US foreign aid freeze threatens health care services for Sudanese refugees in Chad

Sudanese refugees living in Chad likely didn't think the most recent U.S. presidential election would impact them, but President Donald Trump's foreign aid freeze has put in jeopardy vital health care services provided by the U.N. to refugees living in displacement camps fleeing the Sudanese conflict in eastern Chad.

The U.S. foreign aid freeze, which has massive implications for the world's poorest and most vulnerable populations, has caused vital services around the world to come to a screeching halt, and it's left aid organizations scrambling to fill funding gaps for programs that have lifesaving implications. At less than 1% of the federal budget, the U.S. Agency for International Development assisted 130 countries in fiscal year 2023, according to the Congressional Research Service.

The Trump Administration has repeatedly said they are freezing foreign aid and shutting down USAID to cut down on the size of the federal government. Secretary of State Marco Rubio announced the administration had finished a six-week purge of programs at USAID last week, cutting 83% of the agency’s programs. Rubio announced the process was complete in a post on X.

Elon Musk said he was “feeding USAID into the wood chipper,” in a post on X on Feb. 3. A federal judge ruled on Tuesday that Elon Musk’s Department of Government Efficiency likely violated the constitution in its dismantling of USAID.

"I've been in humanitarian work for 25 years, and this is the worst thing I've ever experienced in terms of just pulling the plug overnight on operations in dozens of countries, and just having to suddenly stop work. It's very, very difficult if you're running maternity wards and entire safe houses, like how do you shut that down overnight?" Anna Jefferys, a U.N. communications specialist, told ABC News.

Almost 700,000 refugees have crossed from Sudan into Chad since April 2023 when the ongoing conflict in Sudan broke out, according to the U.N. While Chad has a history of taking in refugees from neighboring countries experiencing violence, the Sudanese conflict has resulted in one of the largest influxes of refugees in Chad's history. Ninety percent of the refugees are women and children, according to the U.N.

The women in Chad are just one example of how the U.S. foreign aid freeze is limiting lifesaving services to some of the world's most vulnerable populations.

'One day, everything changed'

"In Sudan, I have a big family and have a happy family. I worked at a university. So everything was good. But one day, everything changed," Daralssalam Issa, a 41-year-old displaced woman living in a refugee camp in Chad, told the U.N. "When they came, they closed schools and hospitals and water went away. We stayed for 40 days like this. [After] that, we go away and ask for water, asking for food, asking for hospital."

Issa, like thousands of other women who have fled the Sudanese conflict in Chad, left her home country because it was unsafe. In eastern Chad, the U.N. Population Fund, or UNFPA, supports the health care system by training and deploying midwives to rural areas where there are no health services and by providing mobile clinics and health care support inside refugee camps where women need services most. UNFPA’s team in Chad filmed interviews with some of the midwives and staff working in Chad and some of the refugees in the camps. UNFPA gave media access to the footage and interviews.

The health system in Sudan has all but collapsed due to the ongoing violence, with up to 60% of the population unable to access health services, the U.N. reports. UNFPA, which receives 70% of its funding for its humanitarian response in eastern Chad from the State Department, in the amount of about $2 million, is one of the humanitarian organizations closing that health care services gap for pregnant women fleeing Sudan in search of a safe place to live and give birth to their unborn children.

"It's lifesaving. It's essential work," Yewande Odia, UNFPA resident representative in Chad, told ABC News in a video interview. "Too many women in this country don't have access to good health care, so having access to health care means sometimes going to them."

UNFPA's program in Chad funds and pays for the salaries of 148 community midwives and 100 case workers who provide direct medical support to Sudanese refugees and other women and girls displaced by conflict in areas in Chad where they would otherwise not have access to health care. UNFPA also has mobile clinics that service areas without any other form of health care. Over 80% of the refugee population is made up of women and girls, Odia said.

Soliri Adete, 32, works as a UNFPA midwife in the maternity ward at the district hospital in Adre. Adre, once a small border town with a population of 40,000, now has a population of 230,000 due to the migration of Sudanese refugees, according to the U.N.

"Every day I come in to the hospital and the goal of coming to the hospital is to help my sisters who are ill and suffering," Adete said in a video filmed by the U.N. "I come to help them recover their health and also to help those who are victims of sexual violence."

Farchana is one of the refugee camps in eastern Chad where refugees are relocated from Adre, the U.N. said. There is no hospital at the camp, but UNFPA-funded and trained midwives help pregnant Sudanese refugees fleeing the conflict have safe births. Chad has the second-highest maternal mortality rate in the world, with 1,063 maternal deaths per 100,000 live births, according to U.N. data.

"Here at the camp, we don't have any hospital and we don't have an ambulance vehicle to rescue pregnant women. We struggle with these pregnant women to deliver," 39-year-old Souat Oumar, who works as the Women's Community Leader at Farchana Camp, told the U.N. "Sometimes they come to me personally at home. ... Sometimes the women might be bleeding seriously or has a miscarriage or other fatal issues. From that, some women might pass away."

Preventing women from dying during childbirth is one of UNFPA's main objectives in their work in eastern Chad.

"We have had a huge impact in ensuring that women have safe deliveries," Odia said. "Women are having children at quite a high rate, so it's a need that we are here to support, to ensure that they are not dying when they're having babies."

The U.S. foreign aid freeze has caused UNFPA to search for alternative funding to pay these midwives, but Odia warned that if the freeze isn't lifted by the end of March, they will be unable to pay the midwives, and the services will stop.

"The midwives will not be paid, and that means that the services that they provide for reproductive health, for victims of violence, will stop," Odia said. "It's hard to imagine how we would be able to address this gap, this huge gap, which will happen if we don't continue to get funding, adequate funding."

Odia said if no other funding is found, the consequences could be dire.

"We're hoping that there will be a review, and that hopefully the funding will be continued. However, if it is not, it really means that salaries will not be paid, and it means that services will not be provided to those who need them, and it also means that the death rates, the maternal mortality rates in Chad will go up," Odia said.

Humanitarian waivers

U.S. Secretary of State Marco Rubio announced humanitarian waivers would be issued to USAID and State Department programs that have lifesaving implications shortly after the U.S. foreign aid freeze went into effect. UNFPA and other aid organizations have applied for these waivers, but the response has been chaotic, sources told ABC News.

"We did try to apply" for the waiver, "because we've been very confused," Odia said. "There's been a lot of back and forth. ... We're hoping that something good comes out."

A senior aid official who works for an international nonprofit organization that receives U.S. funding for 38 programs globally told ABC News applying for the waivers was very confusing, and the organization had not received any indication their funding was unfrozen.

"Basically, emergency health care, emergency nutrition, emergency water and sanitation projects, these have all been in theory permitted to restart," a senior aid official who did not want to be named for fear of retribution told ABC News on the phone. "There doesn't seem to be a logic, right? I can only assume that it's all chaos over there."