Updated February 28, 2025 at 09:01 AM ET
Makele Hailu is afraid of the future.
"We don't even want to open our eyes to see the disaster that's coming," he says.
For 30 years, Hailu has worked with HIV-positive children in a war-torn part of Ethiopia. He's a program manager at the Organization for Social Services, Health and Development — an Ethiopian nonprofit that used to get 70% of its funding from the US.
One of the most critical parts of his job is helping 1,600 children and adolescents get the daily medications they need to keep the virus in check.
A freeze, then a termination
A month ago, his work screeched to a halt as President Trump froze almost all foreign aid for a 90-day review. That meant his young clients could not get their drugs, Hailu says. On the news, he heard that "life saving humanitarian assistance" got waivers. His program applied but it never came. And funding did not resume.
Then, on Thursday morning, when he was still at home he got word that the U.S. Agency for International Development had terminated the program — effective immediately.
"All our hopes are wiped out," he says. "This is just a disaster."
This week the Trump administration killed more than 90% of USAID programs and 28% of foreign assistance from the State Department. In all, that meant terminating nearly 10,000 grants, contracts and awards worth almost $60 billion.
The move sent shockwaves through the aid community and prompted outcries. "It is nihilistically reckless, and it is going to kill a huge number of people," says Jeremy Konyndyk, the president of Refugees International and former head of Foreign Disaster Assistance at USAID during the Obama administration. "It's an extraordinarily terrifying thing that we now have a government that is that callous about human life."
According to a statement from the State Department, these "commonsense eliminations" help "to reform the way the United States delivers foreign assistance" with the goal of aligning with the America First agenda and making "America stronger, safer, and more prosperous."
Advocates for scaling back the U.S. role in global health assistance have argued that low- and middle-income countries have become too reliant on U.S. aid — and the focus of U.S. aid spending should be to help its own citizens.
"It's only fair to Americans if we can prove that $1 is better spent going abroad than staying in the pocket of an American who is, right now, hustling and grinding it out at work," said Rep. Brian Mast, R-Fla, at congressional hearing on USAID earlier this month.
Conflicting claims
The State Department statement sent Wednesday night to NPR said: "USAID retained critical awards, including food assistance; life-saving medical treatments for HIV, TB, and malaria."
However, international organizations and local nonprofits dispute this claim. For example, Martin Edlund, the CEO of Malaria No More, said in a statement the terminations left "critical bilateral malaria assistance on the cutting room floor." The halts will lead to "an exponential increase in deaths …. New modeling shows that a year of disruptions would lead to nearly 15 million additional cases of malaria and 107,000 additional deaths," he said.
In Ethiopia, Hailu says the termination means his program must lay off all 135 staff members — including case workers and social workers. And that he too will be looking for a new job.
These terminations come more than a month after Hailu's team received stop work orders pending the Trump team's review. With no salary and no work since then, Hailu's spent his time in his community in Tigray, Ethiopia. Everywhere he goes all people want to talk about is the sudden end of aid programs, he says. So, he pauses to talk, "listening to their traumas and listening to all the challenges they are facing at the moment," he says.
One woman told him about her nephew. He's 15 and an AIDS orphan, who is HIV-positive himself. Because of the disruptions in aid, his supply of HIV medications ran out a few weeks ago. After watching his parents die from AIDS when he was a boy, the 15-year-old is convinced that will now be his own fate too.
"This child is not going to school because he feels so scared that he will be dying soon," Hailu says.
Local hospitals and clinics have all run out of HIV medication since there was no forewarning or transition plan before aid was cut, says Hailu. And he is not optimistic that the drugs will be restocked. "The government [of Ethiopia] is not capable enough to fill those gaps," he says. According to a report by the Congressional Research Service, Ethiopia was among the top recipients of USAID funding in 2023, receiving more than $1.3 billion in U.S. foreign assistance.
Without HIV medications for his young clients, Hailu worries the virus will come raging back — and medical experts agree. Days to weeks after an HIV-positive person stops taking their medications, they start falling ill not only from AIDS but also from other infections that take advantage of their fragile health.
"Very soon," he says with a sigh. "We will sadly witness the loss of life of many children and adolescents."
His community just went through a brutal civil war — where HIV spiked and drugs and medical care were basically unavailable. He says not having access to medications again feels eerily familiar.
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