Ethiopia with its over 125 million people had been the biggest beneficiary of U.S. aid in sub-Saharan Africa, receiving $1.8 billion in the 2023 financial year.

In addition to life-saving food, the funds were spent on HIV medications, vaccines, literacy programs and jobs creation, as well as services for 1 million refugees hosted by Ethiopia.

Most of these programs have been stopped. The USAID staffers who oversaw them have been placed on administrative leave and told not to work, as they face the threat of termination. The U.S. Embassy didn’t respond to questions.

Emergency food was exempted from President Donald Trump’s executive order, signed on his first day in office, suspending foreign aid during a 90-day review amid the administration’s allegations of waste.

As a result, a consortium of aid agencies in Tigray has had to stop distributions to the over 1 million people it has been responsible for feeding with U.S.-provided grain. It has no money to pay for fuel, trucks and drivers to distribute existing food stockpiles.

That includes 5,000 metric tons of sorghum – enough to feed 300,000 people for a month – stuck in a storage facility in Mekele that could rot before it reaches those in need.

“This is just one warehouse. There are several others across the region,” said Teklewoini Assefa, head of the Relief Society of Tigray, part of the consortium.

“This will create malnutrition, disease. If this situation continues, what follows? Death.”

He added: “Everything boils down to the payment system.”

The effects of the aid cuts are widespread, with many USAID contracts terminated.

Already, Ethiopia has been forced to lay off 5,000 local healthcare workers who were working on its HIV response.

Tigray relied heavily on U.S. funds. More than two years after the war killed hundreds of thousands, full-scale recovery efforts are yet to start. The region’s health system is in ruins and hundreds of schools remain closed.

In 2024, child malnutrition stood at 21 per cent in some areas, according to a survey reviewed by The Associated Press – far above the World Health Organisation’s threshold of 15 per cent at which a situation is classified as an emergency.

Now, aid workers say many programs to improve nutrition have halted. Projects to deliver medicines and vaccines have stopped. Dozens of camps for displaced people have had water sources cut off.

“The impact has been huge,” said Ashenafi Asmelash, executive director of Mums for Mums, which has had two USAID- funded programs terminated.

One helped build long-term resilience among farmers. The other helped improve the nutrition of children and new mothers.

Management Sciences for Health, another Tigray organisation, has halted a project to combat tuberculosis and told its staff to expect mass layoffs in March, according to a senior executive, who spoke on condition of anonymity for fear of reprisals.

Efforts to assist thousands of women who were raped during the war have been derailed, said Rigat Bishaw at Ayder Hospital, Tigray’s biggest healthcare facility.

This includes counselling and physiotherapy sessions for survivors run by the U.S.-based Centre for Victims of Torture, which received a stop-work order from the Trump administration in February and furloughed its staff.

CVT also halted a program to train health workers to recognise sexual abuse cases and refer survivors to appropriate health services.

“This sudden disruption is having a huge impact on the healing of traumatised people,” said Yohannes Fisseha, a CVT manager.

Major projects to support people living with HIV, improve access to life-saving nutrition services and improve relations between war-affected communities have also been cut off, said Yirga Gebregziabher, the Tigray branch manager of an Ethiopian organisation called OSSHD, which helped implement the projects.

The organisation has been forced to fire dozens of expert staff.

“Our picture of America was as a protector of rights, a positive force in the world,” Yigra said.

“That image has now been broken. If there was a process, maybe the shock would have been less. But there was no consultation, no engagement.”