A vast shipment of food stranded in containers risks rotting before it reaches millions of hungry people. Deliveries of life-saving medicines to remote rural clinics are paused. And thousands of HIV patients and sexual violence survivors are abruptly cut off from support.
Donald Trump’s executive order freezing USAid funding for 90 days has derailed multiple vital activities in Ethiopia. Although some life-saving programmes have received waivers, most have not, and USAid officials in the country are scrambling to secure exemptions for their work even as they are threatened with dismissal by Elon Musk’s “government efficiency” agency.
In 2023 Ethiopia received American aid worth more than $1bn as it grappled with drought and civil conflict, making it the largest recipient of US assistance in sub-Saharan Africa and the fifth biggest in the world.
Most of this money went on emergency humanitarian aid, from bags of grain, medications and high-energy biscuits for malnourished children, to water and tents for displaced people.
But USAid also invested hundreds of millions in strengthening Ethiopia’s hospitals, creating jobs and boosting literacy – projects to support the long-term development and stability of a country with 120 million people long seen by the US as its key partner in the Horn of Africa, a volatile region abutting the Red Sea’s strategic shipping lanes.
Ahmed Hussein from the Ethiopian Civil Society Organisations Council, which represents 4,400 local NGOs, said Trump’s abrupt order sent shockwaves through Ethiopia’s humanitarian community and gave them no time to seek alternative funding for life-saving work.
“This directly affects millions of Ethiopians,” Ahmed said. “If the funding does not resume, it could lead to deaths and an even larger humanitarian crisis in conflict-affected and food-insecure regions.”
Emergency food aid
Nearly 16 million Ethiopians relied on donated grain in 2024 and half its children were malnourished, as the country dealt with climate change shocks and civil strife. USAid was the single biggest donor of food, channelling it through the UN’s World Food Programme (WFP) and NGOs such as Catholic Relief Services.
Most of this is bought directly from American farmers and shipped to Ethiopia via Djibouti, in bags stamped with the American flag.
Even before the USAid freeze, agencies in Ethiopia were grappling with an unprecedented funding gap: last year, they only received 29% of the $3.2bn they needed. The WFP has already cut rations by 40% for nearly 800,000 refugees. In 2025, the number of people targeted for food assistance has been reduced to 5 million. This is partly because needs have lessened, but also because shortages have forced aid groups to cut back on assistance for all but the most needy. Humanitarian officials fear the USAid freeze could deepen this funding crisis even further.
Although life-saving food was exempt from Trump’s executive order, the WFP still needed to secure a wavier to continue distributing American grain, disrupting deliveries to millions of beneficiaries for a week.
These have now resumed. However, USAid’s payments system is offline and, as things stand, the agency will not be able to buy more food once its existing supplies in Ethiopia are finished.
This is already having an impact. Currently, 34,880 metric tonnes of sorghum, pulses and vegetable oil – enough to feed 2.1 million people for a month – are trapped in Djibouti’s port, at risk of spoiling before it reaches those in need because there is no money to pay contractors to bring it into Ethiopia.
34,880
Metric tonnes of sorghum, pulses and vegetable oil trapped in Djibouti
“There is a huge liquidity crisis,” a senior aid official in Ethiopia said. “Even if you have a waiver, there is limited money to pay for warehouses, guards or trucks. You risk a situation where thousands of bags of food can’t be distributed and will sit there, rotting or at risk of being looted.”
Healthcare
Health is USAid’s second biggest priority in Ethiopia, after emergency food, with the agency investing $200m a year in the country’s health system. These funds go to the ministry of health, which then distributes them to regional health bureaus. USAid also funds projects by aid agencies that tackle infectious diseases and malnutrition.
7.3m
Number of malaria cases in Ethiopia in 2024
Ethiopia’s disease burden is soaring after years of successful eradication efforts, which means – according to health officials – that the USAid freeze could not have come at a worse time. Malaria cases surged from 900,000 in 2019 to 7.3 million in 2024 owing to conflict, climate breakdown and funding shortfalls. Measles rose from just 1,941 cases in 2021 to 28,129 last year.
USAid funds went towards disease surveillance, treating fistulas, preventing malaria, funding cold storage units for medicines, reducing child and maternal health, and buying basic items like surgical gloves. Many of these activities have been stopped.
Tackling HIV/Aids was another major area of US investment. Nearly $3bn had been funnelled into Ethiopia to help with its response to the disease as of 2023.
Ethiopia’s health ministry may be forced to fire more than 5,000 employees hired with US help. A five-year project to train doctors, nurses, midwives and surgeons has been halted, as has the work of a polio vaccination programme, which means doses risk expiring before they can be put into children’s arms. USAid-funded programmes to deliver medications for HIV, tuberculosis and malaria to rural clinics are also on pause.
The Tesfa Social and Development Association (TSDA) is one of thousands of Ethiopian NGOs that received a stop-work order in January. The 17 staff of its US-funded project in the Amhara region helped 40,000 people with HIV, providing them with food, clothes and school equipment for their children.
These efforts alleviated poverty but also helped prevent destitute HIV-positive people from spreading the disease by turning to prostitution. They have now been stopped. The TSDA has also shelved plans to find foster homes for children orphaned by HIV and help HIV patients set up small businesses.
“We are still in complete shock,” said Dawit Melese, TDSA’s manager. “We gave the people we helped hope, but now I don’t know what will happen to our work. The impact has been devastating.”
Support for refugees
Ethiopia is home to more than 1 million people who fled war and repression in South Sudan, Somalia, Eritrea and Sudan, making it the third-biggest host country for refugees in Africa after Uganda and Chad.
$240m
Amount provided by US to help with hosting refugees in 2022 and 2023
The US provided $240m to help Ethiopia host refugees in 2022 and 2023. These funds went through the US state department, which has also frozen nearly all foreign assistance while pausing new aid.
US support for refugees in Ethiopia went beyond supplying food, tents, vaccinations, water and cooking equipment. One aid agency has had to halt work not deemed as “life-saving” such as counselling survivors of sexual violence, promoting hygiene practices to stop the spread of cholera, cash support to help people set up small businesses and upgrading water points so they are safe for humans and their livestock to use.
A worker at the agency described having to navigate “grey areas” in the waiver process. They can continue trucking water to refugees, for example, but do not know if they are allowed to lay water pipes, an intervention that would reduce costs in the long run.
Help for survivors of sexual abuse
Several projects providing therapy, shelter and other support to survivors of rape have been suspended. The US-based Centre for Victims of Torture (CVT), which runs five sites in Ethiopia’s Tigray region, has had to stop counselling and physiotherapy sessions for women raped in the devastating conflict that gripped northern Ethiopia between 2020 and 2022.
It also halted work on a programme that trained healthcare workers to recognise rape cases so survivors could receive proper treatment.
“We couldn’t believe it when we went into the office on 27 January and were told we had a stop-work order,” said Yohannes Fisseha, a CVT project coordinator in Tigray who has been furloughed without pay. “Mental health work needs a proper exit strategy: you have to communicate to the patients and end the work safely. Having to stop suddenly was shocking. It just adds to the survivor’s trauma.”
