‘People will die’: Chaos and mounting fear in Uganda as USAID cuts lead to ‘total panic’ and HIV clinic closures
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.
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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.
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.”
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.”
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”.
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Donald Trump and Marco Rubio have given contradictory messages about parts of the USAID cuts. Pic: AP
The result in Uganda is chaos – and mounting fear.
“Really, we are grieving about this, we are grieving,” Ms Kyomukama said. “Livelihoods will be lost – and lives will be lost.”
US
Trump issues Gaza ceasefire ultimatum to Hamas as he warns ‘all hell is going to break out’ if hostages not returned
Donald Trump says the Gaza ceasefire should be cancelled if all remaining Israeli hostages are not returned by noon on Saturday – as he warned Hamas that “all hell is going to break out”.
The US president’s intervention came hours after Hamas has said it will delay the release of more hostages and accused Israel of violating their ceasefire deal.
While signing a series of new executive orders, Mr Trump said he feared many Israeli hostages scheduled for release are already dead.
Referring to his Saturday deadline for the release of hostages, Mr Trump said: “If they’re not here, all hell is going to break out.”
He acknowledged that a decision to end the ceasefire was up to Israel, adding: “I’m speaking for myself. Israel can override it.”
Hours earlier, Mr Trump said Palestinians would not have the right to return under his plan for US “ownership” of Gaza – contradicting officials in his administration who said they would be relocated temporarily.
Trump latest: ‘Palestinians will have no right to Gaza return’
Widespread destruction seen in Gaza City. Pic: AP
Hamas halts release of hostages
Earlier on Monday, Hamas claimed ceasefire violations had included “delaying the return of the displaced to the northern Gaza Strip, and targeting them with shelling and gunfire”.
Spokesman Abu Obeida said Hamas remained committed if Israel kept to the terms, but that the 15 February handover was postponed “until the occupation commits to and compensates for the past weeks”.
Egyptian security sources told Reuters that mediators now fear the deal will break down.
They said Hamas believes Israel isn’t serious about the ceasefire – which began on 19 January.
The last hostage release took place at the weekend and saw three Israeli men set free. Five Thai citizens released last month were also finally reunited with their families in Bangkok.
They were among about 250 people taken during the 7 October 2023 attack, when 1,200 people were murdered.
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Tears as Thai hostages return home
Five swaps have taken place so far, with 21 hostages and more than 730 Palestinian prisoners released.
Saturday’s exchange was due to involve three more Israelis and hundreds of Palestinians.
Defence minister Israel Katz said any delay in releasing hostages would be “a complete violation” and he had instructed troops to be on highest alert.
The Hostages and Missing Family Forum called on mediating countries to restore the deal, saying “time is of the essence” and citing “the shocking conditions of the hostages released last Saturday”.
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As part of the ceasefire deal, Israeli forces pulled back from a key passage through Gaza on Sunday.
The four-mile-long Netzarim corridor separates northern Gaza from the south, and hundreds of thousands of displaced Palestinians have now crossed back over.
However, Israel pushed back the withdrawal by a few days in protest at the chaotic release of hostages Arbel Yehud and Gadi Moses.
This may be what Hamas is referencing what it talks of “delaying the return of the displaced”.
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Palestinians return to destroyed Netzarim
There have also been examples of Israeli troops shooting at or near Palestinians approaching Israeli forces after being warned to stay back.
So far, little progress has been made on an extension to the first six-week phase of the ceasefire.
A delegation from Israel has arrived in Qatar for further talks amid concern the deal might collapse before all remaining hostages are freed.
Israel has previously said it will not agree to a complete withdrawal from Gaza until Hamas’s military and political capabilities are eliminated.
Hamas has countered that it will not hand over the final hostages until Israel removes all its troops from Gaza.
Donald Trump has signed two proclamations imposing 25% tariffs on all steel and aluminium imports to the US.
A proclamation is a form of presidential directive to government officials, but they do not carry the force of law, as an executive order would.
However the White House has said the tariffs will take effect from 4 March.
“This is a big deal,” Mr Trump said in the Oval Office as he announced the tariffs. “The beginning of making America rich again.”
He added: “We were being pummelled by both friend and foe alike.”
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‘We were being pummelled by both friend and foe alike,’ said the US president
The proclamations mean the president has now removed the exceptions and exemptions from his 2018 tariffs on steel to allow for all imports of the metal to be taxed at 25%.
The new tariff on aluminium is also much higher than the 10% duty he imposed on the material in his first term.
The tariffs are part of an aggressive push by Mr Trump to reset global trade, as he claims that price hikes on the people and companies buying foreign-made products will ultimately strengthen domestic manufacturing.
Outside economic analyses suggest the tariffs would increase costs for the factories that use steel and aluminium, possibly leaving US manufacturers worse off.
Canada, the largest source of steel imports to the US, criticised the move.
Candace Laing, CEO of the Canadian Chamber of Commerce, said Mr Trump was destabilising the global economy.
“Today’s news makes it clear that perpetual uncertainty is here to stay,” she said.
Hard to see how tariffs won’t be inflationary
At least part of the idea behind tariffs is to bring some production back to the US, but imposing them will have consequences.
What kinds of consequences? Well, at its simplest, tariffs push up prices. This is, when you think about it, blindingly obvious.
A tariff is a tax on a good entering the country.
So if aluminium and steel are going up in price then that means, all else equal, that the cost of making everything from aircraft wings to steel rivets also goes up.
That in turn means consumers end up paying the price – and if a company can’t make ends meet in the face of these tariffs, it means job losses – possibly within the very industrial sectors the president wants to protect.
So says the economic theory. But in practice, economics isn’t everything.
There are countless examples throughout history of countries defying economic logic in search of other goals.
Perhaps they want to improve their national self-reliance in a given product; perhaps they want to ensure certain jobs in cherished areas or industries are protected.
But nothing comes for free, and even if Donald Trump’s tariffs succeed in persuading domestic producers to smelt more aluminium or steel, such things don’t happen overnight.
In the short run, it’s hard to see how these tariffs wouldn’t be significantly inflationary.
Trump’s war of tariffs
Mr Trump’s proclamations come days after the US imposed a 10% tariff on all goods imported from China.
In return, China imposed 10% tariffs on American crude oil, agricultural machinery, large-displacement cars and pickup trucks.
There will also be 15% tariffs on coal and liquefied natural gas from the US.
US plans to impose 25% tariffs on Mexico and Canada were paused after agreements were reached on border security.
Mexico’s president said she was sending 10,000 National Guard troops to the US border immediately in return for a tariff delay.
Mr Trump said the Mexican soldiers would be “specifically designated” to stop the flow of fentanyl into the US, as well as illegal migrants.
Meanwhile, Canada’s prime minister Justin Trudeau said almost 10,000 frontline personnel “are and will be working on protecting the border”.
He added that his country was appointing a “fentanyl czar”, drug cartels would be listed as terrorists, and there would be “24/7 eyes on the border”.
Donald Trump has said Palestinians would have no right to return to Gaza under his proposal to relocate its population and rebuild the Strip.
The president last week debuted his suggestion to “own” Gaza and shut out Hamas while it’s redeveloped, but has now contradicted officials who had said any relocation would be temporary.
Asked by Fox News if Palestinians could return, he replied: “No, they wouldn’t, because they’re going to have much better housing. In other words, I’m talking about building a permanent place for them.”
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Speaking on Monday at the White House, Mr Trump also suggested the current ceasefire in Gaza should end on Saturday if Hamas does not release hostages as planned.
He then went further, saying all the remaining hostages should be released by midday on Saturday, or the ceasefire should be cancelled – and that “all hell is going to break out” if the hostages are not freed then.
But the US president added: “I’m speaking for myself. Israel can override it.”
Hamas said earlier it would delay the release of hostages – accusing Israel of violating the ceasefire.
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‘I would own this’ – Trump on Gaza
Mr Trump told Fox News his future vision for Gaza was to build multiple “safe communities, a little bit away from where they are, where all of this danger is”, adding the area is currently “not habitable”.
He said he believed he could cut a deal with Jordan or Egypt to take people in.
However, Arab allies – including Egypt and Saudi Arabia – have dismissed the idea of relocating Gaza’s two-million-plus population.
Western countries have also rejected the proposal; an independent state for Palestinians remains the favoured way forward but is a no-go for the Israeli government.
When asked in the media, Palestinians have also rubbished the idea.
Israeli Prime Minister Benjamin Netanyahu has supported Mr Trump’s controversial proposal.
Donald Trump meets with Israeli Prime Minister Benjamin Netanyahu in the Oval Office. Pic: Reuters
Much of Gaza lies in ruins due to Israel‘s attempt to wipe out Hamas after its 2023 terror attack that killed around 1,200 people in Israel.
About 250 were also kidnapped, but those still alive have started to be released in recent weeks after a hard-won truce took effect last month.
Since the ceasefire began on 19 January, five swaps have taken place – with 16 Israeli and five Thai hostages released.
In total, Israel has said it will release up to 1,904 Palestinian prisoners in return for 33 Israeli hostages during the deal’s first phase.
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So far, little progress has been made on an extension to the first six-week phase of the ceasefire.
A delegation from Israel has arrived in Qatar for further talks amid concern the deal might collapse before all remaining hostages are freed.
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