On Trump’s Executive Orders: Are There Any Lessons For Global (Children’s) Surgery?

On Raging Foreign Aid Cuts: Are There Any Lessons For Global (Children’s) Surgery? 

When President Trump re-took office earlier this year (2025), one of his first moves sent shockwaves through the global health and development world.

Foreign aid: paused for 90 days, pending review, and ultimately cut.

USAID - relied upon by over 100 countries to build long-term self-reliance – dissolved altogether.

The global surgical community banded together - immediately offering solidarity to their global health counterparts in low- and middle-income countries (LMICs) who had seen their funding, and capacity to provide care, devastated. And more aid cuts have followed; from donor countries such as the United Kingdom, France, and the Netherlands.

Suddenly - many countries which had life-saving health programmes funded by aid have to figure out how they can sustain these services, both now and in the future, in the face of growing nationalism, populism and isolationism in the global north.

But, it is our belief that this moment presents an opportunity for the global children's surgery actors to learn some critical lessons. Here's why.  

Why would global children’s surgery actors need to draw any lessons? 

Global surgery advocacy exists, in part, to help develop funding, including from foreign aid, to strengthen surgical healthcare systems. This includes support for both national planning and implementation, but also the work of NGO or charity-led interventions with a key objective of delivering timely and safe surgical healthcare amidst the increasing burden of surgical disease.

But despite advocacy efforts, global children's surgery remains woefully under-resourced to meet the ever-growing need. Funding and philanthropic contributions have failed to grow at the rate required - leaving paediatric surgery neglected in many LMICs health systems. That means leaving children waiting, sometimes for longer than needed; and sometimes dying prematurely before getting the care they need.

And this is due, partly, to so many LMIC government's health policies being shaped by the funding priorities of their donors. If the donor does not care about a certain cause - chances are it will be sidelined in national health policy agenda.

That means we're reliant on increased recognition from donors to move this crucial care up the priority list.

But children's access to safe surgery, despite its clear and inarguable importance, remains overlooked.

And the neglect continues.

The undeniable impact of paediatric surgical care across the entire life course - from newborn, to infant, to under-five survival and beyond - ignored, still.

The children's surgical health interventions that do exist have remain focused on capacity - to enable timely access to safe surgical and anaesthesia care. And this can clearly be pointed to the chronic lack of resource that exists - in workforce, infrastructure, equipment and technology.

So now imagine the impact of a stop work order and aid cuts in a situation like this, where the access is so limited and the need so high. Operations stopped. Children's access to life-saving care denied.

And these interruptions expose a hard truth: global children's surgery, like much of global health, remains dangerously dependent on wholly external funding and foreign agendas, leaving entire health systems vulnerable to the whims of political shifts.

So this moment demands urgent reflection. What lessons must the global children’s surgery community learn from the sudden reality of executive orders pausing foreign aid? 

1. Decolonise Global (Children’s) Surgery 

Despite global rhetoric around “decolonising” global health, the power structures remain the same. The funding, and therefore the power, still flows in the same direction.

Global North to Global South.

And where you do find global surgical capacity building in LMICs - it is often donor or organisation-led with little to no role from governments or national funders.

Global surgery can - and must now - do better.

And that means putting Global South voices at the head of the table - with support from existing initiative leaders - to ensure ownership of healthcare systems is held by those who work in and are served by them.

 

2. Support Community Led Advocacy and Fundraising 

Heavy reliance on philanthropic funding from the Global North has stifled the development of strong local fundraising ecosystems. But LMICs are changing. Many countries now have growing economies and a rising class of local philanthropists who want to invest in health.

The current funding crisis has made this opportunity impossible to ignore. National and community-based fundraising, coupled with grassroots advocacy, can insulate health systems from political swings elsewhere. We must start building those local ecosystems now - before the next crisis hits. 

3. Embrace Co-production/Co-Development 

Too often, surgical interventions are designed far from the places they’re built to serve. That disconnect leads to wasted resources and programmes with expiration dates. True co-development - where governments, local surgical teams, and communities are involved from day one - creates interventions that are more effective, more accepted, and more sustainable.

Let’s move past the model of imported solutions. Let’s build systems with the people who live in them. 

Conclusion  

Whilst globally, steps are taken away from international development support, it is crucial that global surgery actors act now to ensure the sustainability of the children's surgical healthcare systems they hold.

We must increase our decolonisation efforts, support community-led advocacy and reduce dependency on aid.

Children deserve better than reliance on the ever-increasing fragility of global health strengthening and international development.

They deserve access to safe surgery - wherever in the world they are, and whoever is in power.

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