{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:07:57Z","timestamp":1779808077973,"version":"3.53.1"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The abrupt withdrawal of humanitarian aid in early 2025 has destabilized health systems across sub-Saharan Africa, yet little is known about the frontline realities of these cuts in refugee-hosting settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To explore health care practitioners\u2019 perspectives and experiences of how reductions in global health funding have affected services and refugee health and to identify practitioner recommendations for sustaining care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This qualitative study used semistructured, in-depth interviews conducted in July 2025 at 6 health facilities within Nakivale Refugee Settlement, Uganda. Participants were health care practitioners representing diverse cadres and facility sizes.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Reduction of humanitarian aid.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were health care practitioners\u2019 perspectives on the impacts of funding reductions, including changes in service delivery, supply availability, staff conditions, and anticipated future health trends, as well as their recommendations to mitigate harms. Rapid qualitative techniques and thematic analysis were used to analyze responses to obtain actionable implications systematically and efficiently.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The 26 participants (mean [SD] age, 30.92 [3.52] years; 16 men [61.5%]) had a mean (SD) duration in practice of 6.80 (2.65) years, with a mean (SD) of 3.09 (1.92) years in Nakivale. Interviews yielded 4 overarching themes and 18 subthemes: (1) reductions in health care services (HIV and tuberculosis services, nutritional support, maternal health, immunization adherence, inpatient and outpatient care, and perceptions of service availability), (2) supply shortages (medical supplies, transportation fuel, and household support), (3) deteriorating staff conditions (staff reduction, workload and burnout, and resilience), and (4) future predictions and recommendations (disease patterns, migration patterns, bridging the funding gap, and general settlement conditions).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This qualitative study examined the cascading outcomes of humanitarian aid withdrawal on refugee health care through the voices of frontline practitioners. Their testimonies underscored urgent priorities for restoring and retargeting aid\u2014investing in high-impact levers, strengthening local leadership, and advancing policy reforms\u2014to safeguard refugee health and system resilience, while reminding us of the shared human stakes of humanitarian policy and the global responsibility to act.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.15000","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:01:39Z","timestamp":1779807699000},"page":"e2615000","source":"Crossref","is-referenced-by-count":0,"title":["Global Aid Cuts and Local Health Consequences in Nakivale Refugee Settlement, Uganda"],"prefix":"10.1001","volume":"9","author":[{"given":"HaEun","family":"Lee","sequence":"first","affiliation":[{"name":"School of Nursing, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Bjelland","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"Wallace","sequence":"additional","affiliation":[{"name":"Medical School, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donath","family":"Asiimire","sequence":"additional","affiliation":[{"name":"Department of Economics, Statistics, and Tourism Management, Bishop Stuart University, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred Sheldon","family":"Mwesigwa","sequence":"additional","affiliation":[{"name":"Department of Humanities, Bishop Stuart University, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"zoi260431r1","doi-asserted-by":"publisher","DOI":"10.1002\/pad.70011","article-title":"The death of USAID: how Elon Musk and Donald Trump ended America\u2019s foreign aid agency.","author":"Moynihan","year":"2025","journal-title":"Public Admin Dev"},{"issue":"10501","key":"zoi260431r3","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/S0140-6736(25)01240-1","article-title":"Tracking development assistance for health, 1990-2030: historical trends, recent cuts, and outlook.","volume":"406","author":"Apeagyei","year":"2025","journal-title":"Lancet"},{"issue":"10500","key":"zoi260431r4","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/S0140-6736(25)01186-9","article-title":"Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis.","volume":"406","author":"Cavalcanti","year":"2025","journal-title":"Lancet"},{"issue":"4","key":"zoi260431r7","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/S2352-4642(25)00068-9","article-title":"USAID funding freeze fails children globally.","volume":"9","author":"Balakrishnan","year":"2025","journal-title":"Lancet Child Adolesc Health"},{"issue":"2","key":"zoi260431r12","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3390\/venereology4020008","article-title":"The cost of cutbacks: how reduction in development assistance for health may affect progress made in HIV\/AIDS control in Africa.","volume":"4","author":"Nketia","year":"2025","journal-title":"Venereology"},{"issue":"9","key":"zoi260431r14","doi-asserted-by":"publisher","first-page":"E1517","DOI":"10.1016\/S2214-109X(25)00232-3","article-title":"The potential impact of reductions in international donor funding on tuberculosis in low-income and middle-income countries: a modelling study.","volume":"13","author":"Clark","year":"2025","journal-title":"Lancet Glob Health"},{"issue":"10488","key":"zoi260431r15","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1016\/S0140-6736(25)00151-5","article-title":"The 2025 report of the Lancet Countdown to 2030 for women\u2019s, children\u2019s, and adolescents\u2019 health: tracking progress on health and nutrition.","volume":"405","author":"Amouzou","year":"2025","journal-title":"Lancet"},{"issue":"1","key":"zoi260431r16","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12963-025-00376-y","article-title":"Measuring population health impact of the Trump administration\u2019s withdrawal from WHO and cuts to USAID: time to start counting.","volume":"23","author":"Hussein","year":"2025","journal-title":"Popul Health Metr"},{"issue":"10488","key":"zoi260431r17","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1016\/S0140-6736(25)00558-6","article-title":"Broken promises: the USA foreign aid freeze threatens women\u2019s, children\u2019s, and adolescents\u2019 health.","volume":"405","author":"Martinez-Alvarez","year":"2025","journal-title":"Lancet"},{"key":"zoi260431r18","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s43621-024-00645-0","article-title":"Sustainable development goals in Africa: perspective from U.S. aid.","volume":"5","author":"Yan","year":"2024","journal-title":"Discov Sustain"},{"key":"zoi260431r19","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1080\/10242694.2020.1773602","article-title":"US refugee aid and civil conflict.","volume":"32","author":"Lehmann","year":"2021","journal-title":"Def Peace Econ"},{"issue":"5","key":"zoi260431r20","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/j.ajcnut.2025.02.020","article-title":"A shock to the global nutrition system: why nutrition scientists should challenge the dismantling of the United States Agency for International Development and the United States\u2019 withdrawal from the World Health Organization.","volume":"121","author":"Locks","year":"2025","journal-title":"Am J Clin Nutr"},{"issue":"5","key":"zoi260431r21","doi-asserted-by":"publisher","first-page":"e820","DOI":"10.1016\/S2214-109X(25)00058-0","article-title":"The impact of aid sanctions on maternal and child mortality, 1990-2019: a panel analysis.","volume":"13","author":"Gibson","year":"2025","journal-title":"Lancet Glob Health"},{"issue":"6","key":"zoi260431r22","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"4","key":"zoi260431r23","doi-asserted-by":"publisher","first-page":"669","DOI":"10.4300\/JGME-D-15-00414.1","article-title":"Choosing a qualitative research approach.","volume":"7","author":"Teherani","year":"2015","journal-title":"J Grad Med Educ"},{"issue":"4","key":"zoi260431r24","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An ecological perspective on health promotion programs.","volume":"15","author":"McLeroy","year":"1988","journal-title":"Health Educ Q"},{"issue":"10","key":"zoi260431r25","doi-asserted-by":"publisher","first-page":"1596","DOI":"10.1177\/1049732320921835","article-title":"Rapid techniques in qualitative research: a critical review of the literature.","volume":"30","author":"Vindrola-Padros","year":"2020","journal-title":"Qual Health Res"},{"issue":"10","key":"zoi260431r26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019993","article-title":"Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? a mixed methods study comparing rapid and thematic analysis.","volume":"8","author":"Taylor","year":"2018","journal-title":"BMJ Open"},{"issue":"4","key":"zoi260431r28","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization.","volume":"52","author":"Saunders","year":"2018","journal-title":"Qual Quant"},{"key":"zoi260431r29","doi-asserted-by":"publisher","first-page":"e266","DOI":"10.1016\/S1473-3099(25)00245-2","article-title":"Gavi under threat from US funding cuts.","volume":"25","author":"Burki","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"zoi260431r31","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.47772\/IJRISS.2025.90300176","article-title":"The power of incentives: examining the impact of rewards on immunization attitudes in humanitarian contexts.","volume":"IX","author":"Okoli","year":"2025","journal-title":"Int J Res Innov Soc Sci"},{"issue":"8","key":"zoi260431r36","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2025-019929","article-title":"Operationalising health in the humanitarian-development-peace nexus (HDPN) in Africa: a new framework for building resilience in countries with fragile, conflict and violence-affected settings.","volume":"10","author":"Talisuna","year":"2025","journal-title":"BMJ Glob Health"},{"key":"zoi260431r37","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1093\/rsq\/hdad022","article-title":"When legal inclusion is not enough: the \u201cUganda Model\u201d of refugee protection on the brink of failure.","volume":"43","author":"Grzeskowiak","year":"2024","journal-title":"Refug Surv Q"},{"key":"zoi260431r38","article-title":"Enhancing capacities of community saving and credit groups towards improvement of socio-economic livelihoods of women in Nakivale refugee settlement: an action research.","author":"Andrew","journal-title":"Am Res J Humanit Soc Sci. 2024;7(6):155-186"},{"key":"zoi260431r2","unstructured":"Segawa? N. Without USAID support, refugees in Uganda lose food, job training. Global Press Journal. February 7, 2025. Accessed April 16, 2026. https:\/\/globalpressjournal.com\/africa\/uganda\/without-usaid-support-refugees-uganda-lose-food-job-training\/"},{"key":"zoi260431r5","unstructured":"Thomason? K. As global aid abandons Ugandan refugees, refugee-led organizations present a promising path forward. Refugees International. July 24, 2025. Accessed April 16, 2026. https:\/\/www.refugeesinternational.org\/perspectives-and-commentaries\/as-global-aid-abandons-ugandan-refugees-refugee-led-organizations-present-a-promising-path-forward\/"},{"key":"zoi260431r6","unstructured":"UNHCR Division of External Relations. Global funding overview for 2025. April 30, 2025. Accessed April 16, 2026. https:\/\/www.unhcr.org\/media\/global-funding-overview-2025"},{"key":"zoi260431r8","unstructured":"UNHCR. Uganda: refugee statistics March 2026. Accessed April 17, 2026. https:\/\/data.unhcr.org\/en\/documents\/details\/121879?"},{"key":"zoi260431r9","unstructured":"Sandefur? J, Kenny? C. USAID cuts: new estimates at the country level. Center for Global Development. March 26, 2025. Accessed April 16, 2026. https:\/\/www.cgdev.org\/blog\/usaid-cuts-new-estimates-country-level"},{"key":"zoi260431r10","unstructured":"UNHCR. On the brink: the devastating toll of aid cuts on people forced to flee. July 18, 2025. Accessed April 16, 2026. https:\/\/www.unhcr.org\/media\/brink-devastating-toll-aid-cuts-people-forced-flee"},{"key":"zoi260431r11","unstructured":"Nsimenta? B. Trump administration nails final coffin on Uganda\u2019s heathcare hope with USAID closure. Nilepost News. July 2, 2025. Accessed April 16, 2026. https:\/\/nilepost.co.ug\/health\/269549\/trump-administration-nails-final-coffin-on-ugandas-heathcare-hope-with-usaid-closure"},{"key":"zoi260431r13","unstructured":"UNHCR. Uganda: refugee statistics March 2026\u2014settlement profiles. Accessed April 17, 2026. https:\/\/data.unhcr.org\/en\/documents\/details\/121878"},{"key":"zoi260431r27","unstructured":"UNHRC. Uganda settlement profiles. February 2026. Accessed April 16, 2026. https:\/\/data.unhcr.org\/en\/documents\/details\/121376"},{"key":"zoi260431r30","unstructured":"Perry? J. The impacts of USAID cuts: less climate resilience, more forced displacement. Refugees International. April 29, 2025. Accessed April 16, 2026. https:\/\/www.refugeesinternational.org\/reports-briefs\/the-impacts-of-usaid-cuts-less-climate-resilience-more-forced-displacement\/"},{"key":"zoi260431r32","unstructured":"World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. November 28, 2016. Accessed April 16, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789241549912"},{"key":"zoi260431r33","unstructured":"Africa Centres for Disease Control and Prevention. The Durban Promise: moving toward self-reliance to achieve universal health coverage and health security in Africa. October 27, 2025. Accessed April 16, 2026. https:\/\/africacdc.org\/download\/the-durban-promise-moving-toward-self-reliance-to-achieve-universal-health-coverage-and-health-security-in-africa\/"},{"key":"zoi260431r34","unstructured":"Muller? N. Nigeria approves $200M to \u2018fill the gap\u2019 from US aid cuts. February 14, 2025. Accessed April 16, 2026. https:\/\/www.dw.com\/en\/nigeria-approves-200m-to-offset-shortfall-from-us-aid-cuts\/a-71607477"},{"key":"zoi260431r35","unstructured":"The Voice of Africa. Nigeria responds to U.S. aid cuts by producing its own HIV, malaria kits. September 13, 2025. Accessed April 16, 2026. https:\/\/thevoiceofafrica.com\/2025\/06\/20\/nigeria-responds-to-u-s-aid-cuts-by-producing-its-own-hiv-malaria-kits\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2849344\/lee_2026_oi_260431_1779114202.23998.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:01:48Z","timestamp":1779807708000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2849344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.15000","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}