WHO Director-General Dr Tedros Adhanom Ghebreyesus

A grim picture is emerging of people running out of food, countries running out of medicine and hospitals closing as a result of the shock slashing of global health budgets by the United States, according to multiple World Health Organization (WHO) staff addressing a media briefing on Monday.

Meanwhile, the WHO is mulling “terrible choices” as it tries to trim 25% of its budget in the wake of the US withdrawal from the body.

Malaria: Additional 15 million cases this year?

“There are now severe disruptions to the supply of malaria diagnostics, medicines and insecticide-treated bed nets due to stockouts, delayed delivery or lack of funding,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, reporting on the early impact of the US Agency for International Development (USAID) funding cuts.

Over the last 20 years, the US has been the largest bilateral malaria control donor, helping to prevent an estimated 2.2 billion cases and 12.7 million deaths.

“If disruptions continue, we could see an additional 15 million cases of malaria and 107,000 deaths this year alone, reversing 15 years of progress,” said Tedros.

HIV: Imminent disruption to ARV supplies

Dr Meg Doherty, WHO’s head of HIV, hepatitis and STIs

“It’s a similar story with HIV,” said Tedros. “The suspension of most funding to PEPFAR, the President’s Emergency Plan for AIDS Relief, caused an immediate stop to services for HIV treatment, testing and prevention in more than 50 countries. 

“Eight countries now have substantial disruptions to antiretroviral (ARV) therapy and will run out of medicines in the coming months. Disruptions to HIV programmes could undo 20 years of progress, leading to more than 10 million additional cases of HIV and three million HIV-related deaths, more than triple the number of deaths last year.”

The eight countries in the most immediate danger of running out of ARVs are Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria and Ukraine.

Dr Meg Doherty, WHO’s head of HIV, hepatitis and STIs, said there have already been reports of deaths of mothers and babies in settings such as South Sudan who were unable to get ARVs. In other settings, overdose deaths among injecting drug users soared within a week of opioid substitution therapy being stopped, a complementary therapy designed to reduce risks of acquring HIV infection from contaminated needles. 

“We are just going to need time to be able to get the data in, but we are seeing effects on the ground right now,” said Doherty.

‘Crippling breakdowns’ in TB response

WHO’s Director of TB, Dr Tereza Kasaeva

“On tuberculosis, 27 countries in Africa and Asia are facing crippling breakdowns in their response, with shortages of human resources, disruptions to diagnosis and treatment, data and surveillance systems collapsing and vital community engagement work deteriorating,” said Tedros.

“Nine countries have reported failing procurement and supply chains for TB drugs,  jeopardising the lives of people with TB.”

Over the past 20 years, US support for TB services has saved almost 80 million lives. 

WHO Director of TB Dr Tereza Kasaeva, said that during COVID-19, there were 700,000 additional TB deaths as a result of service disruptions, and this was a grim indication of what to expect.

“When [service] disruptions last more than three months, even a 20% drop in [diagnosis] will lead to a significant increase in TB deaths,” said Kasaeva.

Threat to immunisation

WHO head of immunisation Dr Kate O’Brien

WHO’s global measles and rubella network of more than 700 laboratories, funded solely by the US, faces “imminent shutdown”, said Tedros. 

“This comes at the worst possible time when measles is making a comeback. Last year, there were 57 live or disruptive measles outbreaks, and that number has been increasing for the past three years.”

WHO head of immunisation Dr Kate O’Brien described the cuts to immunisation programmes as “life-threatening”, although the results may only become clear in the years to come.

“We estimate that there will be hundreds of thousands of additional deaths as a result of the actions to compromise the vaccine programmes in place now, and many hundreds of thousands more as a result of the failure to deploy and introduce vaccines that are ready to go and to protect communities around the world, including the malaria vaccine,” said O’Brien.

Collapsed humanitarian response

Teresa Zakaria, WHO head of humanitarian relief.

“Almost 24 million people living inside crisis are at risk of not being able to access essential health services,” said Tedros.

“More than 2,600 health facilities in 12 humanitarian crises have already suspended services at least partially, or will do very soon.”

 In Afghanistan, funding shortages could force the closure of 80% of WHO-supported essential health care services. By the first week of March, 167 health facilities had already closed, denying lifesaving medical care to 1.6 million people across 25 provinces.

“Without urgent intervention, over 220 more facilities could close by June 2025, leaving an additional 1.8 million Afghans without access to primary health care,” said the WHO in a statement on Monday.

“In Cox Bazar in Bangladesh, the largest refugee camp in the world, diagnosis and treatment of hepatitis C has been disrupted, and disease surveillance, primary and secondary health care, laboratory services, procurement of supplies and salaries of health workers,” said Tedros.

Teresa Zakaria, WHO head of humanitarian relief, said that over 300 million people in 72 countries “require urgent humanitarian assistance to remain alive”. 

With data from only 12 countries, 23.8 million people are “directly affected by reduced health services” and “without urgent life saving health services, all of these individuals will be at risk of dying”. 

In these 12 countries, over 2,600 health facilities have been impacted and 900 hospitals in and over 1200 primary healthcare facilities are at risk of closing. 

It’s very early in our determination and quantification of the entire impact, but already we’re seeing how bad the situation is,” said Zakaria.

‘Terrible choices’ with WHO restructuring

WHO executive director of health emergencies, Dr Mike Ryan, is also chairing the WHO’s prioritisation committee

WHO executive director of health emergencies, Dr Mike Ryan, is also chairing the WHO’s prioritisation committee to determine how to reduce costs while maintaining essential programmes.  

“We’re severely containing our costs to $4.9 billion over the next two years,” said Ryan, adding that a re-prioritised budget will be presented to the World Health Assembly in May.

The health emergencies budget needs to be cut from $1.2 billion for two years to around $872 million.

“That will result in a 25% contraction of the emergencies programme,” said Ryan. “What do you want to stop doing? Do you want to stop doing Ebola? Do you want to stop doing emergency medical teams responding to major disasters in the world? Would you like to stop intelligence gathering so that we know what the next epidemic or pandemic will be? There are some terrible choices to be made.”

All departments are “making similar terrible choices we would never have wanted to make,” said Ryan. 

“But we will ensure that this organisation moves into the future. We will be smaller, but we will be efficient as ever, and we will be stronger, and we will be ready to to to grow again when the time is right.”

To meet the crisis, WHO has already frozen new staff hires, laid off temporary staff, and offered early retirement packages to employees over the age of 55. But it has not responded to the Health Policy Watch report on the dramatic rise in numbers of consultants and expansion of senior WHO Directors, and particularly those at the top  (D2) level, which occurred since Tedros took over as Director General in 2017 – with corresponding costs increases.

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

US responsible for ‘orderly and humane withdrawal’

“The US administration has been extremely generous over many years, and of course, it’s within its rights to decide what it supports and to what extent,” said Tedros.

“But the US also has a responsibility to ensure that, if it withdraws direct funding for countries, it is done in an orderly and humane way, to allow them to find alternative sources of funding. 

“We ask the US to reconsider its support and help, which not only saves lives around the world, it also makes the US safer by preventing outbreaks from spreading internationally,” he added.

Meanwhile, Ryan said that he mourns the loss of his US colleagues, “not for the dollars, but for the loss of contact”. 

“I’ve worked in this space for 30 years. We speak every day with colleagues in the United States, with institutions around the United States. They are the core of global public health. They are the heroes of disease control.”

How can health inequality be reduced?

This was the topic of the most recent episode of the Global Health Matters podcast with Dr. Garry Aslanyan.

Understanding Health Inequality

“Health inequity is produced by and within social relations that govern the production and exchange of concrete material things that we need to survive and flourish, to ensure well-being, like health,” explained guest Hani Kim, executive director of the Right Foundation in Seoul, Korea. “By material conditions, I mean how much we own and control various economic resources—resources that can produce things like money, land, credentials, and labour. What you own and how much of these resources you control critically determine what you have to do to get what you need to ensure your well-being.”

In other words, she explained, the relationships amongst different actors within global health—be it nations, non-governmental organisations, private philanthropies, or stakeholder groups within nations—are deeply embedded in a system that perpetuates inequalities of resources and power both amongst and within countries.

“These inequalities, along with material and power relations, have a profound impact on the strategies and directions that the field of global health employs to meet its goals,” Kim added.

The Role of Local Voices

Kim pointed out that global health efforts are often led by elites who impose solutions from above, assuming they have the best answers. This tendency normalises and universalises their perspectives at the cost of marginalising views that do not align with them.

She has made it a priority to invite and listen to partners from countries facing local health challenges. While she has seen some progress in this area, she emphasised that there is still a long way to go. Moreover, she cautioned that simply including local voices is not enough—it is essential to ensure they are truly representative, not just elites from their own communities.

“We live in a structure where inequalities of resources and power are so pervasive that even within these countries, the degree of inequality is immense. So, figuring out what the working classes and communities really want cannot be achieved simply by selecting a few so-called representatives,” Kim said. “The needs and wants of these communities are best expressed through movements and actions led by the members of those communities and working-class groups in their local context. This is inherently difficult to capture by simply selecting one or two representatives for forums, meetings, and conferences hosted by elites.”

Taking Action

Kim stressed that achieving change requires individuals to act within their own domains—whether as students, researchers, or professors—and to acknowledge their inherent limitations.

“Let us guard ourselves against the temptation to portray a world-view where what we can do, just because it is something we can do, is the most important or the best approach,” Kim added. “Solving health inequity is possible only when inequalities and material relations are addressed. And history teaches us that struggles for equality have been fought and won by the oppressed and exploited classes, not by elites.”

Building Sustainable Change

Another guest on the podcast, Seye Abimbola, an associate professor of health systems research at the University of Sydney’s School of Public Health, echoed much of what Kim said but added another critical perspective: many change efforts fail because people assume change will happen on its own.

“Change doesn’t just happen by accident or on autopilot,” Abimbola emphasised. “You have to build things, and be part of building structures that consistently do right by the people on whose behalf, with whom, and for whom we ought to be working.”

Listen to more Global Health Matters podcasts on Health Policy Watch >>

Image Credits: TDR Global Health Matters.

“There is ability in disability,” says Mulikat Okanlawon, a Noma survivor from Nigeria.

Okanlawon shared this message on a recent episode of the Global Health Matters podcast with Dr. Garry Aslanyan. The episode was one of two focused on the real-life experiences of people living with neglected tropical diseases (NTDs).

Noma primarily affects children. The disease begins in the mouth and spreads rapidly, destroying facial tissue. About 90% of those affected die quickly. However, if diagnosed early, Noma is preventable, treatable, and not contagious.

For Okanlawon, the disease left lasting physical and emotional scars. She explained to Aslanyan how it deeply impacted her self-esteem.

“It affected me so much that I couldn’t go out or go anywhere. Even if I wanted to, it had to be in the evening, and I would cover my face before leaving,” she said. “I cried all the time when I looked at myself in the mirror. Of course, because I looked different. It really affected me emotionally.”

Noma caused a deep, open wound on Okanlawon’s cheek and nose, also damaging the bone around her eye. As a result, she struggled to eat and speak. So far, she has undergone five surgeries and is preparing for a sixth.

Despite these challenges, Okanlawon decided to take action. She co-founded the Elysium Foundation, which supports survivors in six countries and advocates globally to raise awareness about Noma and improve care for those affected.

Thanks to the tireless advocacy of survivors like her, the World Health Organization officially recognised Noma as an NTD in 2023.

“It changed everything to have Mulikat or another survivor at the table, speaking with decision-makers,” said Claire Jeantet, an award-winning documentary film-maker who has worked with Okanlawon for over eight years to share the stories of Noma survivors. “It’s estimated that less than 10% of people survive the disease, so meeting someone who has lived through it is very powerful for most people.”

Okanlawon’s journey sheds light on the devastating impact of Noma. Yet, her story is also one of resilience, strength, and the power of advocacy, Aslanyan noted.

‘Hoping to get to heaven’

In the second part of the series, Aslanyan interviewed Dan Izzett, a former civil engineering technician and pastor who has dedicated his retirement to advocating for people living with leprosy.

Izzett developed leprosy as a child but wasn’t diagnosed until years later—after he was already married. By then, the disease had progressed, leaving him severely disabled.

“I like the term ‘fat man with one leg, three toes, nine fingers hoping to get to heaven one day,’” Izzett said on the podcast.

When he was first diagnosed, his biggest fear was the stigma.

“It’s a precast case, the stigma of leprosy—the movies that are put out, the pictures, the jokes. As a young man, I can remember telling jokes about lepers,” he explained, adding that he feared rejection.

Over time, Izzett not only came to accept his disability but also turned it into a force for good. He wanted to help ensure that others wouldn’t suffer as he had. In his case, the delayed diagnosis led to severe complications and permanent loss. His wife, Babs, who also had leprosy, was diagnosed early and never developed any serious issues.

“I have no problem with being called disabled because technically that is what I am,” Izzett said. “I think with self-acceptance, self-proclamation, self-declaration, it doesn’t matter any more that I’m disabled because that’s what I am. In fact, I’ve actually been able to embrace my disabilities and use them to advance our advocacy work.”

Peter Waddup, CEO of the Leprosy Mission in Great Britain, emphasised the connection between discrimination and disability.

“For many people with neglected tropical diseases, it’s not the disease itself that’s the problem,” he said. “Most of them, if diagnosed early, can get the pills or whatever it takes to clear up the disease. But the discrimination stops them from coming forward and acknowledging it. They hide the early signs. And the sad thing about that is—that’s when the disability starts to occur.”

Dan Izzett (left) and Peter Waddup
Dan Izzett (left) and Peter Waddup

Despite his challenges, Izzett has transformed adversity into purpose.

“You can either live in the negative—you can choose to stay there and dwell on it—or you can live in the positive. We’ve chosen to make it positive,” he said.

Listen to more Global Health Matters podcasts on Health Policy Watch >>

Image Credits: TDR Global Health Matters.

EPA
The US EPA announced it would target 31 key environmental regulations.

The US Environmental Protection Agency announced it would seek to roll back 31 climate, air and water pollution, and emissions regulations, declaring this is the “biggest deregulatory action” in US history.

Leading environmental health voices say that rolling back pollution and climate regulations will inextricably harm the public’s health, though the Trump administration asserts that no such link exists.

In a flurry of press releases, the US Environmental Protection announced it would review or revise dozens of landmark regulations dating back decades – though it is not clear which regulations would be weakened or eliminated. 

“Today is the greatest day of deregulation our nation has seen. We are driving a dagger straight into the heart of the climate change religion to drive down cost of living for American families, unleash American energy, bring auto jobs back to the US and more,” said EPA Administrator Lee Zeldin in a press statement.

If the EPA’s actions are approved through a period of public comment, the Trump administration will eliminate “trillions of dollars” in regulatory costs and “hidden taxes,” according to Zeldin.

Under attack is a 2009 EPA finding that climate change-causing pollutants, including methane and carbon dioxide, harm human health. Without this “endangerment” clause, the EPA will clear the way for widespread dismantling of greenhouse gas emission regulations. 

“I’ve been told the endangerment finding is considered the holy grail of the climate change religion,” Zeldin said in a video posted on X. 

But environmental health experts warn reversing this finding will directly affect health, and point to how protecting public health seemed second to lowering energy costs and regulatory burden for the EPA now.

“The potential increase in health-related expenses, environmental degradation, and the stifling of innovation will lead to higher costs for consumers and impede economic growth,” said Margo Oge, former EPA director of transportation and air quality. 

“These actions will not make America great – they will just make Americans sicker,” she said in a LinkedIn post.

President Trump’s chief environmental officer also announced plans to target 31 key regulations that would reduce wetland protections, loosen climate pollution from vehicles and power plants, wastewater from coal plants, and air pollution from the energy and manufacturing sectors – including restrictions on mercury, a known neurotoxin. The administration also plans to overturn the “good neighbor rule,” which requires states to address pollution carried downwind to other states. 

Wednesday’s announcements follow similar actions upending the US’s environmental protection, including shuttering offices dedicated to environmental justice, firing hundreds of EPA staff, and removing key scientific advisors from leadership.

Clean air ‘inextricably’ linked to better health

Air pollution from fossil fuels is a leading risk factor for mortality globally.

Currently, the EPA has operated under the Endangerment Finding, which determined that climate change pollutants threaten public health and welfare. This has led to multiple actions establishing pollution standards for power plants, cars and freight trucks, and oil and gas facilities, according to an Environmental Defense Fund (EDF) analysis.    

The EPA claims that its actions reflect “updated science” since the Supreme Court’s 2007 ruling that greenhouse gases are considered pollutants under the Clean Air Act. But experts posit that the scientific evidence linking climate change to adverse health outcomes has only grown.

Recent epidemiological modelling studies attribute 5-10 million deaths from air pollution each year. Particulate matter and ozone air pollutants can trigger heart disease, strokes, chronic pulmonary diseases, in addition to asthmas and respiratory diseases.

clean air act modelling
The Clean Air Act has averted 230,000 premature deaths in the US between 1990 and 2020. Visibility projections with and without the Clean Air Act.

More broadly, climate change can disrupt access to health care services, threaten infrastructure, and pose physical and mental health risks, according to a still-active EPA webpage. Extreme weather, poor air and water quality, flooding, droughts, and insect-borne diseases are all expected to increase as the global climate continues to change.

But under the EPA’s cornerstone Clean Air Act, which until this week included greenhouse gas emissions, returns $9 to public health, the environment, and productivity for every $1 spent reducing mobile source emissions, according to an EPA webpage.

 “We have ample evidence that climate change pollutants, both directly and indirectly, are profoundly harming health,” said Dr Lynn Goldman, dean of the George Washington Milken School of Public Health, and former EPA official in a statement to Health Policy Watch.

“We need to confront the dangers of harmful pollution using a multitude of tools whether regulatory or via providing economic incentives. There seems to be an intention of willfully cutting off both of these avenues but putting our heads in the sand, while providing some with short term profits, is no solution to the challenge of climate change.”

When asked for comments, researchers at other US universities declined to comment based on policies against issuing public statements.

Clean water regulation also under attack

Antibiotic manufacturing water pollution
Among the 31 regulations under scrutiny are those protecting American wetlands and streams from pollution.

The EPA specifically singled out how the agency would define “waters of the United States,” which guides how waterways are protected. A 2023 Supreme Court ruling narrowed the definition of waterways the Clean Water Act protects, saying the Act only extends to “wetlands with a continuous surface connection to bodies that are ‘waters of the United States’ in their own right”.

The Trump-era EPA leadership has since asserted that it should only protect “continuously flowing body of waters,” excluding smaller, seasonal streams and revoking protections for more than half of US wetlands. 

But environmental groups contend that an attack on wetlands is an attack on water quality.  

“Without Clean Water Act protections for the more than half of the wetlands in the United States targeted by this rule, Americans can expect: lower quality drinking water resulting in poorer human health, less resilience to flooding,” said Jared Mott, Conservation Director for the Izaak Walton League, a conservation and recreation group.

Though Zeldin has promised to protect America’s water, the administrator argued that  “[t]he previous Administration’s definition of ‘waters of the United States’ placed unfair burdens on the American people and drove up the cost of doing business.

“Our goal is to protect America’s water resources consistent with the law of the land while empowering American farmers, landowners, entrepreneurs, and families to help Power the Great American Comeback.” 

A win for industry to ‘unleash American power’

EPA admin Lee Zeldin confirmation hearing Jan 2025 forever chemicals
Lee Zeldin, EPA administrator under president Trump, positioned the EPA’s mission as focused on lowering energy costs and unburdening industry from regulations.

The fossil fuel, chemical, and vehicle industries have lobbied for these rollbacks since the first Trump administration, arguing that regulations stifle growth.

The EPA said it would obtain input from stakeholders “sidelined” during the Biden administration, such as ranchers, developers, and larger industry. 

“While accomplishing EPA’s core mission of protecting the environment, the agency is committed to fulfilling President Trump’s promise to unleash American energy, lower cost of living for Americans, revitalize the American auto industry, restore the rule of law, and give power back to states to make their own decisions,” the agency said in a statement.

Though the EPA’s efforts appear to combat the rising costs of energy for US households, analysts expect the costs to increase nonetheless as Trump’s tariff wars escalate. Oil production in the US’s vast energy sector relies on metal now tariffed from Canada and Mexico, according to industry experts. 

Furthermore, the EPA’s plans are likely to be challenged in court. “In the face of overwhelming science, it’s impossible to think that the EPA could develop a contradictory finding that would stand up in court,” said David Doniger, a climate expert at the Natural Resources Defense Council, an environmental group.

Responding to criticism that the EPA would leave the environment vulnerable to degradation, Zeldin wrote in a WSJ opinion “[n]othing could be further from the truth. Under the Trump administration, the EPA’s core mission remains safeguarding human health and the environment. The difference lies in how we achieve these goals—through partnership rather than prescriptive bureaucracy, through collaboration rather than regulation.”

But critics say rolling back decades of regulation undermines the US’s position as an environmental health protection leader. “We are sacrificing our ability to lead the world in developing common sense solutions,” said Goldman. 

Last updated 17 March.

Image Credits: AP/Sierra Club, Janusz Walczak/ Unsplash, EPA, Janusz Walczak, Face the Nation.

pandemic
USAID assisted health workers in Guatemala to maintain antenatal services and social support for pregnant women during COVID-19.

The list of United States Agency for International Development (USAID) projects that the Trump administration has cancelled runs to 368 pages and provides a rare glimpse of the extent of the US international influence.

READ HERE: USAID Terminated Awards (6 March 2025)

Projects vary from huge infrastructure support programmes (14 to unspecified countries worth $800 million each) to a $10 million investment in developing insect-resistant eggplants.

They range from supporting famine early warning system networks (three projects worth $900 million each) to establishing an American Chamber of Commerce in Belarus. Almost every country is affected – from Albania to Zambia.

A huge $520 million ‘Prosper Africa’ programme to foster trade between the US and Africa has been terminated, and so too have programmes to improve the soybean yield in sub-Saharan Africa and to assist African health ministries to deal with infectious diseases.

There are some surprises. Venezuela received a few grants, including one to secure its agricultural sector. Although the communist government of Venezuela is a sworn enemy of the US, it was no doubt prudent for the US to try to support the country to stem the tide of immigrants.

Grants were also made to Iraq and Syria for “technical assistance to repatriate families” and to assist with child immunisation despite the rancour between the US and those countries.

Grants for “humanitarian assistance for persecuted people in Cuba” and to promote “religious and ethnic freedom” in Asia were also cancelled.

Numerous projects aimed at bolstering food security, and combatting malaria, tuberculosis and HIV were also canned. 

So too were projects to combat corruption and cybercrime. The door is wide open for new donors – and criminals – to take advantage of the resource vacuum. 

HIV sector warns of millions of deaths

Earlier this week, over 530 HIV doctors, researchers, scientists, and public health experts gathered at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco wrote to Rubio calling for “an urgent reversal of recent decisions by the Trump administration that are doing catastrophic harm to the global and US response to the AIDS pandemic”.

The signatories wrote that the termination of projects on 26 February – “virtually eliminated” all US President’s Emergency Plan for AIDS Relief (PEPFAR) programming implemented by USAID, and US-supported malaria and tuberculosis programmes – will “result in millions of preventable deaths around the world while decimating global progress over the last 25 years”.

They also expressed alarm at the defunding of clinical trials that have “stranded study participants without clinical support” and the stripping of scientific institutions of staff and funding.

“Over time, these policy decisions may be proven illegal in US courts but the human suffering and loss of lives happening now cannot be reversed by any court order,” they note.

Meanwhile, the US State Department has refused to comment on reports that over 700 diplomats have signed a letter addressed to US Secretary of State Marco Rubio condemning the cuts for endangering US security.

An extract of the letter, said to have been filed on a staff channel that allows anonymous contributions, says: “The decision to freeze and terminate foreign aid contracts and assistance awards without any meaningful review jeopardizes our partnerships with key allies, erodes trust, and creates openings for adversaries to expand their influence.”

An online group to track job losses from USAID closures, USAID Stop Work, estimates that over 50,000 US citizens and 100,000 global workers have lost their jobs. It has been able to confirm 14,762 US jobs and 64,910 global jobs lost so far.

Image Credits: MSH.

Marburg containment
Health workers contain the highly fatal Marburg virus during an outbreak.

Tanzania has extinguished a deadly outbreak of Marburg virus, but elsewhere across Africa, an alarming surge of health crises continue to unfold – including expanding mpox infections in Uganda, a cholera outbreak in Angola and a first-ever cholera case in neighbouring Namibia.

The Marburg virus outbreak in Tanzania has officially ended, Tanzanian health authorities declared Thursday, marking a pivotal achievement in the continent’s ongoing battle against highly lethal infectious diseases. The success reflects the effectiveness of the coordinated international health response, said Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC), commending the Tanzanian government’s swift and decisive action at a press briefing on Thursday.

Infamous for its haemorrhagic fever, Marburg virus kills up to 88% of those infected, posing a significant threat after it rapidly spread across Tanzania. The outbreak, declared on 20 January 2025, resulted in 10 fatalities –  eight probable and two laboratory-confirmed cases. Tanzanian authorities implemented containment measures, with substantial technical and logistical assistance from the World Health Organization (WHO) and Africa CDC, including disease surveillance enhancements and extensive frontline health worker training.

WHO’s Regional Office for Africa confirmed that the outbreak officially ended after 42 days had passed without new cases, meeting the criteria to declare an outbreak over; it commended Tanzanian authorities for prompt action in squashing the outbreak. 

WHO, Africa CDC cooperation to quell Marburg

This marks Tanzania’s second successful containment of Marburg, following an outbreak in the same northeastern Kagera region in 2023. In this year’s outbreak, WHO said it collaborated with Tanzanian health authorities to scale up surveillance and response activities, training over 1,000 frontline health workers in contact tracing, clinical management, and risk communication, and delivering over five tonnes of essential medical supplies.

Dr Jean Kaseya, Africa CDC Director General, commended Tanzania’s swift response.

“While the outbreak has been declared over, we remain vigilant to respond swiftly if any cases are detected and are supporting ongoing efforts to provide psychosocial care to families affected by the outbreak,” said Charles Sagoe-Moses, WHO Representative in Tanzania.

Kaseya also emphasized Africa CDC’s supportive role, including substantial assistance in laboratory reinforcement, provision of diagnostic kits capable of thousands of tests, and extensive healthcare worker training programs. These interventions enabled rapid case identification, isolation, and treatment – crucially preventing the virus’s broader spread.

Persistent health emergencies across Africa

A new and more deadly variant of Mpox continues to threaten 16 countries.

But even as Tanzania celebrates its victory over Marburg, outbreaks of mpox, Ebola, cholera, and COVID-19 are placing immense pressure on healthcare systems across Africa, revealing systemic weaknesses and vulnerabilities, Kaseya emphasized.

Uganda continues to face a troubling escalation of mpox – even though although recent weeks have seen no new cases of the even more deadly Ebola virus. Uganda’s mpox epicenter is in the country’s south-central region around the capital Kampala area.  And nearby, on the shores of Lake Victoria, the overwhelmed Entebbe treatment center has seen most of Uganda’s mpox-related fatalities. Kaseya emphasized the urgent need for expanded isolation facilities, increased healthcare staffing, and strategies for home-based patient care to manage mild cases effectively.

Meanwhile, the Democratic Republic of Congo (DRC) presents its own complex scenario, further complicated by continuing violence and instability in the North and South Kivu regions of Eastern DRC, where Rwanda-supported M-23 militia have made big inroads against government forces. Over 600 mpox patients fled treatment centers in the regional capital of Goma, Bukavu and other areas that were overrun by rebel forces, creating significant challenges in tracking and managing the disease. There are intensified efforts to establish humanitarian corridors, involving community health workers tasked with locating and reintegrating affected individuals into the health system. However, until a cease-fire is reached, insecurity will likely hamper those efforts, Kaseya said. 

Funding shortfalls threaten containment efforts

Cholera Namibia 2025
Namibia reported its first cholera case in over a decade, highlighting vulnerabilities in the continent’s health infrastructure.

Kaseya also revealed that funding shortages present a severe obstacle. Dramatic cuts to international aid, notably from traditional donors such as the United States and the United Kingdom, have only exacerbated the situation. These reductions, he said, significantly affect Africa’s capacity to manage public health crises effectively, creating urgent shortfalls in vital resources needed for outbreak response and containment efforts.

“Mpox remains a serious concern,” Kaseya warned. “We are facing a critical risk. Without sufficient vaccines, we will inevitably see more cases.”

The financial strain extends beyond mpox. Angola now faces an ongoing cholera outbreak, for which Africa CDC is providing emergency support, delivering 2,000 doses of oral cholera vaccines. Primarily affecting children, the cholera crisis in Angola highlights continued regional challenges in water and sanitation infrastructure. And neighbouring, Namibia recently reported its first cholera case in nearly a decade within a community near the Angola border – underscoring the interconnected fragility of public health systems across the region.

Seeking sustainable solutions

Amid these pressing challenges, Kaseya articulated Africa CDC’s commitment to fostering innovative and sustainable financing solutions. At the forthcoming World Bank and IMF spring meetings, African health and finance officials will participate in discussions with multilateral development agencies about how they can enhance national resilience and promote self-reliance in managing public health threats. Emphasizing the importance of national ownership, sustainable funding mechanisms, and strengthening local manufacturing capabilities, Kaseya advocated for sustained international engagement and solidarity.

“Health security in Africa is global health security,” Kaseya reiterated.

Image Credits: WHO, Africa CDC, Africa CDC.

Switching from biomass to LPG for cooking, reduced exposures to air pollution, but didn’t lead to measurably significant health gains, a four-country study found.

A four-year, multi-country trial measuring health impacts of reduced indoor air pollution due to the shifting of households from biomass to Liquefied Petroleum Gas (LPG) has yielded  mixed results – defying expectations that reduced indoor air pollution would yield significant health benefits.

The study of 3,200 households in four Asian, African and Latin America countries showed that while the exposure to indoor smoke fell, the expected health gains did not follow.

Despite improvements in air quality so that two-thirds of the households met WHO’s Interim Target 1 for household air pollution, the incidence of severe pneumonia among infants up to one-year “did not differ significantly” when compared to infants in those households that continued to use biomass, investigators with the Household Air Pollution Intervention Network (HAPIN), found.

Nor did the birthweight of newborns rise significantly or incidence  of stunting at 12 months decline – two other early childhood health impacts associated with poor household air quality.

WHO Interim Targets 1 (35 µg/m3) and 2 (25 µg/m3) offer milestones for countries aiming to reduce high household air pollution levels, on the way to the recommended guideline level of 5 µg/m3 of PM2.5.

WHO has set several interim targets to guide countries as they aim to reduce their air pollution levels.

“Everybody kind of expected on the basis of observational studies that now we’re going to see some health benefits from this, even though, you know, a few other experimental studies were saying, well, we’re not seeing it,” Thomas Clasen, the trial’s principal investigator told Health Policy Watch. “So, people are really scratching their heads.” He is an epidemiologist and professor at Emory University.

This also raises a core policy question: should countries push ahead with fossil fuel-heavy LPG or should they instead leapfrog to electric cooking powered by renewable energy like solar?

The HAPIN trial was launched in 2017 and followed 800 pregnant women, 120 older adult women, and 800 infants in poor communities dependent on solid fuels across Guatemala, India, Peru, and Rwanda. One half of the 3200 households were provided access to LPG for 18 months and results were monitored. The trial was funded by the National Institutes of Health (NIH) and the Gates Foundation, among others.

A woman in Guatemala cooks on an LPG stove that she received for free through the HAPIN study.

Mix of positive and negative results

The results showed a mix of positive and negative outcomes.

“Intervention households used LPG exclusively 99.99% of the time,” said Kalpana Balakrishnan of Sri Ramachandra Institute of Higher Education and Research who led the India-leg of the trial. “That answered the question that if you remove the economic barrier, households are willing and able to use a clean energy source, i.e LPG exclusively,” she said.

Average air pollution concentrations in two-thirds of the LPG households declined by half or more – less than 35 µg/m3 (micrograms per cubic meter), Clasen said. The control group that did not use LPG had household air pollution hovering around 70 µg/m3.

“All the health improvements that we expected to see in the intervention compared to the control we did not see,” Balakrishnan told HPW.

Muddying the debate over fuel switching

The World Health Organization (WHO) has also avidly promoted LPG as a clean cooking fuel alternative – despite its climate impacts as a fossil fuel, derived from oil and gas production. These trial results now muddy the debate over whether LPG is still the best option as an “interim” clean fuel choice – or whether countries would be better off promoting electric cooking and heating options, which could reduce indoor emissions even more if they were powered by renewables – and not oil or coal generation.

WHO, for its part, says that the issue will surely be a hot topic of discussion at a major upcoming meeting on air pollution – the Second Global Conference on Air Quality and Health, scheduled for 25-29 March in Cartagena, Colombia.

“WHO is currently reviewing the results from the HAPIN trial and will integrate such evidence in the guidance and support we provide to countries to protect health from household air pollution,” Heather Adair-Rohani who leads the work on air quality, energy and health at WHO headquarters in Geneva told Health Policy Watch in an email response.

“How best to use the results of HAPIN and other key studies to inform decision-making on household energy will be key topic at the upcoming second WHO global conference on air pollution, where WHO, in cooperation with the government of Colombia is calling on countries, cities and organizations to work together to cut the health impacts from air pollution in half by 2040,” she added.

The curious case of lack of health gains despite reduced air pollution 

WHO estimates that around 2.1 billion people worldwide cook on open fires or inefficient stoves that use either kerosene, biomass or coal. Household air pollution was linked to 3.2 million deaths per year in 2020.

And while poor air quality is linked to worsening health, improving air quality in the HAPIN trial did not translate to improved health gains.

A majority of the world’s population still without access to clean cooking energy is in the developing world.

The researchers have one key hypothesis as to why.

“In a community where you have multi-dimensional poverty, if you give a clean fuel intervention for a short time, you may not be in a position to pick up the health benefits that result from it,” Balakrishnan said.

“What you need is to follow them up for a much longer period of time where they continue to use LPG,” she added.

Balakrishnan continued, “The way we have to approach this, … in these poor households, you need a package of interventions to achieve improvement in health.”

Clasen too agreed, “We have to say, well, maybe this isn’t going to be enough by itself to achieve the benefits, the health benefits that you were after.”

Households with the biggest declines in air pollution did see some benefits

One other striking factor is that a small set of households with the biggest concentrations of air pollution before the trial, and thus the biggest declines in pollution from the shift to LPG  – did experience more measurable health impacts.

That could suggest that reductions in air pollution that are larger and more dramatic in order yield more measurable health impacts, at least short term.

“When we look at the folks who had the biggest reductions in exposure, it does look like they’ve benefited…at least reductions in PM, 2.5 and black carbon,” Clasen said.

However, at the lower end of the household air pollution scale, the precise relationship between pollution declines and improvement in health benefits – the so-called “dose-response curve” are not yet well defined, Clasen added

“We do not have well-populated dose-response curves for HAP and [health] outcomes,” he said. “So we cannot rule out health benefits that might have been gained at very low levels of exposure.”

But practically speaking, it’s going to be very difficult to push household concentrations further down in many low-income settings when other environmental and cultural factors such as high rates of smoking, as well as high levels of outdoor air pollution also come into play, he added.

“It’s unlikely that any programmatically delivered HAP intervention is going to achieve lower levels of exposure than what we achieved here, when we had the benefit of free stoves and fuel – and thus nearly exclusive LPG adoption. So from a practical standpoint, we are not likely to improve these health endpoints by getting householders to lower levels of exposure than what we achieved in the trial.”

What do these results mean for policy?

Regardless of the mixed outcomes, Clasen stressed that the results should not be read as a signal to put brakes on transitioning to LPG in developing countries.

LPG is significantly better for climate when compared to biomass because of its lower greenhouse gas emissions.

Even if switching to LPG does not lead to expected health gains in the short run, it still is a significantly efficient fuel. It also lowers greenhouse gas emissions compared to biomass and thus has climate benefits apart from reducing the drudgery involved for women.

LPG’s positive impact on women

“When you’re cooking over a chulha (earthen stove), the drudgery from collecting the firewood or the coal or the gobar (cowdung) to prepare the chulha versus cooking on an LPG…the time it takes…there’s also an opportunity loss because of the time that’s lost in cooking and working around it,” said Neha Saigal, Director of the Gender and Climate Change programme with India-based Asar Social Impact Advisors. Women in the communities Asar works with expressed willingness to use LPG when it was an affordable option.

Cooking on a traditional stove using biomass or coal also directly exposes women to even higher levels of air pollution than might be measured as ambient indoor levels, Saigal said. So shifting may have other health benefits that weren’t captured yet by the HAPIN trial.

An Indian woman cooks with an LPG stove that she received as a participant in the HAPIN study.

Beyond LPG: Staring at limited options

LPG is increasingly affordable and accessible in many developing countries. India, the world’s most populous country, has made tremendous gains in improving LPG access among poor and rural communities though gaps remain. Around 99.8% households in the country now have access to LPG for cooking, according to government data from the year 2021.

And while LPG is a fossil fuel, it is significantly cleaner than biomass. Alternatives to LPG are either not efficient enough for everyday and reliable use, like solar, or require reliable electricity.

Clasen has two reservations about promoting electricity for household cooking in developing countries right now. “One is, is electricity going to do any better than LPG? Right, number two is that [the] electricity is usually generated using fossil fuels, so we may not actually be reducing the climate load by transitioning to electricity unless we also can figure out how to do it renewably,” he said.

Other experts said the quest for better solutions should nonetheless continue.

“I don’t see any other solution at this point of time, at scale other than LPG. But yes, there’s a lot of scope to demonstrate, to pilot with electric cooking, to come up with better chulhas that don’t give out smoke…solar cook stoves,” Saigal of Asar said. “But if we want to support women at the moment, we should make LPG available to them, because that is the thing that’s available now in the market,” she added.

Balakrishnan also raises an ethical question – the poor should not bear the burden of waiting to transition to electric cooking when it is not the norm in urban and well off households. Given that LPG is a viable near-term clean energy choice, the poor too should have access to it right away, she said.

Continuing long-term research will yield more answers 

For now, the HAPIN trial continues to follow children in three locations – Guatemala, India and Rwanda – until they reach the age of five. They want to see if delivering their mothers LPG access for 18 months has had any long-term health benefits that might become clear only later, like neurocognitive development or development of a child’s mental abilities.

“It could be quite compelling from a policymaker standpoint,” Clasen said.

Image Credits: WHO/Adobe Stock/Dennis Wegewijs, WHO, Guatemala HAPIN team, T20 Policy Brief, July 2023, India HAPIN team.

Power outages are common in Kashmiri hospital, particularly in winter.

BARAMULLA, India – The biting cold seeped through the cracks of the health facility in Tangmarg in northern Kashmir as 23-year-old Madiha* wrapped her shawl tighter around her shoulders. She had barely stepped inside when the lights flickered—and then went out.

A tense silence fell over the dimly lit corridor before the deep, guttural roar of the backup diesel generator filled the air. Thick, acrid smoke curled into the room, stinging her nose and leaving a metallic taste on her tongue. Patients huddled together, their breath visible in the freezing air, while nurses rushed around under the weak glow of emergency lights.

Madiha’s experience is an everyday crisis for health facilities across Kashmir, in India’s northernmost region. Kashmir is administered by India as a union territory after being the subject of a dispute with Pakistan in 1947.

Across the region, hospitals battle chronic electricity shortages that have increased reliance on polluting diesel generators that spew toxic emissions into already pollution-choked air. Poor waste management in rural hospitals compounds problems.

These systemic failures, which get worsen every winter, not only cripple healthcare services but also fuel respiratory illnesses and waterborne diseases, turning hospitals from places of healing into sources of environmental and public health hazards.

Climate change reduces hydropower 

“We rely on diesel generators, but they often fail,” said a doctor who asked not to be named, at a hospital in Baramulla where daily power cuts often stretch beyond five hours, leaving critical patients in distress.

“For patients with respiratory illnesses, the fumes and the lack of consistent oxygen supply make it unbearable.”

Some 112 Primary Health Centers (PHCs) and 710 sub-centers across the territory of Jammu and Kashmir (J&K) operate without electricity, according to official data. 

But the situation on the ground is far worse, according to residents who report frequent and prolonged blackouts that force hospitals to depend on diesel generators. 

J&K’s electricity derives from hydropower, and a combination of climate change and neglect has reduced the region’s supply – particularly in winter where lower rainfall, drier conditions and glaciers freezing dramatically reduce water levels in rivers.

During the winter of 2024, hydropower generation plummeted by 65% to a mere 250 MW – a stark decline from the region’s capacity of 1,140 MW. The shortfall left hospitals scrambling to keep the lights on, often at the cost of public health.

“We have endured power outages lasting up to eight hours. This is particularly dangerous for healthcare,” said policy expert Abrar Dar, speaking to Health Policy Watch in Srinagar. “Generators have a load limit, and exceeding that capacity can disrupt critical medical services.”

Dar also pointed out the stark disparity in electricity access across India. “I often stay in Delhi, where 24/7 power is a given. Why don’t we have the same in Jammu and Kashmir?”

Despite spending ₹55,254 crore (over $6,3 million) on power purchases over the last decade, the region continues to face chronic shortages. 

While only 3.8% of healthcare facilities in India lack electricity, the number is 10.7% in Kashmir, highlighting central government neglect and the region’s severe healthcare infrastructure crisis.

Kashmir sells hydropower 

For rural Kashmiris, power shortages are a harsh, generational reality. Ishtiyaq Wani, 64, has lived with it his entire life.

“For 60 years, I’ve heard on the radio how fast the world is moving,” Wani said. “Decades ago, I heard about people going to the moon, yet despite Kashmir having its own hydropower projects, we still have to beg for electricity.”

Kashmir’s 13 hydropower projects have generated 48,808 million units (MU) of energy over the last decade. But during the bleak winter months, the regional power utility, Jammu and Kashmir State Power Development Corporation (JKSPDC), is forced to buy electricity from private companies.

It has been unable to recoup these costs from consumers so JKSPDC is forced to sell up to half the electricity it generates in the summer to private companies to recover its winter costs.

“J&K has vast hydropower potential, but most of our electricity is sent to the national grid or sold to other states,” explained social activist Muhjeeb Wani from Budgam. 

The central government’s refusal to fund three major hydropower projects – Kiru, Ratle, and Kwar – in the 2025-26 financial year has further delayed much-needed infrastructure.

Diesel generators worsen air pollution

A hospital generator in Kashmir

Diesel generators, used as a lifeline during blackouts, are also major contributor to air pollution including black carbon, further endangering public health.

“Thousands die each year from pollution, yet despite having our own hydropower projects, we continue to suffer from electricity shortages,” said Mukhtar*, a 24-year-old from North Kashmir, frustration evident in his voice. “Hospitals, which are supposed to heal people, are instead worsening the climate crisis.”

According to the World Health Organization, air pollution-related death rates in India are approximately 140 per 100,000 people. Reports suggest that 10,000 people die each year in J&K due to PM2.5 exposure.

Beyond electricity shortages, improper medical waste disposal poses another health hazard. Many rural hospitals dump hazardous biomedical waste in open areas, contaminating drinking water and farmland.

“Hospital waste is thrown into streams, and we’re forced to drink polluted water,” said Mukhtar.

A 2019–2020 Jammu and Kashmir government report found that only 35.6% of the 1,518.91 metric tons of solid waste generated daily was treated. Although this figure improved to 63.1% by 2020–21, over 500 tons of garbage remain untreated every day. 

Last September and October, Kashmir reported over 130 cases of Hepatitis, highlighting a growing public health crisis. 

“Water pollution has multiple causes, but hospital waste should never be dumped in open areas,” Dr Shazaib Mir told Health Policy Watch. “It must be safely disposed of, or incinerated. Waterborne diseases claim millions of lives every year.”

In a 2017 study of 500 households in North Kashmir, a third of the 3,185 individuals surveyed suffered from waterborne diseases, including diarrhea, Hepatitis A and gastrointestinal infections. 

“These illnesses are only part of the struggle,” says Mukhtar. “In winter, Kashmir’s crumbling healthcare system collides with another deadly reality—impassable roads.”

In winter, healthcare is a challenge

On paper, J&K has a network of government-run hospitals and health centers. But in reality, harsh winters between November and February turn medical emergencies into life-or-death struggles.

“If an emergency strikes in winter, we have no choice but to carry the patient on our shoulders, walking for eight kilometers,” says Nasreena*, a heart patient from Nilsar, a remote town in Kashmir.

“We locals have somehow adapted to these challenges, but what if a tourist has a medical emergency? What will they do?” 

A record 2.95 million tourists visited J&K in 2024. In critical cases, patients have to walk over eight kilometers for proper care, which can turn fatal in sub-zero temperatures.

On 10 March, a helicopter landed in Tulail, a snowbound village, to rescue 27 stranded passengers including a pregnant woman in urgent need of medical attention. But such interventions are rare.

For most Kashmiris, winter isolation means making treacherous journeys on foot, often with tragic consequences. In Baramulla, 54-year-old Mumtaza* suffered a heart attack one freezing night. With no ambulance and no accessible roads, her family carried her for six kilometers through knee-deep snow. By the time they reached the hospital, she had passed away.

“My aunt could have survived if help had reached us,” says her niece, Mehnaaz*. “Instead, we walked for hours, and she died on the way.”

Official data states that 11.5% of healthcare facilities in Jammu and Kashmir remain inaccessible by all-weather roads, but locals insist the reality is far worse. Without urgent investment in road infrastructure and emergency transport, more lives will continue to be lost—not just to illness, but to the sheer inability to reach medical care in time.

Patients crowd a pharmacy in Kashmir to buy medicine.

Starved of investment

At the heart of Kashmir’s healthcare crisis is a severe lack of investment in infrastructure. While India has steadily increased healthcare spending in other regions in recent years, development in Jammu & Kashmir continues to lag, with underfunded hospitals, poor road networks, and an unreliable electricity supply exacerbating the situation.

According to the National Health Profile 2023, India spends only 2.5% of its GDP on healthcare, one of the lowest rates of major economies 

This chronic underfunding is reflected in the state of health infrastructure, where rural health facilities lack electricity, medical equipment, and essential drugs. 

The situation is worse in J&K, where there was a slight dip in the health budget allocation for 2024-25, according to the Jammu and Kashmir Economic Survey (from ₹8,362.28 crore in 2023-24 to ₹8,333.45 crore).

The healthcare sector’s struggles are also reflected in the shortage of health workers. J&K faced a shortfall of 700 doctors and specialists at Primary Health Centers (PHCs) and Community Health Centers (CHCs) in 2022-23, according to a health ministry report. In many remote areas, a single doctor is responsible for thousands of patients, making access to timely medical care nearly impossible.

For Kashmiris, these systemic failures translate into daily struggles – from mothers giving birth in candle-lit rooms to elderly patients gasping for air in smoke-filled wards, and families carrying their sick along snowbound mountain trails. 

Experts warn that without a significant increase in healthcare investment, improved road connectivity, and a reliable power supply, thousands more will continue to bear the brunt of a broken system – year after year.

*Some patients asked not to be identified by their full names.

Image Credits: Arsalan Bukhari.

USAID
USAID staff offload emergency supplies.

Secretary of State Marco Rubio announced that 83% of US international aid programs were “canceled” hours before a federal district judge ruled that the administration’s actions were an overreach of the Executive branch’s power. At risk are thousands of lifesaving humanitarian programs.

In a refugee camp in Bangladesh, 500,000 Rohynga children depend on food treatment aid for their survival. One-year-old Mariam recovered from severe malnutrition after treatment in a UNICEF camp, but now her mother fears the clinic would shutter. 

“If you stop providing us with this therapeutic food, my child could die,” she told UNICEF.  

Thousands of US Agency for International Development (USAID) contracts have been terminated, after Secretary of State Marco Rubio signaled that the six-week review of the aid agency is “officially” complete. The remaining programs overseen by the six-decade-old USAID will now be part of the State Department, Rubio said.

Late Monday, a federal district judge said that the Trump administration’s halt of foreign assistance overstepped the Executive branch’s authority. The judge ordered the administration to pay USAID partners for work already completed before 13 February, but stopped short of restoring the more than 10,000 contracts the administration has canceled.

Separation of powers

A vaccination site in South Africa co-sponsored by USAID.

The judge ruled that the administration could not withhold the billions of dollars Congress had already approved for foreign aid, saying the president does not have “unbounded power” in foreign affairs. 

“The Executive not only claims his constitutional authority to determine how to spend appropriated funds, but usurps Congress’s exclusive authority to dictate whether the funds should be spent in the first place,” Washington DC district’s Judge Amir Ali said.

Ali ruled in his preliminary injunction late Monday that Trump could not ignore the $60 billion Congress already allocated for foreign assistance to USAID. Congress alone has the power to allocate funding under the US Constitution. 

“The constitutional power over whether to spend foreign aid is not the President’s own — and it is Congress’s own,” said Ali. In response to a suit filed by the AIDS Vaccine Advocacy Coalition (AVAC), the Journalism Development Network, and the Global Health Council, Ali ordered the administration to pay aid groups the money owed for work completed up to 13 February, at a pace of at least 300 back payments a day. 

But he declined to restore contracts the administration canceled, saying it was up to the Trump administration to decide which organizations could win contracts. 

Ali’s ruling came after the Supreme Court cleared the way for a lower court to rule on the aid freeze.

Trump ‘is not king’

“Today’s decision affirms a basic principle of our Constitution: the president is not a king,” said Lauren Bateman, an attorney with Public Citizen Litigation Group and lead counsel representing the two organizations filing suit, in a statement.

“But we are painfully aware that, without unwinding the mass termination of foreign assistance awards, winning on the constitutional issues does not avert the humanitarian disaster caused by the Trump administration’s freeze on foreign assistance. And it does not undo the damage that the freeze has already inflicted on millions of vulnerable people across the world. Deaths will continue to mount.

“While the courts have an important role to play in standing up for the rule of law, Americans need more than just the courts. We need Congress, which has always supported foreign aid on a bipartisan basis, to assert itself.”

Whether Congress will act is yet to be seen, especially as the deadline to fund the federal government  looms. The House passed a procedural measure for its funding bill Tuesday along party lines, which critics say is a “blank check” for the Trump administration’s agenda.  

Republican members of congress have voiced support for a narrower definition of US’s involvement in foreign development programs, and support Elon Musk’s Department of Government Efficiency’s (DOGE) efforts to cut back the federal government. 

Earlier in February, the House Foreign Affairs Committee held a hearing titled “the USAID Betrayal,” where chair Brian Mast (R-FL) argued that USAID programs “hurt America’s standing around the globe, and I think the fact is clear that America would have been better off if your money had been simply thrown into a fireplace.”

‘Reform’ completed 

Rubio’s declaration that thousands of aid contracts were “officially” canceled came after the Trump administration’s six-week battle to gut USAID, calling the move an “overdue and historic reform.” His post was one of the few public comments on the swift dismantling of US policy of soft power and aid in developing countries.

“The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” said Rubio on X.

He said the remaining 1,000 contracts would be administered directly by the State Department. 

The Trump administration has made misleading claims that millions of taxpayer dollars were being used for diversity, equity, and inclusion (DEI) initiatives. Funding for many of these activities came through the State Department not USAID, at the request of embassies, according to independent fact checkers.

“It’s been run by a bunch of radical lunatics,” Trump said last month. “And we’re going to get them out.” But the dismantling of USAID has meant a freeze on malaria, HIV, and tuberculosis aid, which combined protect millions of people in Africa, Latin America, and Southeast Asia from the leading infectious diseases. 

“Under President Trump, the waste, fraud, and abuse ENDS NOW,” the White House said in a February statement.

Humanitarian groups offer dire warnings 

unicef rohingya usaid malnutrition
UNICEF personnel measure a Rohingya child’s arm for signs of malnutrition.

Mariam and her mother are among thousands of Rohingya refugees at risk of malnutrition in the Cox’s Bazar camp, said Rana Flowers, UNICEF representative in Bangladesh.

“Children in the world’s largest refugee camp are experiencing the worst levels of malnutrition since the massive displacement that occurred in 2017,” she said at a press briefing in Geneva on Tuesday.

Other UN organizations echoed her warning that cuts to humanitarian aid would result in further devastation.

The UN Commmision on Human Rights (UNCHR) has already shut down a US-funded program that worked with torture victims and families of disappeared persons. The US represented more than 40% of UNHCR’s budget in Colombia, meaning the agency’s work of “resolving” and “pre-empting” crises is threatened, said Ravina Shamdasani, UNCHR Chief Spokesperson at the Geneva press conference.

The agency received USAID suspension letters for all projects in Equatorial Guinea, Iraq and Ukraine, as well as Bangladesh, Colombia, Ethiopia and Peru.

‘No replacement’ for USAID

Rana Flowers, UNICEF representative in Bangladesh, speaking about the 500,000 children living in the world’s largest refugee camp.

Although the US granted a waiver for UNICEF’s work to prevent malnutrition in refugee camps, there is no guarantee that the agency will be able to continue using the therapeutic food to treat and cure sick children with acute malnutrition.

Flowers noted that the agency needs both the waiver and actual funding to continue the work. Funding for malnutrition treatments runs out in June. Unless additional funding is secured, only half of refugee Rohingya children will have access to treatment this year, Flowers warned. 

Without access to treatment, up to 7,000 children are at risk of severe malnutrition. UNICEF expects an increase in morbidity and mortality in these camps. 

“There’s no replacement for the valuable partnership with the United States,” said Flowers.

“Until now, this community has survived thanks to the solidarity of the international humanitarian community,” she said. “But today, an aid funding crisis risks becoming a child survival crisis.” 

Additional reporting by Elaine Fletcher.

Image Credits: USAID Press Office, USAID, UNICEF/Njiokiktjien.

Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund,
Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund,

“The poison of patriarchy is back and is back with a vengeance,” United Nations (UN) Secretary-General António Guterres told the opening of the annual session of the Commission on the Status of Women (CSW) at the UN in New York on Monday.

The CSW takes place amid a major global backlash against women’s rights, from the Taliban banning Afghan women from public life to the Trump administration in the United States pushing back against “diversity, equity and inclusion” (DEI) which has resulted in cuts to research on women’s health. 

“Misogyny is on the rise, and so, violence and discrimination,” said Sima Bahous, who heads UN Women, noting that “domestic and ODA [official development assistance] allocations to gender equality remain woefully inadequate and, in some cases, are being cut altogether”. 

Declaration passed despite US, Russian objections

The CSW’s political declaration was adopted by consensus on Monday. And despite earlier reports that the US and Russia had tried to purge a clause that encouraged member states from nominating women candidates for the UN Secretary-General position and  President of the General Assembly, that clause survived.

So did commitments to “gender equality and the empowerment of all women and girls”, and the “accelerated implementation” of the Beijing Declaration and Platform for Action, the first global roadmap for gender equality that was adopted 30 years ago.

Bahous also commended the 159 member states that have affirmed their support for the Beijing Declaration in national reports.

Despite the backlash, there has also been progress in the past 30 years, she noted: “Today, more girls are in school. More women are in parliaments, in boardrooms, in the judiciary. Maternal mortality has fallen. Legal barriers have been dismantled. Policies to protect and advance women’s rights are advancing. Violence against women and girls is widely recognized as a global scourge.” 

‘Calculated cut’ to funds

Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, told the opening plenary that “the decision by several governments and philanthropic actors to cut funding for gender equality in the past few years is a calculated blow to women’s access to education, healthcare, economic independence, political participation and bodily autonomy”. 

“The recent funding cuts by just two governments and two private philanthropic donors to women’s rights organisations were recently estimated to around $730 million per year,” she added.

“We must immediately commit to protecting protecting gender equality for all, not with words but with resources,” Moudouthe stressed.

Bahous declared that: “We, the champions of gender equality, are not afraid of the pushback. We have faced it before. We have not backed down. And we will not back down.”

The proportion of women killed in wars had doubled over the past year alone, added Bahous, pointing to women’s and girls’ rights being “systematically stripping away” by climate change and conflicts in Afghanistan, the Democratic Republic of Congo (DRC), Palestine, Gaza, Haiti, Myanmar, Sudan and Ukraine.

Call for sanctions on Taliban

Meanwhile, at the UN Security Council meeting happening at the same time, Afghan lawyer Azadah Raz Mohammad urged the body to impose sanctions on all Taliban leaders who have committed human rights violations against Afghan women and girls, and not to lift sanctions, including travel bans, on those who are guilty of such crimes.  

“If the people of Afghanistan had been able to hold the Taliban accountable in 2001 and earlier, perhaps we would not have witnessed the Taliban’s violent return to power 20 years later,” Mohammad said, concluding: “If impunity is the disease, accountability is the antidote.”  

She also urged all member states to assist the International Criminal Court to pursue charges against all senior Taliban leaders who have committed acts of “gender persecution and other crimes against humanity, and war crimes” in Afghanistan since 2003.