In its first days in office, the new US administration suddenly decided to freeze a large part of its foreign aid commitments. As of 24 February, the United States – the world’s largest bilateral humanitarian donor – froze funds, cancelled contracts, blocked payments and dismantled USAID, the United States Agency for International Development, destabilising the entire humanitarian system.

The consequences of these decisions are dramatic, both for people affected by crises and for the organisations that support them. The executive orders have forced the closure of hospitals and health centres, halted nutrition programmes, cash and food distributions, legal aid for displaced people, and essential shelter, education, water and sanitation programmes. All this is happening in a dire global humanitarian context: according to the Global Humanitarian Overview (GHO), 305 million people worldwide are in need of urgent humanitarian assistance and protection in 2025.

Impact on the Humanitarian System

The United States is the leading global donor of humanitarian aid, with a contribution of $13.80 billion in 2024, accounting for 43.04% of total funding monitored by the United Nations Financial Tracking Service (FTS). This figure exceeds the combined contributions of the next 10 largest donors in the world.

Many humanitarian organisations, including the UN agencies, international NGOs, and local NGOs, rely heavily on US funding to provide food, medical supplies, shelter, and other emergency services and life-saving programmes for people living in conflict-affected regions and natural disasters.

Local, national, and international NGOs, the backbone of the humanitarian response, are now facing severe operational disruptions and are being forced to close projects, lay off staff, and withdraw from communities where trust and infrastructure have taken years to build.

Organisations are facing cash flow and liquidity problems, as well as a high level of risk regarding employees with US-funded contracts, leading to significant financial losses due to human resources costs and penalties for contract terminations that do not comply with local labour laws. Additionally, costs and penalties due to pre-ordered supplies will also create an additional financial burden.

Impact on INTERSOS

The USAID budget cuts have forced us to halt projects providing essential humanitarian aid in West Africa (Burkina Faso, Chad, Nigeria), Afghanistan, Yemen, and Lebanon. This is leaving approximately 500,000 people without life-saving medical assistance and humanitarian protection.

Due to a lack of liquidity (caused by USAID’s failure to reimburse expenses advanced to implement projects), we have had to furlough all workers (doctors, midwives, psychologists, social and legal workers, etc.) on USAID-funded projects and close medical centres, halt child malnutrition programmes, stop assistance for women with high-risk pregnancies living in remote areas without other services available, and much more. People continue to call us daily for emergencies, visit our centres, and seek assistance, but we are not in a position to help them. In 2024, USAID represented 17% of INTERSOS’s total budget, and the impact of the cuts since late January is impossible to absorb in the short term without compromising our services in the coming months as well.

Ukraine enters its fourth year of war, and the Ukrainian population is exhausted by increasingly complex humanitarian needs. Attacks on cities and villages along the front line in the east, south, and northeast of the country continue unabated. Civilian infrastructure, such as power grids, water supply networks, and transportation infrastructure, are targeted, disrupting essential services like water, gas, and winter heating and affecting homes, collective shelters, schools, and healthcare facilities.

Hospitals and schools are not spared from attacks. The World Health Organization (WHO) has reported over 2,100 attacks on healthcare facilities, resulting in at least 197 deaths, including healthcare workers and patients, and many more injuries, further disrupting health services. Since the beginning of the war, nearly 2,000 schools have been damaged, and 371 educational facilities have been completely destroyed. Schools that remain operational in many areas are overcrowded and lack sufficient teachers. In frontline areas where in-person education is impossible, e-learning is not always a viable alternative due to unstable internet connections and unreliable electricity. Today, in Ukraine, an entire generation of children is partially or totally denied the right to education.

The ongoing violence in the country has caused and continues to cause massive displacements, with government evacuation orders covering increasingly wider areas. From the escalation of the war in February 2022 to mid-October 2024, nearly 6.9 million refugees from Ukraine have been recorded, 92% of whom have sought protection in Europe. Within Ukraine, 3.6 million people are internally displaced. 82% of these people have been displaced for over a year and still have no practical prospects of returning soon.

The Ukrainian situation is now a consolidated crisis: In addition to physical destruction, the prolonged war has caused a severe economic crisis and exposed millions of people to trauma and psychological stress due to constant uncertainty and fear of attacks. Although the worsening of mental health affects all age groups, children are particularly vulnerable: about 1.5 million children in Ukraine are at risk of post-traumatic stress disorder (PTSD), depression, and other mental health problems. With a generalized deterioration of people’s mental health, episodes of abuse and gender-based violence are also increasing.

Universal health coverage represents a commitment to ensure that everyone, everywhere, can readily access the health services they need without facing financial hardship. It encompasses a wide range of interventions, from prevention, such as vaccinations and health education, to promoting healthier lifestyles. It also includes curative services for treating diseases, rehabilitation interventions to promote recovery and, finally, palliative care to improve the quality of life in the most delicate phases.

In concrete terms, the lack of access to essential health services means that billions of people cannot receive basic vaccinations, treatments for curable diseases, or support during health emergencies. Mothers do not have adequate assistance during pregnancy and childbirth, children do not receive essential care to prevent deadly diseases or cope with malnutrition, and those suffering from chronic or terminal conditions do not have access to therapies or palliative care. This gap creates profound inequalities: already vulnerable families are forced to choose between seeking treatment and meeting basic needs such as food or education.

Achieving universal health coverage, therefore, means investing in strong and inclusive health systems capable of responding to the needs of all, with particular attention to the most disadvantaged communities, eliminating economic and geographical barriers to guarantee the fundamental right to health. Access to care, in addition to being a universal human right, is the prerequisite for the birth of more resilient, productive, peaceful and prosperous communities.

With our projects in Africa, Asia, Europe, and Latin America, we have been committed for years to promoting universal health coverage, guaranteeing access to free and quality care as well as essential medicines, vaccines, and diagnostics, and supporting and strengthening existing health systems without upsetting them.

We prioritize the most vulnerable people, especially children under 5, women of reproductive age, people with disabilities and the elderly, and we guarantee access to primary health care to populations affected by crises, such as internally displaced persons, refugees, returnees, migrants and vulnerable host communities. We involve the affected communities in every phase of our health interventions, from program assessment and design to implementation to monitoring.

Since October 2023, the conflict in Israel and the Occupied Palestinian Territories has rapidly spread to other countries in the Middle East, in particular Lebanon. Exchanges of fire between Israeli forces and Hezbollah and other armed groups on the country’s southern border have been going on daily for months until the end of September, when Israeli airstrikes dramatically intensified in south and east Lebanon, spreading to other areas of the country previously unaffected by the violence and targeting densely populated areas. On 28 November, a fragile ceasefire agreement was reached in the country.

For months we have denounced violations of international humanitarian law by the Israeli armed forces in the country: indiscriminate attacks on civilians and civilian infrastructure, the use of explosive weapons in densely populated areas, inadequate evacuation notices and mass displacement orders for entire villages, which are insufficient, inadequate and almost impossible to comply with.

The attacks also targeted health facilities and personnel: according to the Lebanese Ministry of Public Health, Israeli attacks have killed at least 163 health and aid workers across Lebanon in the past year and damaged 158 ambulances and 55 hospitals. Some hospitals in the conflict zones have also suffered structural damage and several of these are partially or completely non-functional.

The conflict has also severely affected access to education, with at least 60 per cent of public schools used as shelters and nearly 400 schools closed due to insecurity or damages.

With the ceasefire in force, many displaced persons have returned to their areas of origin, but they still have to deal with the effects of the war: unexploded ordnance, unsafe buildings and movement restrictions imposed by the Israeli army on people returning to areas south of the Litani river.

On the other hand, the population still displaced needs adequate housing, food, water, access to health care and adequate sanitation, as well as fuel to power collective shelters and water points. The overcrowding that characterised the reception sites prior to the ceasefire and the lack of adequate space partitioning and dedicated sanitation facilities exposed displaced persons to the spread of disease and women and children to a high risk of being abused and sexually assaulted for a long time.

In 1988, the World Health Assembly adopted a resolution for the worldwide eradication of polio, marking the launch of the Global Polio Eradication Initiative (GPEI). Since then, the incidence of polio worldwide has been reduced by 99%, and the world stands on the threshold of eradicating a human disease globally for only the second time in history, after smallpox in 1980.

On 15 April 2023, the alliance between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) collapsed into a violent power struggle, pushing Sudan into civil war. The conflict, initially erupted in Khartoum – the capital city of Sudan – has rapidly spread across the country, leading to mass displacement, ethnic cleansing, and widespread violence, particularly in Darfur. Sudan has a long history of civil war and armed insurgency, so several other armed groups are also involved.

Over 30.4 million people in the country are currently in need of assistance. War has severely impeded access to essential resources such as food, water, shelter, cash, fuel, and basic services, alongside diminishing livelihood opportunities.

Levels of food insecurity in the country are alarming: over half of the population of Sudan faces crisis or worse levels of food insecurity (IPC Phase 3 or above). That includes more than 8.1 million people facing emergency levels of hunger (IPC 4), and at least 638,000 people who are in catastrophic conditions (IPC 5). The latest IPC analysis shows that food insecurity in Sudan has reached worse levels than expected. Famine has been detected in at least five areas of the country and five more areas are expected to face famine between December 2024 and May 2025. In July 2024, famine conditions were confirmed in parts of North Darfur, including the Zamzam camp, one of the largest IDP camps in Sudan with an estimated population of at least 500,000. According to the latest IPC analysis, the famine persists and has also spread to the Al Salam and Abu shouk camps and the western Nuba Mountains. Between December 2024 and May 2025, famine is expected to expand in several locations in North Darfur.

Since the onset of the rainy season in June, heavy rains and flooding have been causing the displacement of hundreds of thousands of people, besides heightening the risk of diseases, damaging infrastructures and affecting road access, further delaying the delivery of humanitarian assistance to conflict-affected areas with acute needs.

As the conflict in Sudan persists and spreads, humanitarian access has increasingly become more limited. Intense violence and restrictions on the movement of humanitarian workers have hindered aid delivery, particularly in the southern regions of Sudan where needs are most acute. Delivering aid in Sudan remains extremely challenging due to ongoing conflict, persistent insecurity, looting of humanitarian facilities, attacks on humanitarian workers and front-line responders, fuel shortage, disrupted banking system and cash shortage and bureaucratic obstacles.

Kassala and River Nile

In Kassala and River Nile states, we are working with the Association for Aid and Relief (AAR) Japan and in partnership with the local organisation JASMAR to ensure access to health and protection for IDPs and host communities.

The states of Kassala and River Nile are located in the east of the country and, due to their proximity to Khartoum and the presence of social networks, are among the main states receiving people fleeing the violence in the capital. River Nile currently hosts more than 1 million IDPs. Since April, an additional 354,000 people have sought refuge in Kassala State, which was already a transit area for migrants from Ethiopia and Eritrea to Europe before the conflict and where humanitarian needs were already very high.

In these two states, we are supporting health centres, training health workers, and providing health and hygiene education to the displaced and local populations, as well as facilitating access to health services for pregnant and lactating women and children under five. We also support those at risk of violence or abuse by providing psychological support, distributing cash to access basic services, and conducting awareness-raising and psycho-education sessions.

Darfur

On 24 April, fighting spread to North and West Darfur, and clashes quickly included various communal militias. Darfur is an area that has long faced interethnic violence and has become a hotspot of fighting. Geneina locality has experienced the most severe fighting levels outside of Khartoum.

Violence has caused the full disruption of all basic services, including electricity, water supply, and health care, with almost all health facilities closed for the past year and experiencing a lack of staff, medical supplies, drugs and vaccines.

Darfur, and West Darfur in particular, is also the region where the current conflict has taken an ethnic and tribal dimension. Since the beginning of the conflict ethnically based attacks and serious violations were committed against the Masalit people and other non-Arab communities mainly in Geneina locality and hundreds of civilians were killed.

On the other hand, Central Darfur is hosting over 920,000 internally displaced persons, on top of the already 422,000 IDPs hosted in the State since the armed conflict 2003-2010, currently making it one of the three top States hosting IDPs.

IDPs and host communities are facing extremely high levels of malnutrition and food insecurity, as well as barriers to healthcare access, inadequate shelter and poor WASH conditions. In Zalingei, in particular, IDPs took refuge in informal settlements such as looted and abandoned public buildings, open-area informal settlements and other camps across the city. The living conditions of these displaced people are horrific: the sites are very crowded, most of them don’t have access to water, latrines are not enough, most of them are without doors and they are also used as showers. In addition, the situation of solid waste is critical. Most IDP households living in these informal settings are headed by women who fled with their children whilst the husbands and men stayed behind to take care of their homes. IDPs in these sites, especially women and girls are exposed to protection risks, especially GBV and violence/harassment by armed men.

North Kivu, a province in the east of the Democratic Republic of Congo, has been plagued by conflict for more than two decades due to the presence of many armed groups, including the March 23rd Movement (M23). Violent fighting between the M23 and the Congolese army (FARDC) has resumed in the area over the past two years, and the situation has deteriorated dramatically since January 2024.

The M23 is gaining ground in the east of the DRC. For months now, the armed group has expanded its presence up to a few kilometres from Goma, the capital of North Kivu, with clashes also taking place on the border with South Kivu province. Currently, the most intense violence is recorded in the Lubero area. These dynamics are aggravating the already massive population displacements. More than 1.5 million people had already been forced to leave their homes as of March 2022, but since the end of 2023, due to the ongoing violence in Rutshuru territory, a large number of people have fled northwards, seeking refuge in the Kanyabayonga area and also reaching the south of Lubero territory.

In total, more than 7 million people are internally displaced in the DRC, in what is one of the largest displacement crises in the world, second only to Sudan. Over 80% of the IDPs in the country reside in areas protected by the United Nations Integrated Peacekeeping Mission (MONUSCO), which has announced its withdrawal from South Kivu. This process could easily lead to a power vacuum and a subsequent upsurge in violence, human rights violations and further displacement.

The widening of the conflict and the escalation of violence in the east have resulted, in addition to mass displacements, a very serious protection crisis: the parties to the conflict regularly use heavy artillery and deliberately target civilians, including IDPs. Settlements housing IDPs in Sake and Goma were bombed in February 2024 and on 3 May 2024 at least 18 civilians – most of them women and children – died, while 32 were injured in attacks on IDP sites near Goma. On 30 June, two aid workers were killed and several injured in an attack on an aid convoy near Butembo.

Other violations, such as arbitrary arrests and detentions, extrajudicial executions, forced recruitment, abductions and sexual violence, are committed with impunity. In April 2024 alone, more than 1.700 new cases of sexual violence were reported in settlements accommodating IDPs.

The ongoing conflict sees a further element of complexity in the involvement of neighbouring countries. The M23 armed group, in fact, is largely supported by Rwanda, while the Congolese army is backed by informal auxiliaries and allies from the Southern African Development Community. If not contained, therefore, the ongoing conflict in North Kivu could result in regional escalation.

Needs grow but humanitarian access is increasingly hampered

25,4 million people are in need of humanitarian assistance in the Democratic Republic of Congo and most of the needs are concentrated in the east of the country. There is a lack of housing, basic necessities, water and adequate sanitation and hygiene services. There are also huge needs related to gender-based violence, health care and food security.

Displacement also exacerbates the humanitarian crisis, as displaced and host populations compete for scarce resources, creating tensions that can erupt into conflicts between communities.

Although humanitarian and protection needs are growing, ensuring that aid reaches the affected populations is increasingly complex. According to reliable reports, the parties to the conflict have militarised and established a presence inside IDP settlements, setting up their own artillery positions and putting both the displaced population and humanitarian personnel in grave danger. Humanitarian access is also restricted by bureaucratic impediments, roadblocks and non-compliance with international humanitarian law. The blockade of the two main roads leading to Goma, for example, is jeopardising the delivery of basic necessities, such as food and medicine, to the city’s two million inhabitants.

“The situation is increasingly complex, and urgent action is necessary to address the escalating protection and humanitarian needs of conflict-affected populations, both in camps and rural areas. To allow this, all efforts must be made to de-escalate the conflict, and to ensure the protection of civilians as well as safe and unhindered access for frontline aid workers engaged in the delivery of life-saving humanitarian assistance.”

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