Hours after taking office last week, United States President Donald Trump announced a temporary freeze on almost all foreign assistance as part of his “America First” agenda, pausing billions of dollars in global funding.

“President Trump stated clearly that the United States is no longer going to blindly dole out money with no return for the American people,” according to a statement from State Department spokesperson Tammy Bruce.

“Reviewing and realigning foreign assistance on behalf of hardworking taxpayers is not just the right thing to do, it is a moral imperative.”

The decision by the world’s single largest donor has sent shockwaves across the world, with aid groups warning that the move will put lives at risk. In 2023, Washington disbursed $72bn in foreign aid across nearly 180 countries.

Over the next three months, Secretary of State Marco Rubio will review and take a call on whether “to continue, modify, or terminate programmes “, according to a State Department memo.

Last Friday, Rubio sent a cable to embassies worldwide to halt the US projects supporting health, education, development, security assistance and other efforts.

Emergency food programmes, like the ones used to help people suffering from a widening famine in war-torn Sudan, are exempt, and so is military aid to close US allies Israel and Egypt.

The Associated Press reported that Rubio agreed to add more exemptions, allowing temporary funding for humanitarian programmes that provide life-saving medicines and food, among other services.

Rachel Bonnifield, a senior fellow at the Center for Global Development, told Al Jazeera that even “the most fervent advocates” of US aid could recognise that not all programmes work well and could be discontinued.

However, the abruptness of the implementation of the order has put people who rely on the aid in a “very compromised position where they might die”.

“It’s not hyperbolic to say that if a child gets malaria [and] shows up to the clinic that used to be run by the USAID programme, that clinic doesn’t exist any more. It’s closed and they don’t get medicine for malaria, that child could die,” she explained.

Here’s what we know about the pause in foreign assistance and its effects:

How is the aid split up and which countries get what?

A major chunk of US aid in 2023 was disbursed in the form of economic assistance ($59.9bn), with Ukraine receiving the most at $14.4bn from the US Agency for International Development (USAID).

The second-highest recipient, Jordan, received $770m in economic aid through USAID. Yemen and Afghanistan received $359.9m and $332m respectively.

The aid is disbursed through various federal departments such as the Pentagon and agencies such as USAID, which received the most funding at $42.45bn followed by the State Department ($19bn) and the Treasury ($2.17bn).

By sector, the most funding is given to economic development at $19bn. Health receives the second highest funding at $16bn while humanitarian aid stands at 15.6bn.

In addition to economic aid, the US gave $8.2bn in military aid to its allies across the world, nearly half of which was received by Israel and Egypt.

How much of total US aid goes to Egypt and Israel?

The US has committed to give Israel $3.8bn in annual military aid through 2028, according to a Memorandum of Understanding signed under President Barack Obama.

Additional military aid of $17.9bn was given to Israel amid the country’s devastating war on the Gaza Strip, according to a Brown University Costs of War report.

Since Israel’s founding in 1948, the US has given some $120bn in military assistance.

Egypt has been the second-highest receiver of US military aid at $1.2bn since the signing of the 1978 Camp David Accords, which saw Cairo becoming the first Arab country to recognise Israel.

The US has also provided Egypt with financial aid since the 1978 treaty.

Which initiatives get the most US aid?

Among the programmes that would be affected include the President’s Emergency Plan for AIDS Relief (PEPFAR), which received approximately $120bn since its launch in 2003. The world’s largest health programme, since its launch by President George W Bush, PEPFAR is believed to have saved 25 million lives, including 5.5 million children, in at least 50 countries.

AmfAR, the Foundation for AIDS Research, slammed the freeze on PEPFAR, saying that “hundreds of thousands of people will immediately be unable to access effective and life-saving HIV treatment and other services”.

The Aurum Institute, a nonprofit that works in Ghana, Mozambique and South Africa in global health research on HIV and tuberculosis, said it was “obliged” to stop activities on US-funded projects.

“We acknowledge the uncertainty you are experiencing and apologise deeply for the inconvenience. Aurum is committed to seeking solutions together with other partners to address the challenges as soon as possible,” the organisation said.

What is the reaction?

International aid organisations, including United Nations agencies, are scrambling to handle the situation, and some are rushing to cut expenditure.

Filippo Grandi, the UN high commissioner for refugees, sent out an overnight email to employees ordering an immediate clampdown on expenditure.

“We must proceed very carefully over the next few weeks to mitigate the impact of this funding uncertainty on refugees and displaced people, on our operations and on our teams,” he said in an internal email accessed by The Guardian news outlet.

The UN refugee agency, which received $2.49bn in US funding last year, provides life-saving assistance to 122 million people across at least 100 countries.

Abby Maxman, head of Oxfam America, said last week that the funding freeze “could have life-or-death consequences” for families worldwide. “By suspending foreign development assistance, the Trump administration is threatening the lives and futures of communities in crisis, and abandoning the United States’ long-held bipartisan approach to foreign assistance which supports people based on need, regardless of politics,” Maxman said in a statement.

On Monday, United Nations Secretary-General Antonio Guterres called for the US to consider additional exemptions to “ensure the continued delivery of critical development and humanitarian activities for the most vulnerable communities around the world”.

Meanwhile, The Associated Press reported that at least 56 senior officials in USAID were put on leave after scrambling to help aid organisations deal with the funding freeze, seek waivers to secure clean water and continue monitoring bird flu, an unnamed former USAID official said.

The entire cadre of leaders (about 60 officials) who run USAID’s Bureau for Global Health, for example, was put on leave, according to the Politico news outlet.

Florida Republican Brian Mast, the new House Foreign Affairs Committee chairman, said the freeze was necessary to ensure that “appropriations are not duplicated, are effective, and are consistent with President Trump’s foreign policy”.

Whether the 90-day aid review will be extended or shortened, or whether programmes get dissolved or restored as Rubio announces more waivers to the freeze is difficult to speculate, Bonnifield of the Center for Global Development told Al Jazeera.

“It could be anything from basically 99 percent of programmes get restored at the end of a review period … or it could be a much more sweeping realignment of the portfolio. I think at this point, we really have no idea where this is headed,” she said.

How US foreign aid has changed over the years

Washington has provided loans, technical assistance and direct budget support, particularly to developing countries to advance US interests for several decades.

In 2023, the Council on Foreign Relations (CFR), an American think tank on foreign policy, said that the US has used foreign aid ia “foreign policy tool”.

The US provided $13bn for the economic recovery of Western European nations as part of the Marshall Plan beginning in 1948 following the devastation of World War II. Washington also helped in the reconstruction of Japan and reforming its political institutions following Tokyo’s defeat in the second world war.

During the COVID-19 pandemic, the US committed $4bn in humanitarian assistance to provide vaccines to “92 low and middle-income countries”.

The US economic aid to Bangladesh has been affected by the latest freeze as the South Asian country recovers from the deadly August 2023 uprising that ousted Prime Minister Sheikh Hasina. Last year, Washington paused more than $95m in assistance to Georgia over a law that was dubbed anti-democratic.

“I think these pauses may end up changing the relationship other countries have with US assistance,” Bonnifield explained.

“If you don’t see it as reliable … it could be cut off one day to the next. You might still want it, but how you think about it and how you interact with it might look quite different. How it makes you think about America might also change to some extent,” she added.