As Donald Trump signed an executive order, everything changed for this clinic 13,000 kilometres away

The White House of former U.S. President Donald Trump is more than 13,000 kilometers away from the Umpiem Mai refugee camp on the Thai-Myanmar border, but it was his freeze on U.S. foreign aid that had the most devastating impact there. Located within the borders of Thailand, this refugee camp is home to more than 10,000 displaced people from conflict-ridden Myanmar.

Until recently, according to the U.S. Agency for International Development (USAID) program, U.S. taxpayer money had been used to pay the salaries of doctors and nurses, providing refugees with everything from basic health care to treatment for chronic diseases. However, due to the Trump administration's 90-day suspension of all foreign aid, these medical services came to an abrupt halt.

According to Sulaiman Mawlawi, a resident of the refugee camp, "International Rescue Committee staff came and ordered the immediate closure of the hospital. Medical staff left without even taking the equipment, and patients had to return home, some of them being carried out." He said that some patients who relied on oxygen support had died. A medical worker also confirmed his statement, saying, "This was a very tragic moment for us."

The International Rescue Committee (IRC) has been operating medical clinics in nine refugee camps along the Thai border, serving approximately 80,000 people. Trump's cost-cutting advisor, the world's richest man Elon Musk, once stated that "USAID is a criminal organization" and "USAID must die," foreshadowing a major overhaul for the agency that distributes $72 billion in U.S. government funds globally each year. The majority of this funding goes to Ukraine, Africa, the Middle East, and Central Asian countries like Afghanistan. The latest data shows that nearly $500 million was allocated to Southeast Asia and the Pacific region in 2023.

A former health worker, who wished to remain anonymous, stated that the medical services provided by U.S. taxpayers to the refugee camp were "essential" for the residents. "When they suddenly closed the hospital, pregnant women and patients with chronic diseases were turned out," she said. "This sudden shock caused a lot of suffering." Although U.S. Secretary of State Marco Rubio issued an exemption for "life-saving humanitarian assistance" on January 28, partially rescinding the suspension, the refugee camp's medical facilities remain closed, and USAID staff remain in a state of uncertainty.

The Trump administration has ordered global USAID partners to cease operations, causing confusion and panic among staff at organizations providing services. According to Reuters, the Trump administration stated that it would retain less than 300 of USAID's more than 10,000 employees worldwide. The closure of the clinics is having a ripple effect. In the nearby town of Mae Sot, Kanchana Thorton of the Myanmar Children's Medical Fund is responsible for referring patients to hospitals in Bangkok and Chiang Mai for surgery, including dozens of children referred from the refugee camps each year. With the suspension of IRC operations, those children in need of surgery are now in a precarious situation.

"We don't know if they can still go to Bangkok for heart surgery," she told the media. "A child cannot breathe, cannot walk, but after heart surgery, they are given a new lease on life. Isn't that money worth spending? To allow a person to stand up again?" It's not just health-related services that are affected. An NGO organizer, who only wished to be identified as May, said that a small grant (50,000 Thai baht, or approximately $2,373) to launch a shelter program for LGBT migrants at risk of abuse in the refugee camp was abruptly canceled in late January. Save the Children, the USAID partner that approved the grant, informed her that the program could not proceed due to the funding freeze.

May said that the initial grant would have made it easier to obtain funding from other sources. "The idea was to set up a few safe houses and train staff, but in order to apply for funding from other groups in the future, we needed to use this grant to start the first project to prove that it works," she told the media. She said that she knew of two other projects targeting Myanmar migrants or people still inside Myanmar that had also been suspended. Save the Children stated: "We remain firmly committed to serving the most vulnerable children in the world and are working urgently to minimize the impact of this transition on children. This includes resuming life-saving activities that are critical for children without delay."

The consequences of Trump's move are spreading throughout Southeast Asia, affecting everything from tuberculosis programs to infrastructure financing plans. USAID's commitment to Indonesia is approximately $150 million per year, the second largest in Southeast Asia, after Myanmar. The organization's Instagram page in Indonesia is an indication of the problem. After posting months of posts detailing the achievements of the USAID team in the country, including field visits to multiple provinces, training courses, and high-level meetings, the latest post is a notice canceling the recruitment of three contractor positions, including an infectious disease consultant and a tuberculosis program management expert.

Not all projects have stopped immediately. A representative of a tuberculosis organization that indirectly receives funding from USAID partner the Global Fund said that her monitoring and testing program in Indonesia is still ongoing. "In Indonesia, much of USAID's funding goes to capacity building, rather than on-site operations or the purchase of tuberculosis drugs," said Harumi Paramaiswari. "Most of it goes to what we call technical assistance, such as training on strategies for communicating with patients." But she said that at a tuberculosis organization meeting in Jakarta this week, many health workers were concerned that once the funds allocated to existing projects were used up, they might not be able to obtain further funding.

A representative of a medical group that operates 19 clinics in Southeast Asia and provides HIV treatment to 5,000 patients said that they would continue to operate, but would cut costs as much as possible. "We can't even get an answer as to whether our HIV [and] tuberculosis services are included in the recently released exemption for essential medicines and medical services," said the spokesperson, who wished to remain anonymous. "Thanks to the support of private donors, we can at least cope with this uncertainty in the short term," he said. "Only time will tell what the long-term impact will be and how we will adapt to this new reality."

The United States is by far the world's largest aid donor. According to the Lowy Institute's Southeast Asia Aid Map, the United States is the fifth largest development partner in Southeast Asia. But for aid grants rather than loans, the United States is the third largest donor in the region, after Japan and Germany. Roland Rajah, Director of the Lowy Institute's Indo-Pacific Development Centre, said that the United States invests heavily in health and governance. "Therefore, in specific areas, cuts to USAID funding will be felt more acutely," he said.

He said that China's funding to the region is mainly focused on loans for infrastructure projects, rather than grants that are traditionally considered aid. "China certainly has the opportunity to move into these civil society, education, and health sectors, but it doesn't even necessarily need to do so," he said. "The United States is actually shooting itself in the foot with these aid cuts. So, this is very strategically advantageous for China." Currently, USAID projects are temporarily suspended, rather than cut, but Musk said that Trump has agreed to close the agency, and he has used the X platform he owns to declare that "USAID must die."

Trump and his aides have said that they want to ensure that billions of dollars in humanitarian aid align with his "America First" agenda. Meanwhile, Secretary of State Marco Rubio has listed more "specially designated projects" to be exempt from the funding freeze, saying that he is looking for initiatives that align with U.S. national interests. "Those that don't will not continue," he said this week, emphasizing that many of the agency's functions will continue. Some in the aid sector believe that projects focusing on climate change, gender, diversity, and LGBT issues are unlikely to survive the U.S. funding overhaul.

"We know that this decision by USAID has already impacted specific climate-related work, and based on comments out of the U.S., we would anticipate that those projects are unlikely to restart after the pause," said Mathew Maury of the Australian Council for International Development. Many climate change projects are in Australia's direct region, where low-lying South Pacific nations have long expressed concerns about rising sea levels. "Australia wants to see these countries thrive and remain stable and secure, so if the U.S. doesn't pull its fair share in supporting that, Australia will have to fill that gap," Rajah said.

But it is unclear to what extent Australia is willing or able to fill this gap in nearby regions such as the Pacific and Southeast Asia. The Australian Department of Foreign Affairs and Trade (DFAT) declined to say whether Australia had raised any concerns with the Trump administration regarding the aid freeze. It also declined to say whether the government was considering increasing any aid to help make up for the shortfall, likely because it is still closely monitoring the progress of the review. "The decision to pause U.S. official development assistance for a policy review is a matter for the U.S. government," a DFAT spokesperson said. "Australia's development program is focused on being a partner of choice for our neighbors. This is critical to the prosperity, stability and security of our region."

Back on the Thai-Myanmar border, residents of the refugee settlement are confused by the anger of the new U.S. government over funding. Layla, a 36-year-old mother who relied on USAID-funded medical facilities to give birth to her four children, said that her access to contraception has been cut off and is unlikely to resume. But she is most concerned about what will happen to other pregnant women. "When I gave birth to my first child, my situation was critical, and they sent me to the hospital, and they saved our lives," she said. "I don't think these services are a waste of money. In fact, it is only since the U.S. president ordered the closure that we have realized how valuable these services are."