Vital aid, vanished

On February 2, the U.S. President made unfounded allegations that the United States Agency for International Development (USAID) has “been run by a bunch of radical lunatics,” followed by Elon Musk stating falsely on his social platform ‘X’ that “USAID is a criminal organization.” These statements followed a January 20 Executive Order to pause all USAID humanitarian assistance for 90 days, without indicating if any programs will be re-started. Many international workers, including Christian missionaries providing vital healthcare services in developing nations, have been left wondering just how bad the fallout will be. Countries like Malawi, with over half its population living in poverty, face uncertainty and chaos.  

4,000 staff sent home 

USAID has been in operation since 1961, in partnership with communities and governments around the world. It has many development aims, including the reduction of poverty, ending preventable child and maternal deaths, and achieving an AIDS-free generation. Many of USAID’s partners, including World Vision, are faith-based. Local communities identify a need and solution, and non-profit agencies bid on executing these projects.

Trump’s Executive Order had immediate effects on all USAID partners. In the small southern African nation of Malawi, all 4,000 PEPFAR staff (the President’s Emergency Plan for AIDS Relief) who provide HIV treatment for the whole country, were immediately unable to work. Since January 20, no one has received Anti-Retroviral Therapy (ART), the cornerstone treatment for HIV patients.

A disruption in the distribution of HIV treatment could be a catastrophe for Malawi, a country that has made significant gains in HIV care over the last decade. According to UNAIDS, in 2017 over one million Malawians were living with HIV. Malawi was one of the few countries that, through USAID support, has been making strides towards its 95-95-95 UNAIDS targets: 95 percent of all people living with HIV being aware of their status, 95 percent of those diagnosed maintained on ARTs, and 95 percent of patients on ART virally suppressed. Even worse, it wasn’t only PEPFAR that was shut down – malaria treatment initiatives, important clinical trials and research projects, and Tuberculosis programs have also been paused.

I worked as a nurse at a missions hospital in Malawi for five years. It was started by an American missionary who worked with the Malawian Ministry of Health to launch what was the most cost-effective and impactful country-wide HIV response in the world. Partners in Hope Hospital has become a model for other low-income countries. Over the past 15 years, this hospital has been a major partner of PEPFAR and has been able to provide 200,000 Malawians with HIV care. Now run entirely by Malawians, it has provided stable employment and initiated HIV care to many who would have had no ART access. Furthermore, it has been creating healthcare advances, such as opening one of the first private Intensive Care Units. All of this was in partnership with Christian missionaries. At CC’s press time, Partners in Hope remains running but not all of its programs are open and there’s incredible uncertainty about what is ahead.

There was no warning

USAID programs received no forewarning of this shutdown. Shortly after the Executive Order, waivers were introduced, stating that “life-saving humanitarian assistance programs” could resume work, which allowed some clinics to re-open to distribute ARTs; however, it is unclear which programs can apply for waivers. Many services remain closed in Malawi. According to one missionary surgeon working outside the capital city of Lilongwe, “There is confusion about how long these waivers will be in place; many programs don’t know what will happen. There are real concerns about the supply chain of things like medications.”  

According to The Times, Malawi has received two billion dollars in U.S. development support since 2006. More than half of healthcare spending in Malawi comes from foreign donors. Much of this funding is disseminated through non-governmental organizations such as Christian ministries. Since 2003, the U.S. has donated more than 2.1 billion towards fighting HIV, malaria and tuberculosis.

Many nursing students’ scholarships from USAID were also immediately cut in Malawi. This has almost bankrupted a nursing college outside Lilongwe which depends on these funds to stay open. These scholarships included daily food allowances for students, meaning that now they will struggle to eat when hunger season is at its peak. These young people, who were hoping for a future beyond subsistence farming, have to reconsider their prospects in a country where jobs are increasingly hard to find.

Further, the poorest of the poor in Malawi – refugees living in Dzaleka’s refugee camp – depend heavily on food supplies provided by sources such as the World Food Programme (which is co-administered by USAID) and USAID. Without the ability to leave the camp to earn money, and without land to grow food on, occupants depend on daily food rations to survive. These are people who have come from war-torn countries, who now have almost no means to feed themselves.  

The extent of damage 

USAID has historically partnered with so many organizations in Malawi – from the UN to small scale non-governmental organizations – that the impact has already been felt far and wide.  Even organizations that did not partner with USAID in Malawi will likely face supply chain disruptions.

Another key concern for Malawi, which has few export products, is the impact this will have on obtaining foreign dollars. With inflation rates at an all time high, its main export crop (tobacco) on decline due to a worldwide reduction in demand, and repeated natural disasters which decimate crops (such as Cyclone Freddy in 2023, which displaced over 659,000 people), the country relies on foreign donations to bring in foreign currency. Without foreign currency, Malawi has little buying power to purchase important medications and medical supplies. In a country where health outcomes are some of the poorest in the world, with a life expectancy of just over 62 years compared to Canada’s 81 years, there is little question that this U.S. Executive Order could be a humanitarian disaster. And this is only Malawi. USAID works in over 50 countries around the world.

Some people will claim that Trump and Musk are doing necessary work to purge the government of inefficient and wasteful spending, or that America shouldn’t be spending taxpayers’ dollars when the country has its own needs. However, many others question the lack of formal auditing processes that led to this sudden halt in all programming and question why programs couldn’t have been given notice.  

Who will fill the gap?   

Politics aside, the sudden cut of USAID services for countries like Malawi, where 13 percent of its national budget for this year is made up of USAID donations, will have dire humanitarian consequences for some of the country’s most poor and vulnerable people.  

The Canadian Foodgrains Bank, a partnership of 15 churches and church agencies working together to end hunger internationally, sounded the alarm on February 13 about how much these USAID cuts will devastate vulnerable communities.

“Now is the time for Canada to continue our commitment to global cooperation and stability, and to increase our efforts to help in emergencies – not back down from our responsibility to our global neighbours.”  If the U.S. is no longer going to offer less than one percent of their country’s GDP through USAID for service to the poor and vulnerable, will the Church around the world fill the gap?

Learn about African Mission Healthcare who help hospitals like Partners in Hope in Malawi. Consider donating to any of their projects: africanmissionhealthcare.org/donation/donate/