Navigating global pressures on humanitarian aid

The rapid decrease in global foreign aid budgets is already impacting the delivery of humanitarian aid. With crises becoming increasingly protracted, and with states increasingly linking aid to national interests, the future has become even more uncertain for the world’s most vulnerable.   

Humanitarian crises are lasting longer. UN-coordinated emergency appeals, which lay out global humanitarian funding needs every year, are a good indicator of this trend. In 2014, 29 per cent of emergency appeals were for protracted crises – where humanitarian response went on for five or more consecutive years. A decade later, that figure reached 91 per cent.   

In the Democratic Republic of Congo, South Sudan, Syria, Yemen and elsewhere, crises have lasted many years, even decades, with intertwined factors of conflict, ethnic disputes, political instability, mass displacement and climate-related disasters. Funding and delivering aid in these conditions has grown more challenging, leaving responders overstretched and vulnerable communities yet more vulnerable.   

At a time when countries should be urgently increasing their aid budgets to meet the scale of need, the opposite is happening. In 2025, the US closed its aid agency USAID and slashed its foreign aid budget by 80 per cent; Germany is cutting its foreign aid budget in half, the UK is reducing its budget by 40 per cent, and France by 37 per cent. Meanwhile, Australia’s aid budget sits at a historic low of 0.2 per cent of gross national income, well below the UN target of 0.7 per cent for developed countries. 

A healthy foreign aid budget can achieve significant advances in public health. “If we take some examples from southern Africa, where we started 25 years ago when HIV was a death sentence, the advances that have been made with the support of the international community are incredible, such that [HIV] is now a chronic disease like any other,” said Dr Tom Ellman, director of MSF’s Southern Africa Medical Unit.  

Historically, much of that support came from USAID.  

“Currently, there are almost 20 million people reliant on US funding for HIV globally,” he said. “The US provided over 70 per cent of global international support for HIV, and around 40 per cent for tuberculosis.”  

What that means for patients can be seen in the overnight collapse of a program for adolescent girls in Harare, Zimbabwe. It was a flagship program of  PEPFAR, the US President’s Emergency Plan for AIDS Relief, and supported 10 million girls in the region with sexual violence prevention, family planning, and HIV support. With no other support mechanism in the area, MSF programs have seen a surge in patients.   

It’s just one example of how a radical decrease in international funding will place enormous pressure on organisations like MSF. In settings where supply chains have collapsed, Dr Ellman stated that, although MSF is independent (i.e. MSF is funded by private donations and does not take government funding, so is not tied to any government’s agenda), we still work within an aid ecosystem and are therefore dependent on the Global Fund for the development, production and supply of medicines.  

The disappearance of funding – possible by year’s end – will reverse the clock on HIV treatment and acceptance.

“We will move back to where we were 10, 20 years ago,” he said.  

That concern is shared by Louise Roland-Gosselin Muamba, MSF’s global humanitarian affairs coordinator, based in Nairobi. “There have been a few months of shock for the humanitarian sector and the populations we assist, but not just because of the funding cuts, but because of the rhetoric that goes around it,” she said.  

“We are now seeing policies that are centring on national interest only. There’s a defunding and a deprioritisation of solidarity, of helping people based on need. And then reframing humanitarian aid as a tool and a transaction,” she said.  

As Dr Ellman explains, the most vulnerable populations and groups – people living with HIV, people identifying as LGBTQI+, and those seen to pose a threat to political and economic priorities – will bear the brunt of drastic change.  

“Communities, and especially vulnerable communities, have been targeted because it is part of the narrative behind some of the cuts – a deliberate targeting of certain groups,” he said.  

“And those groups were historically abandoned by their own governments. They were particularly dependent on foreign support – on US government, on EU support, and on organisations like ours to provide for their needs. The disappearance of that support has pulled the rug from under them. They were always resilient, always working in tension with their own governments, and now they’ve lost the last support they had.”  

“As we speak out – and we must continue – we will be ever more reliant on people whose trust we need, both to provide our services and exist,” Dr Ellman said. “I am hopeful that the model we have developed over the last 50 years, one that relies on communities and on independence, is one that will serve us ever more strongly in the future.”