A dire warning from researchers at The Lancet medical journal says humanitarian aid, particularly in support of global public health systems, has been so reduced that it has become "rationing by design" and now demands an immediate overhaul.
The architecture of the humanitarian system has become so selective and difficult to access that it is merely "survival triage", more than three dozen researchers from the Johns Hopkins Center for Humanitarian Health and The Lancet Commission on health, conflict, and forced displacement argued in a report published on Wednesday.
The politicisation of aid - when it is linked to national security and foreign policy priorities - is a key factor in the breakdown of the system, particularly after US President Donald Trump returned to power in January 2025 and gutted the US Agency for International Development (USAID).
For decades, Washington had been the world's largest donor to humanitarian projects around the globe.
What began as a 90-day freeze on foreign assistance turned into an almost complete dismantling of American humanitarian efforts. By July 2025, USAID was fully shut down and its functions transferred to the State Department.
