold. When the freeze expired, Secretary of State Marco Rubio scrapped 83 percent of USAID’s portfolio. On July 1, after more than sixty years in the field, USAID shut its doors; the handful of surviving projects – fewer than one in five – shifted to the State Department.
Although the American cut is the single biggest shock – Washington supplied 43 percent of all government humanitarian funding in 2023 – similar retrenchment is visible among long-time donors elsewhere. In 2024 the 17 main contributors on the OECD Development Assistance Committee disbursed $198 billion, down 7% year-on-year, and forecasts point to another $31 billion drop in 2025.
In 2024 the United States channelled almost $10 billion into humanitarian aid and another $10 billion into global health, with sub-Saharan Africa the chief beneficiary. Over two decades, USAID interventions have averted an estimated 91 million deaths – including 30 million children – contributing to reducing HIV/AIDS fatalities by 65 percent, malaria deaths by 51 percent and deaths due to neglected tropical diseases by 50 percent. If funding is not restored, the Lancet team warns, maternal-and-child-health support could plunge by 88 percent, disease-surveillance aid by 87 percent and family-planning resources by 94 percent, leading to the projected 14 million excess deaths, 4.5 million among children under five.
The stoppage has inflicted structural damage far beyond the suspension of particular projects. Humanitarian action relies on continuous operations made possible by the interconnection of actors and sectors at the global and local levels. This network is what guarantees fast responses, adaptability and response capacity. Prolonged gaps freeze medicine and food pipelines, push qualified personnel out of work and compromise the effectiveness of the interventions.
While ODA cuts have affected essential programs, such as food assistance in crisis areas – according to the WFP, aid is expected to be reduced or suspended in 28 of the most critical operations by 2025 – the most profound damage concerns the dismantling of local networks. Many non-governmental organizations have been forced to halt programs and lay off local staff, with lasting effects on their operational capacity. This is not just a financial contraction, but the disintegration of an operational infrastructure – logistics, distribution networks, partnerships – that makes it possible to reach the most isolated communities every day. Even if the cuts were reversed and the funds reinstated, it would take months to reestablish adequate operating conditions. In the meantime, the absence of intervention in crucial areas risks having irreversible consequences, with an avoidable increase in mortality.
The cuts to public development aid must be viewed in the light of the current historical situation, marked by the proliferation of conflicts, the rearmament of the great powers, and the progressive weakening of the multilateral order. In this context, the humanitarian issue can no longer be considered a separate area, but must be understood as an integral part of the political and strategic dynamics that are currently redefining international relations. Restoring and reshaping the aid system does not only mean replenishing financial resources, but rethinking the entire infrastructure that translates economic commitments into concrete support. The goal cannot be a “return to normal,” but the construction of a resilient system capable of ensuring operational continuity beyond the unilateral decisions of individual actors.
Originally published at https://ilmanifesto.it/14-milioni-di-morti-entro-il-2030-il-vero-costo-della-fine-di-usaid on 2025-07-20