Withholding U.S. Foreign Aid Unlawfully Endangers Lives
Facts
For more than six decades, Congress has sustained a bipartisan commitment to global health through foreign assistance, building one of the world’s most extensive aid programs. Administered primarily through the U.S. Agency for International Development (USAID), these initiatives have saved tens of millions of lives, reduced maternal and child mortality, slowed epidemics of HIV/AIDS, tuberculosis, and malaria, and helped stabilize fragile health systems in ways that advance both humanitarian values and U.S. national security.
That lifeline was abruptly severed on January 20, 2025, when President Trump issued Executive Order 14169, freezing nearly all foreign assistance funds pending a “policy review.” The order suspended billions in congressionally mandated appropriations under the Further Consolidated Appropriations Act of 2024, halting programs midstream. Clinics shuttered, antiretroviral treatments were interrupted, maternal and neonatal care was disrupted, and vaccine campaigns were suspended. The freeze destabilized critical health services on which millions depend for survival.
The human toll was immediate. Pregnant women in sub-Saharan Africa lost access to prenatal care and safe delivery services; children at risk of malnutrition were cut off from therapeutic food; and people living with HIV faced sudden interruptions in lifesaving medication, risking drug resistance and rapid progression to AIDS. In Ethiopia and the Democratic Republic of the Congo, health workers reported preventable deaths after USAID-funded services collapsed. Researchers warned that gains in HIV prevention were unraveling in real time, with new infections among infants already rising.
Experts project that if the freeze persists, it will lead to 14 million avoidable deaths over the next five years, including 4 million children under five. Each year, 17 million pregnant women and 11 million newborns will lose essential care, and 1 million children with severe malnutrition will be left without treatment. Cuts to immunization programs are expected to cause 500,000 preventable child deaths annually, while halted HIV and tuberculosis programs risk fueling drug-resistant strains with catastrophic global consequences
Epidemiologists cautioned that these harms extend beyond affected regions. Suspending global treatment and prevention programs creates conditions for viral resurgence and drug-resistant strains of tuberculosis, HIV, and other infectious diseases—threats that do not respect borders. Experts warned that the freeze risks cascading public health consequences worldwide, including inside the United States. As one former USAID administrator testified, dismantling America’s global health infrastructure “will make America less safe” and sacrifice decades of investment in stability, security, and lives saved.
Proceedings
On February 10, 2025, the AIDS Vaccine Advocacy Coalition (AVAC), joined by other longtime implementers of U.S. foreign assistance, filed suit against the President, the State Department, USAID, and related agencies, seeking emergency relief from the administration’s abrupt freeze on congressionally mandated aid. The following day, the Global Health Council and allied organizations brought a parallel action. The cases were consolidated in the U.S. District Court for the District of Columbia. Together, plaintiffs argued that the Executive Order unlawfully impounded funds appropriated by Congress in violation of the separation of powers, and further constituted violations of the Administrative Procedure Act (APA) and ultra vires action by federal agencies. They sought urgent relief to avert irreparable damage to global health programs sustained by U.S. assistance.
On February 13, 2025, Judge Amir Ali issued a temporary restraining order, concluding that the plaintiffs were likely to succeed on the merits and finding that the freeze inflicted “immense” and “irrebuttable” harm on organizations. When the government failed to comply, the plaintiffs sought contempt sanctions, supported by whistleblower declarations attesting to deliberate defiance of the court’s order. After several enforcement directives, the court issued a preliminary injunction on March 10, requiring the administration to release USAID payments owed under existing contracts.
The government appealed. On August 13, 2025, a divided panel of the U.S. Court of Appeals for the D.C. Circuit vacated the injunction by a 2-1 vote. The majority held that private parties lacked both constitutional and statutory causes of action to enforce Congress’s appropriations, and that the Impoundment Control Act foreclosed APA review. In dissent, Judge Florence Pan criticized the majority for adopting an argument the government had never raised, warning that the decision “announces a new and sweeping constitutional rule in the President’s favor.”
Plaintiffs petitioned for rehearing en banc (before all active judges of the D.C. Circuit rather than a three-judge panel), stressing the exceptional importance of the case and the irreparable harms caused by the continued withholding of foreign aid.
In a related case, Personal Services Contractor Association v. Trump et al., U.S. Personal Services Contractors who work abroad to implement USAID's sustainable development programs challenged the Trump administration’s dismantling of USAID. They likewise sought appellate review in the D.C. Circuit after the district court denied their request for preliminary injunctive relief.
Open Society Justice Initiative Involvement
The Justice Initiative filed an amicus curiae brief in support of plaintiffs petition for rehearing en banc the consolidated case of AIDS Vaccine Advocacy Coalition v. U.S. Department of State / Global Health Council v. Donald J. Trump et al. and an amicus curiae brief in support of plaintiff's request for injunctive relief and reversal in Personal Services Contractor Association v. Trump et al. on behalf of Physicians for Human Rights, Dr. Dvora Joseph Davey, Dr. Salim S. Abdool Karim, and “Mary” Doe. PHR, a Nobel Peace Prize co-laureate, has documented the impact of U.S. funding cuts on public health and human rights across Africa. Dr. Davey, an infectious disease epidemiologist based in Cape Town, has led HIV-prevention research in Southern Africa for more than two decades, with a focus on maternal and neonatal health. Dr. Abdool Karim, a South African clinical infectious diseases epidemiologist, is recognized internationally for his pioneering contributions to HIV prevention and treatment. Mary, a mother and caregiver to eight children in Kenya, provides support to orphans living with HIV and struggles to secure lifesaving antiretroviral treatment for her 15-year-old daughter. Together, amici conveyed to the Court the profound human cost of unlawfully impounding congressionally appropriated foreign assistance.
Physicians for Human Rights served as co-counsel.
Arguments
Injunctive Relief Exists to Prevent Irreparable Harm
A preliminary injunction requires showing likelihood of success on the merits, irreparable harm, that the balance of equities tips in the movant’s favor, and that an injunction serves the public interest. While the panel majority acknowledged aspects of this framework, it did not fully engage with the balance of equities and public interest. In doing so, it set aside the essential reality that lives are at stake, and once lost they cannot be restored. Only a preliminary injunction can prevent such irreparable harm and ensure that the Court’s ultimate judgment is not hollow.
Catastrophic Global Health Impacts Tip the Equities Decisively
USAID programs, which represent less than one percent of the federal budget, have prevented more than 91 million deaths over two decades. They reduced HIV/AIDS mortality by 65 percent, cut malaria deaths by half, eradicated wild poliovirus in Africa, and supplied lifesaving food to millions of children. Cutting off these programs now is projected to cause 14 million avoidable deaths in just five years, including 4 million children under five. Each of these real-world consequences underscores the catastrophic, irreparable harm caused by withholding funds. The scale and irreversibility of these harms underscore why the balance of equities weighs decisively in favor of injunctive relief.
U.S. Public Health Is Directly at Risk
Infectious diseases travel, and when USAID programs are halted abroad, Americans become less safe at home. History shows that reductions in global health funding correlate with surges in disease, while investments prevent domestic crises. The current freeze fosters conditions ripe for mutation and drug resistance. Vaccine disruptions abroad heighten the risk of outbreaks. Protecting Americans requires prevention through continued foreign assistance, not reactive crisis spending. The public interest in maintaining aid is overwhelming.
Fiscal Prudence Aligns with Human Survival
The government claims fiscal or institutional interests in defending the freeze. But taxpayers lose twice when appropriated funds are withheld: first when funded programs collapse, and again when the U.S. must respond to preventable emergencies at exponentially higher cost. Congress appropriated these funds to save lives and protect U.S. national interests. Withholding them frustrates Congress’s will, wastes appropriations, and multiplies humanitarian and fiscal harm.
Preserving aid through a preliminary injunction is consistent with law and the preservation of human life.
The Justice Initiative files an amicus brief in the D.C. Circuit in Personal Services Contractor Association v. Trump et al. on behalf of public health experts and Mary Doe, arguing that the district court failed to properly weigh the immediate and irreversible harms to global and U.S. health—harms that overwhelmingly tip the equities in favor of granting injunctive relief.
The U.S. Supreme Court grants the Trump administration’s request to stay the district court’s injunction requiring the obligation of $4 billion in foreign assistance funds.
The Justice Initiative files an amicus brief on behalf of public health experts and Mary Doe, arguing that extraordinary relief is required to prevent immediate and irreversible harms, which overwhelmingly tip the equities in favor of an injunction.
Plaintiffs file a motion for emergency stay pending further proceedings and a petition for rehearing en banc.
The D.C. Circuit (2-1) vacates in part the preliminary injunction, holding plaintiffs lacked statutory and constitutional causes of action.
USAID whistleblower releases memo detailing unlawful terminations of foreign assistance, supporting plaintiffs’ claims.
Oral argument held before a three-judge panel of the D.C. Circuit.
The government appeals to the U.S. Court of Appeals for the D.C. Circuit.
The District Court grants a preliminary injunction, ordering release of USAID payments owed under existing contracts through February 13, and enjoins the government from other actions taken to implement the foreign aid freeze.
The Supreme Court by a vote of 5-4 denies the government’s request to vacate the TRO.
Plaintiffs submit USAID memos showing the government misled the Court about waivers and compliance.
Plaintiffs move for contempt, citing evidence that USAID intentionally disregarded the TRO.
The District Court for the District of Columbia issues a Temporary Restraining Order (TRO), directing the government to reinstate foreign aid funding.
Global Health Council and additional plaintiffs file a parallel suit.
AVAC and other groups file suit against the administration’s freeze on foreign assistance, arguing it is unlawful and dangerous.
The District Court orders the government to pay all invoices submitted before February 13. The government appeals to the D.C. Circuit of Appeals.
USAID building is closed.
USAID website is taken down.
The President issues Executive Order 14169, pausing foreign aid for a 90-day review and directing that no further U.S. foreign assistance be disbursed unless fully aligned with presidential foreign policy.
