How a US freeze has upended global aid

The administration has made clear that it specifically opposes any projects supporting diversity and inclusion, transgender rights, family planning, abortion access and other issues – some of which have been long-targeted by Republican administrations. The freeze, they say, is designed to create an opportunity to root out wasteful spending.

“Every dollar we spend, every program we fund, and every policy we pursue must be justified with the answer to three simple questions,” Mr Rubio has said. “Does it make America safer? Does it make America stronger? Does it make America more prosperous?”

The programmes affected, however, have been vast, triggering widespread shock and criticism in many parts of a global system intertwined with US funding. Aid contractors fearful of losing further funding have mostly been voicing these concerns privately, though some have spoken out.

On Monday evening, staff who work on the US programme countering the global spread of HIV could no longer log into their computer systems, according to Dr. Atul Gawande, former Assistant Administrator for Global Health at USAID, and an expert on the project.

Then-President Bush launched the President’s Emergency Plan for AIDS Relief (Pepfar) in 2003. It now employs more than 250,000 doctors, nurses and other staff across 55 countries distributing anti-viral medication and doing critical preventative work. It is credited with saving millions of lives and suppressing the spread of HIV and Aids.

“The program is shuttered…. Services are shut,” Dr Gawande told the BBC on Tuesday, saying clinics that served 20 million people with HIV were affected.

Paul Jordan, who works at the European Institute of Peace on repatriating foreign citizens from Al-Hol and Al-Roj, said much of his work funded by Washington had stopped immediately.

“In terms of immediate impact I’ve never seen anything as significant as this before,” he told a UK parliamentary committee on Tuesday, adding the camps were set to be “in limbo” for months while the review was carried out.

“What that led to was in the last few days basically nothing being delivered within the camps,” he said. “There was no camp administration, very little security, food wasn’t delivered.”

Later on Tuesday, as aid organisations clamoured for exemptions from the US government to continue programmes, the first signs emerged that the State Department was trying to limit the impact of its sweeping freeze.

The definition of “life-saving humanitarian assistance” allowed to continue was broadened beyond emergency food aid to include “core life-saving medicine”, medical services, food, shelter and other provisions.

That guidance has reportedly seen Pepfar programmes restart, but whether preventative drugs – rather than just HIV treatments – are covered remains unclear.