‘You feel helpless’: A Mideast health system buckles after U.S. cuts

AL KAWD, Yemen — In the cramped examination room of this small village clinic, Rania Moussa lay on her side, covering her eyes with a pillow; His thin, childish frame belied the fact that he was 13 years old. It had been days since he had received the powerful antibiotic injection he needed to manage his condition, a form of anemia.

But the clinic that used to give free of charge now had nothing to offer; and aid cuts since the US froze aid last year have meant they are unlikely to be received any time soon. Rania’s mother said that without medicine her daughter could not do anything.

“She can’t walk; she can barely move. I had to carry her here. We were able to give injections before, but no clinic has them anymore, so I have to buy them from the pharmacy,” said Jamilah Omar, Rania’s mother. “We can’t even afford to buy food, let alone medicine.”

Omar somehow saved money for antibiotics administered by the clinic staff.

In the year since the U.S. Agency for International Development was gutted at the hands of Elon Musk and his so-called Department of Government Efficiency (DOGE), debates over shutting down the agency may turn into political point-scoring, with defenders and opponents of the Trump administration shouting at each other about savings, or lack thereof.

But it’s in the dusty clusters of cinder block houses and dilapidated buildings that make up Al Kawd where the real-world impact of these disruptions is felt most clearly.

“You feel helpless,” said Areeda Fadhli, a 53-year-old medical assistant who runs the clinic, as she shifted the pillow to look at Rania’s face.

“Imagine your son or daughter disappearing in front of you,” he said. “How do you think this feels?”

Fadhli pointed to some boxes of basic medical supplies squirreled away in a corner.

“This is the last shipment and it arrived over nine months ago,” he said. “We try to extend them as long as possible.”

The contraction in Yemen reflects the broader destruction of foreign aid around the world. In 2025, the United States has pledged $3.4 billion in global aid, a fraction of the $14.1 billion funded under President Biden. This includes funding from USAID and other US agencies.

And that amount is dwindling: Late last year, the Trump administration announced it would provide $2 billion to U.N. programs in 17 countries in 2026, but would explicitly exclude Afghanistan and Yemen.

Nurse Rabie Nasr cleans a child’s wound at a hospital in Yemen’s Abyan province. His injury did not require stitches, which was fortunate because there were no stitches or surgical threads left in the hospital.

(Nebih Bulos/Los Angeles Times)

Other rich countries are following suit; Germany has cut its humanitarian aid budget for 2026 by more than half compared to last year. France plans to cut development aid by nearly 40 percent, and Britain is reducing aid spending from 0.5 percent to 0.3 percent of gross national income by 2027.

The Trump administration gave different reasons for cutting foreign aid. While President Trump claimed “billions of dollars in waste, fraud and abuse,” DOGE officials boasted about cost savings. Secretary of State Marco Rubio said USAID does not serve and in some cases harms “the core national interests of the United States.”

Administration officials offered no evidence of corruption and cited examples of waste that proved false, such as Trump’s claim that $100 million was spent on condoms for the militant group Hamas in Gaza.

In any case, observers say funds allocated for foreign development assistance under Biden are less than 1% of the federal budget.

Last year, the United States reduced funding for Yemen from USAID and other sources — accounting for half of the country’s humanitarian response budget in 2024 — from $768 million to $42.5 million. ConclusionAccording to the UN, 453 health facilities across the country, including hospitals, primary care centers and mobile clinics, were in danger of partial or imminent closure.

The respected British medical journal Lancet published a study predicting this in July. Cut to USAID It could result in 14 million otherwise preventable deaths worldwide by 2030. The estimates were based in part on the lifesaving impacts of USAID’s past work on food security, HIV treatment, medical care and other services.

The disruptions have already deeply affected Yemen, which is no stranger to tragedy. A grave civil war that began in 2014 when Iran-backed Houthi rebels seized the capital, spurring a violent offensive by the Saudi-led coalition, has made Yemen the site of the world’s worst humanitarian disasters in recent years.

The UN says that although the devastation in Yemen is greater than in other conflict hotspots, 19.5 million people (just under half the population) will need humanitarian assistance in 2025, with the majority experiencing food shortages.

This year, the number is expected to rise to 21 million as political turmoil continues across the country; This situation became even more difficult when the Trump administration designated the Houthis as a foreign terrorist organization in 2025.

A soldier walks in front of the U.S. Embassy in Sanaa, Yemen, on Wednesday.

(Osamah Abdulrahman / Associated Press)

Humanitarian experts say the designation actually prohibits the distribution of aid to areas under Houthi control, where 70 percent of the population lives. At the same time, the Houthis detained 73 UN staff and seized vehicles and telecommunications equipment, leaving the UN unable to operate.

“There are unrest from conflict and growing humanitarian needs, while the challenging financing environment constrains the delivery environment,” said Julien Harneis, the UN resident coordinator in Yemen. “So all the conditions are coming together for a very difficult year.”

The aim of aid organizations in Yemen, relying on US generosity, has turned to preserving what is left of their operations.

One aid worker, who spoke on condition of anonymity for fear of jeopardizing remaining aid flows, said the organization he worked for had closed one of its two offices, laid off 250 of 300 staff and suspended support for dozens of health centres. The organization’s portfolio had fallen from roughly $32 million to $2 million.

“Yes, we have other donors from Europe and Canada, but this is not even equal to 5 percent of what the Americans will give,” he said.

Some organizations have sought to align their proposals with Washington’s regional priorities, including the fight against Iran and Al Qaeda, or to exclude terms effectively banned under the Trump administration.

“Anything that focuses on gender, feminism or LGBT protection: a statement containing any of these concepts will not be signed,” he said.

To understand what a difference a year makes, last January, before the aid cuts, Fadhli was about to expand the Al Kawd clinic’s operations from 12-hour shifts to 24 shifts.

Three doctors, an obstetrician and two general practitioners, made the 32-mile daily journey from Aden, Yemen’s main city in southern Yemen, to Al Kawd to treat about 300 patients each day. Healthcare assistants selected from local village women received $100 a month and training sessions to work in the clinic and help meet the needs of the community.

The clinic had enough basic medicines to last three months, and funds were available to procure specialized medicines for patients with complex diseases.

The last doctor remaining in the clinic, 37-year-old Gynecologist Dr. “People come here because they don’t have money, but they come before we can offer them solutions to their problems,” said Umayma Jamil. He comes only once a week and gets money from whatever fund the clinic can raise.

Jamil said that now he will make a diagnosis, prescribe medication and then see if the patient comes back with the same complaint.

“I asked them, ‘Did you take any medicine?’ I ask. And they say they can’t do it because there is no money,” Jamil said.

“It’s natural to be angry, but I don’t know what to do. It’s out of my hands.”

The effects of such a drastic reduction in aid are not limited to smaller facilities; It even includes large medical institutions such as Al-Razi, which is the main hospital of Abyan province and serves more than 30,000 people every year.

The surgeon heading the emergency room, Dr. Muhsen Abdullah spoke with the tired voice of a ward with no surgical threads or stitches, and anesthesiologists had to ask patients to buy their own anesthesia supplies.

“Surgical supplies, antibiotics, even iodine and rubbing alcohol; all these things the patient has to buy outside before coming in for surgery. This is ridiculous,” he said, adding that some patients postpone procedures because they cannot afford post-operative treatment.

There were other signs of disrepair around it: an X-ray examination table with a non-functioning backlight and a dust-covered ultraviolet sterilization machine that hadn’t worked in months.

Because humanitarian organizations operate under extremely tight budgets, there is little they can do when outbreaks occur; Since most of this information is based on health centers reporting outbreaks, we assume they will be able to detect them in the first place.

“We don’t have any reports anymore. Zero,” the aid worker said. For example, he said cholera cases in Yemen appear to be fewer than last year, although suspected numbers are much higher.

“How could they tell you that anyway? There are no kits to test.”

In Al Kawd, Fadhli and Jamil have already detected several cases of cholera in the village. That’s a scary prospect, they said, because the infected waterborne disease killed several dozen people last year, mostly children. But there isn’t much they can do because they don’t have money for quarantine or medicines, so they wait for the epidemic to get worse.

This is in line with predictions by UN resident coordinator Harneis, who said aid groups in Yemen expected an increase in epidemics “that we cannot control” and an increase in death and disease, especially affecting young children.

“Children are dying, and more children will die this year,” he said. And once such outbreaks emerge, there is no guarantee they will remain within Yemen’s borders, he added. “Epidemics do not stop at the border.”

The group said this month that the United States completed its withdrawal from the World Health Organization, a decision that made “both the United States and the world less safe.”

Many in the aid community acknowledge that USAID is not perfect and understand complaints that it could be used to promote ideas that the Trump administration has denounced as “woke.”

However, they still complain about their work being taken back. One person compared it to America abruptly withdrawing from Afghanistan, leaving the field open for the Taliban to destroy all of USAID’s projects.

“Okay, you can say USAID is unsustainable, but there’s an argument that the tap shouldn’t be turned off completely,” the aid worker said, adding that his employer has been operating in Yemen since 1994.

“With this move, you have destroyed decades of work.”