WASHINGTON (AP) — Dozens of senior officials put on leave. Thousands of contractors laid off. A freeze put on billions of dollars in humanitarian assistance to other countries.

Over the last two weeks, President Donald Trump’s administration has made significant changes to the U.S. agency charged with delivering humanitarian assistance overseas that has left aid organizations agonizing over whether they can continue with programs such as nutritional assistance for malnourished infants and children.

Then-President John F. Kennedy established the U.S. Agency for International Development, known as USAID, during the Cold War. In the decades since, Republicans and Democrats have fought over the agency and its funding.

Here’s a look at USAID, its history and the changes made since Trump took office.

What is USAID?

Kennedy created USAID at the height of the United States’ Cold War struggle with the Soviet Union. He wanted a more efficient way to counter Soviet influence abroad through foreign assistance and saw the State Department as frustratingly bureaucratic at doing that.

Congress passed the Foreign Assistance Act and Kennedy set up USAID as an independent agency in 1961.

USAID has outlived the Soviet Union, which fell in 1991. Today, supporters of USAID argue that U.S. assistance in countries counters Russian and Chinese influence. China has its own “belt and road” foreign aid program worldwide operating in many countries that the U.S. also wants as partners.

Critics say the programs are wasteful and promote a liberal agenda.

What’s going on with USAID?

On his first day in office Jan. 20, Trump implemented a 90-day freeze on foreign assistance. Four days later, Peter Marocco — a returning political appointee from Trump’s first term — drafted a tougher than expected interpretation of that order, a move that shut down thousands of programs around the world and forced furloughs and layoffs.

Secretary of State Marco Rubio has since moved to keep more kinds of strictly life-saving emergency programs going during the freeze. But confusion over what programs are exempted from the Trump administration’s stop-work orders — and fear of losing U.S. aid permanently — is still freezing aid and development work globally.

Dozens of senior officials have been put on leave, thousands of contractors laid off, and employees were told Monday not to enter its Washington headquarters. And USAID’s website and its account on the X platform have been taken down.

It’s part of a Trump administration crackdown that’s hitting across the federal government and its programs. But USAID and foreign aid are among those hit the hardest.

Rubio said the administration’s aim was a program-by-program review of which projects make “America safer, stronger or more prosperous.”

The decision to shut down U.S.-funded programs during the 90-day review meant the U.S. was “getting a lot more cooperation” from recipients of humanitarian, development and security assistance, Rubio said.

What do critics of USAID say?

Republicans typically push to give the State Department — which provides overall foreign policy guidance to USAID — more control of its policy and funds. Democrats typically promote USAID autonomy and authority.

Funding for United Nations agencies, including peacekeeping, human rights and refugee agencies, have been traditional targets for Republican administrations to cut. The first Trump administration moved to reduce foreign aid spending, suspending payments to various U.N. agencies, including the U.N. Population Fund and funding to the Palestinian Authority.

In Trump’s first term, the U.S. pulled out of the U.N. Human Rights Council and its financial obligations to that body. The U.S. is also barred from funding the U.N. agency for Palestinian refugees, or UNRWA, under a bill signed by then-President Joe Biden last March.

Why is Elon Musk going after USAID?

Musk’s Department of Government Efficiency, known as DOGE, has launched a sweeping effort empowered by Trump to fire government workers and cut trillions in government spending. USAID is one of his prime targets. Musk alleges USAID funding been used to launch deadly programs and called it a “criminal organization.”

What is being affected by the USAID freeze?

Sub-Saharan Africa could suffer more than any other region during the aid pause. The U.S. gave the region more than $6.5 billion in humanitarian assistance last year. HIV patients in Africa arriving at clinics funded by an acclaimed U.S. program that helped rein in the global AIDS epidemic of the 1980s found locked doors.

There are also already ramifications in Latin America. In Mexico, a busy shelter for migrants in southern Mexico has been left without a doctor. A program to provide mental health support for LGBTQ+ youth fleeing Venezuela was disbanded.

In Colombia, Costa Rica, Ecuador and Guatemala, so-called “Safe Mobility Offices” where migrants can apply to enter the U.S. legally have shuttered.

The aid community is struggling to get the full picture—how many thousands of programs have shut down and how many thousands of workers were furloughed and laid off under the freeze?

How much does the U.S. spend on foreign aid?

In all, the U.S. spent about roughly $40 billion in foreign aid in the 2023 fiscal year, according to a report published last month by the nonpartisan Congressional Research Service.

The U.S. is the largest provider of humanitarian assistance globally, although some other countries spend a bigger share of their budget on it. Foreign assistance overall amounts to less than 1% of the U.S. budget.

Could Trump dissolve USAID on his own?

Democrats say presidents lack the constitutional authority to eliminate USAID. But it’s not clear what would stop him from trying.

A mini-version of that legal battle played out in Trump’s first term, when he tried to cut the budget for foreign operations by a third.

When Congress refused, the Trump administration used freezes and other tactics to cut the flow of funds already appropriated by Congress for the foreign programs. The General Accounting Office later ruled that violated a law known as the Impoundment Control Act.

It’s a law we may be hearing more of.

“Live by executive order, die by executive order,” Musk said on X Saturday in reference to USAID.

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Kinnard reported from Houston. Knickmeyer can be reached at https://x.com/EllenKnickmeyer and Kinnard can be reached at http://x.com/MegKinnardAP.

Ellen Knickmeyer And Meg Kinnard, The Associated Press

GENEVA (AP) — The World Health Organization chief asked global leaders to lean on Washington to reverse President Donald Trump’s decision to withdraw from the U.N. health agency, insisting in a closed-door meeting with diplomats last week that the U.S. will miss out on critical information about global disease outbreaks.

But countries also pressed WHO at a key budget meeting last Wednesday about how it might cope with the exit of its biggest donor, according to internal meeting materials obtained by The Associated Press. A German envoy, Bjorn Kummel, warned: “The roof is on fire, and we need to stop the fire as soon as possible.”

For 2024-2025, the U.S. is WHO’s biggest donor by far, putting in an estimated $988 million, roughly 14% of WHO’s $6.9 billion budget.

A budget document presented at the meeting showed WHO’s health emergencies program has a “heavy reliance” on American cash. “Readiness functions” in WHO’s Europe office were more than 80% reliant on the $154 million the U.S. contributes.

The document said U.S. funding “provides the backbone of many of WHO’s large-scale emergency operations,” covering up to 40%. It said responses in the Middle East, Ukraine and Sudan were at risk, in addition to hundreds of millions of dollars lost by polio-eradication and HIV programs.

The U.S. also covers 95% of WHO’s tuberculosis work in Europe and more than 60% of TB efforts in Africa, the Western Pacific and at the agency headquarters in Geneva, the document said.

At a separate private meeting on the impact of the U.S. exit last Wednesday, WHO finance director George Kyriacou said if the agency spends at its current rate, the organization would “be very much in a hand-to-mouth type situation when it comes to our cash flows” in the first half of 2026. He added the current rate of spending is “something we’re not going to do,” according to a recording obtained by the AP.

Since Trump’s executive order, WHO has attempted to withdraw funds from the U.S. for past expenses, Kyriacou said, but most of those “have not been accepted.”

The U.S. also has yet to settle its owed contributions to WHO for 2024, pushing the agency into a deficit, he added.

WHO’s leader wants to bring back the US

Last week, officials at the U.S. Centers for Disease Control and Prevention were instructed to stop working with WHO immediately.

WHO Director-General Tedros Adhanom Ghebreyesus told the attendees at the budget meeting that the agency is still providing U.S. scientists with some data — though it isn’t known what data.

“We continue to give them information because they need it,” Tedros said, urging member countries to contact U.S officials. “We would appreciate it if you continue to push and reach out to them to reconsider.”

Among other health crises, WHO is currently working to stop outbreaks of Marburg virus in Tanzania, Ebola in Uganda and mpox in Congo.

Tedros rebutted Trump’s three stated reasons for leaving the agency in the executive order signed on Jan. 20 — Trump’s first day back in office. In the order, the president said WHO mishandled the COVID-19 pandemic that began in China, failed to adopt needed reforms and that U.S. membership required “unfairly onerous payments.”

Tedros said WHO alerted the world in January 2020 about the potential dangers of the coronavirus and has made dozens of reforms since — including efforts to expand its donor base.

Tedros also said he believed the U.S. departure was “not about the money” but more about the “void” in outbreak details and other critical health information that the United States would face in the future.

“Bringing the U.S. back will be very important,” he told meeting attendees. “And on that, I think all of you can play a role.”

Kummel, a senior advisor on global health in Germany’s health ministry, described the U.S. exit as “the most extensive crisis WHO has been facing in the past decades.”

He also asked: “What concrete functions of WHO will collapse if the funding of the U.S. is not existent anymore?”

Officials from countries including Bangladesh and France asked what specific plans WHO had to deal with the loss of U.S. funding and wondered which health programs would be cut as a result.

The AP obtained a document shared among some WHO senior managers that laid out several options, including a proposal that each major department or office might be slashed in half by the end of the year.

WHO declined to comment on whether Tedros had privately asked countries to lobby on the agency’s behalf.

Experts say US benefits from WHO

Some experts said that while the departure of the U.S. was a major crisis, it might also serve as an opportunity to reshape global public health.

Less than 1% of the U.S. health budget goes to WHO, said Matthew Kavanagh, director of Georgetown University’s Center for Global Health Policy and Politics. In exchange, the U.S. gets “a wide variety of benefits to Americans that matter quite a bit,” he said. That includes intelligence about disease epidemics globally and virus samples for vaccines.

Kavanagh also said the WHO is “massively underfunded,” describing the contributions from rich countries as “peanuts.”

WHO emergencies chief Dr. Michael Ryan said at the meeting on the impact of the U.S. withdrawal last week that losing the U.S. was “terrible,” but member states had “tremendous capacity to fill in those gaps.”

Ryan told WHO member countries: “The U.S. is leaving a community of nations. It’s essentially breaking up with you.”

Kavanagh doubted the U.S. would be able to match WHO’s ability to gather details about emerging health threats globally, and said its exit from the agency “will absolutely lead to worse health outcomes for Americans.”

“How much worse remains to be seen,” Kavanagh said.

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Cheng reported from Toronto.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Maria Cheng And Jamey Keaten, The Associated Press