The future of aid is in the future
[Note: a slightly updated version of this is posted here.]
We should fight the battle for the present
The Trump administration is effectively a disaster. The abrupt cut-off of funding, staff, and support to tens of millions of people across the world has created the kind of shock and human harm you might expect from an earthquake or the outbreak of war. The fact that this disaster was fully avoidable and intentionally caused by President Trump and his henchmen makes it worse than if it were an act of God.
We don’t know how many people have died as a result of the foreign aid disruption. Several estimates have been made; probably the most cited is a counter from researchers at Boston University. As of mid-June, more than 300,000 have died as a result of the foreign aid cuts, more than 200,000 of them children, according to the counter. Totals run as high as 25 million avoidable deaths. The Rwandan genocide killed about 500,000–700,000.
These are estimates, based on modeling. But there is plenty of real and on-the-ground information to support the case. Nicholas Kristof says Evan Anzoo, age 5, and his mother died after they lost access to antiretrovial medicines supported by the USA in South Sudan. There’s lots of reporting like this.
It has been impossible to get reliable information from USAID or the State Department on what funding has been paused, what staffing and capacity remains, which programs are still intact. But what information we can gather indicates deep budget cuts, program stoppages, staff cuts, and logistical and administrative chaos. Notwithstanding claims by Secretary Marco Rubio and Elon Musk, it’s clear that the result is death, disease, human misery, and economic losses.
The information gaps are partly the result of the cuts to funding and capacity by the Trump administration. Country staff have been fired, offices closed, local development partners have been cut. The US government now lacks eyes and ears on the ground, lacks data gathering and situation reports. Nor is there capacity at headquarters to aggregate information, communicate to the public or policy-makers, and to raise red flags. We know that we don’t know a lot about the harm and destruction playing out in countries around world. Even worse, though, is that we also don’t know what we don’t know.
We do know that food stocks are rotting in warehouses. We know medical supplies are sitting and expiring on shelves. Clinics are closed. Health workers are laid off.
The disruption has halted polio vaccines, emergency care for mothers and newborns, HIV prevention for mother-to-child transmission, therapeutic food for children wasting away. Future epidemiologists may be able to detect the disaster of the Trump administration, much like they can see the long-term scars of other disasters.
Performing Triage
We’re in the middle of a disaster. We don’t yet know how bad it is. We don’t know how bad it will be. We don’t know how long it will continue and when it might stabilize. That’s the “fog of war.”
But many of us are disaster practitioners — we do disasters for a living. There are strategies and procedures, like applying triage. In triage, you make choices for how to use limited resources:
Red — Immediate care needed
Yellow — Delayed care is acceptable
Green — Minor injuries (can wait)
Black — Deceased or beyond help
There are things we have lost that we will never recover: black. We can mourn them, but no amount of effort will restore them.
There are things that have been damaged, but will probably be ok: yellow and green.
Finally, and most importantly, there are things in acute jeopardy, but we can save them with effort: red.
I don’t mean to be critical, but I worry that folks are spending too much time on things black, green, and yellow. There are a lot of essays and seminars talking about “the future of foreign.” Some of them argue that foreign aid, as we know it, is gone. But I’m here to argue that we should spend less effort on the future and more on the present. At the same time, I think the idea that foreign aid is already gone is also wrong.
Most decisions about the structure, goals, and funding for foreign aid are still in play, and we need to fight. DOGE and the vandals at the State Department have overplayed their hand in destroying USAID and gutting foreign aid. Much of what they have done is illegal, or at least unlawful. Much of what they have done is on shaky legal ground and may be reverse or mitigated through the courts. Much of what they have done is on shaky political ground and may be overturned or mitigated through Congress.
Clearly, the “impoundment” of appropriated funds is illegal. Unless or until the Supreme Court rules that impoundments are fine, the judiciary can and should force the Trump administration to spend the money as Congress intended. There are billions of dollars at stake and the administration is falling behind in spending the funds.
Through the blitzkrieg of the first few months, Congress has not spoken. And while cowardice and fecklessness in Congress is widespread — especially among Republicans — support for the Trump attack on foreign aid is weak.
Support for foreign aid as been bipartisan and broad, if not very robust. Just look to former Senator Marco Rubio for strong support for foreign aid, especially PEPFAR.
The scale and destructiveness of the attack on foreign aid was not part of the original plan in a Trump take-over. You can’t find shutting down USAID or PEPFAR or slashing foreign aid by 83% in Project 2025. Candidate Trump didn’t mention it. Instead, the ignorant and malevolent Elon Musk and Pete Marocco grabbed the steering wheel and drove USAID and foreign aid off a cliff. Luckily, both Musk and Marocco are out of the way for now.
It’s too early to write aid’s eulogy, and our priority should be fighting to preserve the best bits, every dollar we can. Likewise, it’s too soon to write about the future of aid; aid is still here and desperately needed. Eventually, the courts and Congress will have their say. And much of what DOGE and the early Trump Administration has done can be unwound or restored.
One reason I’m reluctant to encourage anything but “fight” right now is that lives are at stake. There’s still a lot to play for, especially in the humanitarian and health sectors. Every dollar we save for programs like PEPFAR and humanitarian response and maternal and child health will save lives. Every program and contract will save lives and improve livelihoods. I feel we have an ethical obligation to stay in this fight to it’s bitter and bureaucratic end.
In the second act: Congress will take the stage
There are signs, that Congress wants a say in what comes next. First, the President sent over a budget that details how he plans to effectively nuke future aid with massive cuts and diversion of money into slush funds. Then the White House sent a package to rescind billions in unspent but already-appropriated foreign aid funds.
The appropriations rescissions package is the first skirmish in this battle, and we have a chance the win. On Thursday (12 June), the House passed the rescissions package but only after the White House “tweaked” and reassured Republicans who had misgivings. Even still, four Republicans voted against the rescissions, which would have defeated the bill if all Members of the House had showed up to vote.
Many “moderate” Republicans expressed concern about the rescissions and restructuring. Probably more importantly, Senator Graham, who Chairs the Appropriations Subcommittee which funds the State Department and USAID hinted strongly that he does not intend to rubber-stamp the Trump budget request. Speaking at a hearing with Secretary Rubio, he said, “Presidential budgets are given some consideration, and this one will get some consideration.” He noted, “I very much believe in soft power for lack of a better term. Why do we have PEPFAR? Not only is it the right thing to do, I think it’s smart foreign policy: if you can save a child, the parents will probably have a good view of you. 500 bucks goes a long way for a starving family — this is national security in another form. I will work with you to change the system, to make it more logical, more effective, but I am here to tell you: if we eliminate some of these programs that create stability over there, the chaos will surely come here.”
The House Foreign Affairs Committee is preparing a bill to reauthorize and reorganize the State Department, which has some important differences with the proposal from the Administration in where foreign aid programs would be located. The State Department sent an earlier congressional notification outlining its restructuring plans.
President Trump and Secretary Rubio will need Congress to make the changes they want and to cut and redirect foreign aid. While Congress under Republican rule is unlikely to directly deny the administration, there is an important window to influence the outcomes and a large range of possible outcomes.
This is a moment for maximum effort among advocates.
ENDS///
