In what will be seen as a signature act of the new Trump administration, the president and his team have denounced and dismembered the US government’s international assistance arm, USAID, in a matter of three weeks.
It is a decision that will have serious, real-world consequences – and the impact is already being felt in countries such as Uganda.
The health ministry in Uganda has announced its intention to shut all dedicated HIV/AIDS and tuberculosis (TB) clinics in the country. Stand-alone pharmacies supplying antiretroviral drugs will also be closed.
These facilities provide HIV treatments and preventative therapies to millions of people in Uganda, including an estimated 1.5 million currently living with the virus.
An official said the closure of HIV clinics was a necessary response as the country grapples with the loss of funding from USAID.
Image: The cuts have sparked protests outside USAID’s now-closed building in Washington DC. Pic: Reuters
Directors and staff at the country’s public hospitals have been instructed to offer the same services at their outpatients and chronic care departments.
A USAID initiative called the President’s Emergency Plan For AIDS Relief – or PEPFAR – has bankrolled much of Uganda’s HIV/AIDS relief plan and it’s an initiative that has wielded impressive results.
Specially trained staff and dedicated clinics are credited with bringing infection rates down from 19% in the late 1990s to 5% in 2024.
‘We are still reeling’
Flavia Kyomukama, from the National Forum of People Living with HIV/AIDS Networks Uganda (NAFOPHANU), said she was stunned by Donald Trump’s decision.
“We are still reeling from the shock of what they have done, it is very difficult to understand,” she said. “There was a memorandum of support [between both countries], there was roadmap [towards zero infections] and they make this decision in a day.”
Image: Flavia Kyomukama
Shifting HIV/AIDS-related care to public hospitals is deeply problematic, Ms Kyomukama added.
These facilities are often overwhelmed, and they offer little, or no, privacy. It is a serious issue in a country where those carrying the virus are badly stigmatised.
“Surveys show 30% of health workers have a negative attitude towards people with HIV,” Ms Kyomukama said. “So, we’re going to see [patients] dropping out [of their treatment plans], drug resistance will increase and we will see more violence in hospital as people with HIV get attacked.”
World is worryingly dependent on US – it now faces a major shock and impossible choices
The Trump administration’s destruction of USAID will bring about the virtual collapse of the international aid and development system, experts have warned.
The US government puts far more money into humanitarian assistance than any other country.
In 2023, the most recent year for which data is largely complete, the Americans disbursed $71.9bn (£57bn) in foreign aid, representing 1.2% of total US government spending.
It is a spending commitment that has remained remarkably consistent over the years.
The Americans underwrite programmes in 177 individual countries with Ukraine registering as the biggest recipient in 2023. It received $16.6bn (£12.9bn) to maintain government services after the Russian invasion.
PEPFAR, USAID’s best-known initiative, provides antiretroviral treatments to 20 million people infected with HIV/AIDS.
The initiative supports NGO-run groups with an extended workforce of 350,000 people – with many employed at local clinics.
The US also bankrolls key UN organisations, such as the refugee agency (UNHCR). Its total budget of $4.8bn (£3.8bn) is propped up by the Americans, who put in US$2bn (£1.6bn).
Without this funding, it is difficult to see how UNHCR can continue to support tens of millions of refugees in countries including Sudan, Syria, Turkey and the Democratic Republic of Congo.
If the residents of refugee camps are not supported with basic services, they are likely to move.
The question then is how US funding compares to other donors – and the answer is startling.
According to the UN’s real-time financial tracking service, Germany contributed funds in 2024 representing 8% of total humanitarian aid contributions, as did the European Union, with the United Kingdom at 6%.
The world, then, is worryingly dependent on the United States.
Former international aid worker turned consultant Thomas Byrnes said: “The modern humanitarian system has been shaped by a long-term commitment from the US.
“For decades, organisations like the UN agencies have relied on this predictable funding stream to address global crises.
“The world faces a major shock and I don’t think anyone is prepared for it.”
To alleviate the situation, Mr Byrnes said other donors – such as the UK and Germany – will need to make up the funding shortfall from USAID.
But that is highly unlikely to happen.
The United Kingdom, currently contributing $2.1bn (£1.7bn), would need to contribute an additional $1.5bn (£1.2bn) – representing a 74% increase.
For Germany, the required extra contribution would be $1.8bn (£1.5bn), representing a substantial increase of 70%.
Furthermore, Trump’s move comes at a time when Germany, France, Sweden and others are planning deep cuts to international aid.
The world is looking at a colossal funding gap – and a colossal crisis – as the number of people in need of humanitarian assistance rises to 305 million people, Mr Byrnes added.
“We’re facing a perfect storm,” he said. “The brutal math means we’re heading toward humanitarian aid of just 17 cents per person per day.
“This isn’t a funding dip – it’s a systemic shock that will force impossible choices about who receives help and who doesn’t. People will die as a result of this.”
‘It’s total panic right now’
Brian Aliganyira is the director of Ark Wellness Hub, a busy health clinic for the LGBT+ community in Uganda’s capital, Kampala.
The clinic has sourced supplies – such as antiretroviral drugs, preventative ‘PrEP’ therapies and testing kits – from partners who are underpinned by USAID.
Now, the 37-year-old has got a major problem on his hands.
“It’s total panic right now,” he said. “Our response teams are panicking and there is a lot of panic in the community.
“We are telling people to go home and it’s not just [our clinic]. There is no more medication left – or maybe there’s one refill at the most. But people keep asking us, ‘have you got any extra, any extra’?
“Without the support we need, HIV will surge and people will die.”
Image: Brian Aliganyira
‘Lives will be lost’
There are some still clinging to hope.
On 1 February, US secretary of state Marco Rubio issued a waiver exempting the PEPFAR programme from the new administration’s cuts to foreign aid.
However, President Trump issued a contradictory order banning programmes designed to “advance equality and human rights for lesbian, gay, bisexual, transgender, queer, and intersex people”.
There is a thickness to the air outside Wang Fuk Court in Hong Kong’s Tai Po district.
The smoke catches in your throat and the emotion catches you off guard.
Seven of the eight tower blocks that make up this complex have been all but blackened. And through the shells that used to be windows, you can only imagine the horror and the panic that must have played out inside, the screams that went unanswered.
More than 30 hours after the blaze began here there was still a sense that it is far from under control. At various points during the day the flames sprung up from different windows, as if the fire has found fresh tinder.
Image: Pockets of fire are still raging
Image: Thousands of people lived at the complex
Debris falls from the buildings periodically, ash still floats in the air.
As of Friday morning here, 94 people are now confirmed to have died.
There is no doubt the community is reeling. Along the surrounding streets hundreds came out to look on in horror, mostly in a stunned sort of silence.
Occasionally the air was pierced with the terrible cries of relatives, who had received the news they were dreading.
But much of the grief was quiet and held close, an arm around the shoulders or a quiet embrace.
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Deadly blaze destroys Hong Kong tower blocks
Image: The community is coming together in their grief, hugging and supporting each other
Among the survivors is the Lam family, three generations of which had been living in the building for 40 years. They have lost their home and haven’t heard from their neighbours.
“The alarm was all off because of the renovation of the outside. So there is no alarm to let all the people know. Many old people, elderly people, they were all having an afternoon sleep. So nobody knew,” Ms Lam, whose father survived the fire, said.
“Once they know the fire has already burned down everything, and they cannot escape, they were all trapped in the house. This is a disaster, actually.”
Image: Three generations of the Lam family lived in Wang Fuk Court for 40 years
Another survivor said: “I feel sadness and hopeless and don’t know what [I’m] going to do. I don’t know. Cannot describe. So sad.”
Hong Kong is one of the world’s most densely populated cities, fire in places like this has a significantly more deadly potential.
And it also means many are displaced. Over 4,500 lived in this complex alone and are in need of emergency shelter.
Image: A woman says she feels sad and hopeless after losing her home in the blaze
The government has offered temporary accommodation to many, but the community is filling the gaps.
Armies of volunteers handed out food, water, blankets and clothes, including to those who had opted to sleep on the floor of a nearby shopping area.
One man, who wanted to sleep on the floor close to his home, said he doesn’t feel supported by the government.
Image: One man opted to sleep on the floor close to his burned-down home
Image: The man said he doesn’t feel supported by the government
There is a thin line between grief and anger, and there’s a feeling it’s narrowing here.
Many fingers have pointed towards the construction company running extensive renovations in the complex.
A netted mesh, bamboo scaffolding and polystyrene that may have been used as part of the works have all been cited as potentially speeding the spread.
Three construction bosses have already been arrested.
But there is a sense that distrust of the authorities more broadly runs deep.
“It is very serious and people are starting to feel furious about the construction company and the construction materials,” one woman said.
“There are so many layers of anger among the people. People feel that every party should take responsibility.”
Image: A woman said many were angry about the construction company
Everyone we spoke to wanted to wear a mask to avoid being targeted, with volunteers actively encouraging the masks, and many hinted that the system shoulders its share of responsibility for what happened.
This fire is already the worst disaster in the modern history of Hong Kong; many of the victims are elderly and many will struggle to rebuild.
There will many days of pain to come, but many days of questions too.
At least 83 people died in the fire, according to South China Morning Post, citing the local fire department, and a further 70 people have been injured, including more than 40 who were described as critically ill in hospital on Wednesday night.
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Deadly blaze destroys Hong Kong tower blocks
Around 900 people are also in shelters as a result of the blaze.
Police have alleged its cause could have been a “grossly negligent” construction firm using unsafe materials.
Three people – two directors and an engineering consultant – have been arrested on suspicion of manslaughter.
“We have reason to believe that the company’s responsible parties were grossly negligent, which led to this accident and caused the fire to spread uncontrollably, resulting in major casualties,” said police superintendent Eileen Chung. Police have not named the company.
The complex, built in the 1980s, had been under renovation for a year.
Image: Smoke rising from the Wang Fuk Court residential complex. Pic: AP Photo/Chan Long Hei
Image: The fire broke out on Wednesday afternoon. Pic: Reuters
Image: Dozens of people remain in hospital, some are critically injured. Pic: AP Photo/Chan Long Hei
One firefighter was among those killed tackling the blaze, which broke out at 2.51pm local time on Wednesday. Another 11 firefighters were among those injured.
Fire crews said they had doused the flames in all seven of the affected blocks by Thursday morning, and were searching each floor for survivors.
Records show the Wang Fuk Court site consists of eight blocks, with almost 2,000 flats housing around 4,800 residents, including many elderly people.
Image: A relative of a resident at the scene. Pic: Reuters
Families have been identifying the bodies of relatives while others have been visiting shelters in the area, searching for missing loved ones.
Hong Kong leader John Lee said on Thursday the government will set up a HK$300m (£29m) fund to help residents.
Image: Charred bamboo and plastic mesh covers the complex, which was undergoing renovation works. Pic: Reuters
Image: Firefighters searching between floors at one of the high-rise blocks. Pic: Reuters
The cause of the fire is being investigated, but it appears to have started in bamboo scaffolding and construction mesh sheets and then spread across seven of the complex’s eight buildings – likely aided by windy conditions.
Bamboo scaffolding is commonly used in Hong Kong, but is in the process of being phased out because of safety concerns.
Hong Kong’s Association for the Rights of Industrial Accident Victims said there have been at least three fires involving bamboo scaffolding this year.
Image: Temporary shelters have been set up for residents. Pic: AP
Image: Supplies are brought to a school which is serving as a shelter. Pic: Kyodo/AP
China’s state broadcaster CCTV said President Xi Jinping has urged an “all-out effort” to extinguish the fire and minimise casualties and losses.
Both the US and British Consulate Generals for Hong Kong have sent condolences to those affected, as has Taiwan’s president.
Image: Parts of the huge complex were still smouldering on Thursday. Pic: AP
Image: Firefighters work to extinguish the blaze. Pic: AP
The number of dead is the highest in a Hong Kong fire since 1948, when 176 people were killed in a warehouse blaze.
The fire has prompted comparisons to the Grenfell Tower blaze which killed 72 people in 2017, blamed on flammable cladding, as well as failings by the government and the construction industry.
“Our hearts go out to all those affected by the horrific fire in Hong Kong,” the Grenfell United survivors’ group said on social media.
“To the families, friends and communities, we stand with you. You are not alone.”
If you’re still under any illusions about how seriously Ukraine’s allies view the wider threat from Russia, the wave of countries bringing back military service should help clarify that.
France is the latest, today announcing a new national service for over 18s.
Ahead of the plan being unveiled, President Emmanuel Macron said: “If the French want to protect ourselves, we must show that we are not weak in the face of one power that threatens us the most.”
Image: President Macron prior to his speech on Thursday. Pic: AP
That threat primarily comes from Russia, a country that numerous military chiefs have warned may be ready to attack a NATO member by 2030.
In essence, with today’s announcement, Mr Macron is trying to prepare a force to help protect France if attacked.
The young recruits would help bolster the military, which is already the second largest in the EU after Poland.
Image: Pic: AP
As more countries look to strengthen their defences, Moscow has accused European leaders of warmongering and consistently denied any threat to wider Europe.
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However, its seeming unwillingness to stop the bloodshed in Ukraine, the recent drone and jet incursions into NATO airspace, and the intensifying hybrid war it’s accused of carrying out across Europe mean few of Ukraine’s allies still trust the Kremlin’s word.
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Uncertainly about whether the US could be relied upon in a fight has fuelled the unease.
That hasn’t been helped by the fact the first 28-point peace plan presented by the US appeared to come straight out Moscow’s playbook.
In these uncertain times, France isn’t alone in looking to bolster its defences. Ten EU countries already have compulsory military service, while nations including Belgium, the Netherlands and Germany are opting for voluntary schemes.
After years of neglecting its military, Germany is massively boosting defence spending, with the chancellor pledging to build the strongest conventional army in Europe.
The German parliament is expected to vote on the military service plan in December.
As one German general told me: “We are not at war, but we are no longer living in peacetime…
“We do not want war, but we must be ready to defend our country.”