In Mbuya, a village on a hill at the edge of the city of Kampala in Uganda, a group of patients waited in vain at a local health clinic.
The patients had HIV and were scheduled to receive the antiretroviral drugs required for their condition. But last week the drugs were not available.
Half a world away in Washington DC, a three-month pause had been placed by the new administration of Donald Trump on spending by the mammoth US government’s international aid agency USAID, which employs about 10,000 staff and has a budget of almost €39 billion.
The patients at the clinic in Mbuya were quickly caught in the fallout as they were told they would not be given their antiretroviral drugs. The USAID 90-day funding pause had hit services supported by PEPFAR, the US president’s emergency plan for Aids relief.
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Healthcare staff in the area quickly realised that all around Kampala, patients would not be getting access to the drugs.
At Hospice Africa Uganda (HAU), a facility supported by people in Ireland through the organisation Hospice Africa Ireland, there was concern.
“News filtered through to us that many HIV-positive people were getting phone calls from their clinics saying not to come,” HAU health services co-ordinator Roselight Katusabe told The Irish Times.
“And some clinics told patients that they were closing due to the US announcement. There was panic among patients who faced having their antiretroviral treatment suddenly stopped.
“The drugs are expensive, so options for patients to source them elsewhere are very slim.”
Katusabe said there was relief a few days later when the US introduced a waiver on its funding freeze to allow people to continue to access treatments funded by the US in 55 countries across the world.
“But this is still very uncertain,” said Katusabe. “If HIV patients are forced to discontinue the antiretroviral drugs, it will lead to viral multiplication, infections and the development of cancers. It will make people sicker and palliative care services like ours could become overwhelmed with very ill people.”
The HIV patients in Uganda were not the only people to be affected by developments in Washington.
The New York Times reported that in Zambia, medical supplies to rural villages – including drugs to stop haemorrhages in pregnant women and rehydration salts that treat life-threatening diarrhoea in toddlers – had been suspended as USAID funding for the trucks that transported the products had dried up.
In Dublin there was grave concern – both in Government and among some aid organisations that receive significant sums from USAID – at what was happening in Washington.
Goal, for example, received €103 million in funding from USAID in 2023, according to its accounts. The charity said this “equates to 54 per cent of the total portfolio”. In 2022 USAID provided €113 million to Goal. This US funding supported projects in Haiti, Zimbabwe and Syria.
[ Trump funding threat leaves South Africans with HIV and Aids in limboOpens in new window ]
Goal spent €93 million in Syria in 2023 – its largest international programme. The charity’s accounts said it had been one of the leading humanitarian agencies in northwest Syria since 2012, with about 1,000 local staff in the region.
Siobhán Walsh, chief executive of Goal, said it had secured a number of waivers from the US government “to continue our life-saving work in countries such as Syria, where we provide life-saving services for over two million people”.
However, the charity did not provide a breakdown of how much of the Syria programme was funded by contributions from USAID.
Goal acknowledged that its work in some countries had been affected by the USAID funding freeze.
Trócaire said in its 2023 report that “USAID funding has increased in 2023 and represents 7 per cent of overall institutional funding”. It said USAID funding had allowed it to work on programmes such as assisting victims of gender-based violence.
Last year, Taoiseach Micheál Martin, as minister for foreign affairs, announced an expansion of a development co-operation partnership between Ireland and the US. The move involved Irish Aid, the development co-operation programme of the Irish Government, and USAID working together on food security in Zambia. The move followed on from a similar agreement in relation to work in Malawi.
Under Joe Biden, the head of USAID was Samantha Power, the most powerful Irish-born person in his administration. Martin had met Power on several occasions on his visits to New York and Washington.
Following a meeting in February, Martin spoke of Ireland’s “long-standing partnership in global food and nutrition security” with USAID. He said the Zambia arrangement would focus “on building sustainable food systems, prioritising improved nutrition, gender equality and climate action”.
While the initial 90-day funding USAID pause caused concern in Government, this was heightened as the criticism of the US agency intensified among Trump and his allies in Washington last week.
A Government spokesman told The Irish Times on Monday: “We are following closely the continuing reports and announcements in Washington in relation to USAID, and are assessing the potential impact for our collaboration in Malawi and Zambia.”
Trump said USAID had been run by “radical lunatics and we are getting them out” and that he would make a decision about the future of the organisation.
Elon Musk, the richest man in the world, the president’s close ally and head of his new department of government efficiency, said Trump had agreed the agency should be shut down.
[ Concerns over impact of Trump cuts on Irish foreign aid effortsOpens in new window ]
Some Republican critics of USAID contend that some of the programmes it funded were wasteful or promoted a liberal agenda. Musk called USAID “a criminal organisation”. Other Trump allies even alleged USAID had been a front for US intelligence.
Staff working for Musk entered the USAID building in Washington this week and made changes to its technology infrastructure. They also tried to gain access to classified material, leading to a confrontation with two top security directors at the aid agency.
The USAID website has been shut down since last weekend, but earlier this week a notice was posted to say that nearly its entire workforce would be put on leave with effect from Friday, February 7th.
Where does this leave the partnerships with the Irish Government and the millions of euro in funding provided to Irish aid organisations?
There has been little public comment from Irish aid agencies about the potential implications of developments at USAID.
Goal, in a statement, said it received US foreign assistance similar to many other global humanitarian organisations.
The charity’s chief executive acknowledged that “the work of our teams has been impacted by the recent suspension of this foreign assistance in some of our countries of operation”.
She did not provide details of the countries or the projects affected by the developments in the US, although she said waivers had been provided in some cases.
“Goal’s work continues to be funded by a wide range of donors, including Irish Aid, the EU, the UK Government, the UN, and USAID and from the people of Ireland and the business community.”
The Department of Foreign Affairs said the partnership with USAID in relation to food security in Zambia was still being designed.
“Since 2023, Irish Aid and USAID have collaborated in Malawi on a programme to improve food security and nutrition in rural areas affected by climate change,” the department said.
“Ireland remains committed to this work and is in discussions with a range of partners, including the government of Malawi, to ensure that it will continue.”
Minister of State for International Development Neale Richmond said: “We remain absolutely committed to working with a range of partners in both Malawi and Zambia to ensure that food security and nutrition, as well as the empowerment of women and girls, will remain key priorities for Ireland’s bilateral aid programmes in both countries.”
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