The Trump administration is reorganising foreign aid at a fraction of its former size after dismantling USAID, a move critics say has cost millions of lives.

The State Department will announce Friday that aid is being consolidated under a new Disaster and Humanitarian Response bureau with a staff of more than 200 people, according to a senior official who spoke on the condition of anonymity to brief reporters.

A bureau of that size would be equivalent to about 5% of the direct-hire staff that worked at the now defunct agency, known as the US Agency for International Development, which President Donald Trump shuttered last year. Including locally hired staff in foreign countries and contractors, USAID had more than 10 000 people working on projects in 2024, the last year of the Biden administration.

The international humanitarian assistance budget for this year was slashed to $5.4-billion. By contrast, USAID managed around $43-billion overall in fiscal year 2023.

The Trump administration says it’s improving aid by maximising efficiencies, ending programs focused on climate and social issues and focusing on life-saving work. But the move reflects Trump’s shift away from overseas aid to more transactional and bilateral deals.

With reduced resources, it’s impossible for US foreign aid to have as much health impact as before, said Jeremy Konyndyk, president of Refugees International, a Washington-based advocacy group focused on humanitarian crises.

“It’s nowhere near the same quality and level of assistance, there are real costs and real damage that it’s doing, and the US is just doing far less,” said Konyndyk, who worked in senior USAID positions in the Biden and Obama administrations.

Dismantling USAID could result in about 14-million additional deaths by 2030, according to a study released in June in the prominent medical journal The Lancet. State Department officials rejected that conclusion, saying those forecasts were based on the mistaken assumption that the US would end foreign assistance rather than make it more efficient.

The Trump administration has focused more on work through the United Nations, pledging $2-billion to its humanitarian fund. It has also focused on global health deals to support foreign governments, although the New York Times reported earlier this week that the State Department is considering withholding lifesaving assistance to people with HIV in Zambia to compel the government to give the US more access to its critical minerals.

Asked to comment on the report, a State Department spokesperson cited longstanding US foreign assistance to Zambia and willingness to help improve health-care infrastructure in the country. The spokesperson also highlighted the need for the nation to modernise industries including mining to attract investment, and the Trump administration’s intention to use foreign aid to advance US strategic interests.