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    They fled war and sexual violence and found a safe space in Athens. Then the aid cuts hit

    The night of 29 May was sombre at 15 Mitsaki Street, a women’s shelter in the centre of Athens. Shoes, winter coats, shampoo bottles and sheets lay strewn around: belongings the 30 refugee women and five children living there had worked hard to acquire, and would now have to abandon. The next day, the shelter would be shuttered for good.“I was so stressed I couldn’t sleep,” says Oksana Kutko, a Ukrainian. “I knew I had nowhere to go.”Operated by the Greek aid organisation METAdrasi since 2020, the shelter’s closure came as a shock.Kutko, 51, had been living there for three years after fleeing Russian bombs in Kharkiv. She hauled what she could carry to a nearby church.Residents could not find alternative accommodation in the short time they were given to leave. A Congolese woman with a seven-year-old son simply laid out a sheet on the pavement outside.By evening, everyone had vacated the refuge, except for one woman.Évodie*, a woman in her 20s who fled severe sexual abuse and violence in the Republic of the Congo, refused to leave. For days after the other women had gone, Évodie clung to the place: the last semblance of stability in her life of uncertainty.Already in a fragile mental and emotional state, losing her place at the shelter cast her back into memories of horrific abuse. Eventually, the police evicted Évodie. She spent the next month homeless.The shelter’s closure is the new reality brought by governments’ overseas aid funding cuts, people with fragile lives being left without lifelines, struggling to stay afloat.“These women’s need for a safe place, their need for hope for the future, their need to heal the past – all these things are connected,” says Thaleia Portokaloglou, a psychologist who knows Évodie from the Melissa Network, an organisation for refugee women in Athens.As support is withdrawn, Portokaloglou is seeing women unravel. How do you ask a person pulled apart like that to keep functioning, she asks.The closure of the Mitsaki Street shelter can be traced back to 20 January 2025, when President Donald Trump, froze the US foreign aid budget hours after his inauguration. Contracts with humanitarian organisations were terminated and over the following months support networks in many countries, including Greece, were gutted; METAdrasi lost a third of its budget, resulting in the shelter’s closure.Greece has received nearly 1.3 million refugees and migrants since 2014. The wait to be granted asylum can take years, leaving many people dependent on humanitarian organisations while their cases are being processed.View image in fullscreenEuropean governments have also been steadily slashing their overseas aid budgets, diverging sharply from the postwar global consensus on humanitarian relief.Lefteris Papagiannakis, director of the Greek Council for Refugees, says: “We are losing the whole of the international protection system that has been in place for the last 80 years in six months.”Meanwhile, Athens has hardened its stance on migration – parliament suspended asylum applications from north Africa in July and instigated laws this month that could mean rejected asylum seekers receiving prison terms if they do not leave within 14 days.Around the world, humanitarian networks have been thrown into chaos. Dimitra Kalogeropoulou, director of the International Rescue Committee in Greece, says: “We are facing an unseen crisis where people are really suffering.”On 30 June, between walls hung with Afghan tapestries, officials from Greece’s migrant-support organisations held an emergency meeting at the Melissa Network.The NGO leaders were visibly shaken. Minutes earlier, they had left an interagency meeting of the Greek branch of the refugee agency, the UN high commissioner for refugees (UNHCR).“All of us are facing an existential crisis,” says Nadina Christopoulou, director and co-founder of the Melissa Network.Before January, 90% of the UNHCR’s funding in Greece came from the US state department, says Papagiannakis. Now, half the funding and half the staff are gone. “Unfortunately, Europe is not stepping in,” he says. “They say, ‘Ah, that’s a good opportunity! We’ll stop too.’”The cuts mean aid organisations have been forced to make hard decisions. Funding for victims of sexual violence has been cut across the board.Christopoulou put it in simple terms: 970 asylum seekers would be stranded without assistance. At least 100 survivors of sexual violence would lose essential services, including emergency housing.skip past newsletter promotionafter newsletter promotionView image in fullscreen“People will no longer come to our centre because they feel it is undignified to come without having taken a shower, without having slept on a bed – and perhaps having been raped overnight,” Christopoulou says. “Because that’s what happens when you sleep in a park.”After her eviction from the METAdrasi shelter, Évodie slept rough in parks and squares for a month. Christopoulou knows from Évodie’s case worker, Irida, that homelessness plunged her into a devastating mental spiral. She has since found a space in a new refuge, but remains uncertain how long she will be able to stay there.When Évodie first came to Melissa in 2023, traumatised by her experiences in the Congo, she did not speak and, unable to find housing, spent nights in a park where she was further harassed. Eventually, Melissa secured a hostel place for her, before she moved into the METAdrasi refuge.Initially, she sat in a corner, without saying a word. It was a surprise, then, when she decided to join Melissa’s choir.On 8 March last year, Évodie stepped on stage and started to sing. Those in the audience who knew her were stunned. “I was crying,” Christiana Kyrkou, a project manager at the Melissa Network, says.“It was one of the first times I heard, loudly and clearly, her voice,” Christopoulou recalls. “Everybody was happy, but Évodie was Oscar happy!”View image in fullscreenWeekly self-defence training sessions offered a space for Évodie to open up. The class instructor, Konstantinos Koufaliotis, says she was his most frequent participant.One day, after Évodie mastered the basics, Koufaliotis taught her how to throw him to the ground. He landed on the foam mats with such a bang that Christopoulou rushed to the room asking if everything was OK.“Évodie laughed and laughed, because she created this,” Koufaliotis says. “She owned that moment.”Over the summer, she opened up to Koufaliotis about her difficulty in trusting those around her. When the conversations were too much for her, Koufaliotis would put up his boxing mitts and they would go back to training.Victims of sexual violence have every reason not to trust people. “Even if you do manage to get out of the circumstances that have created trauma, it’s such a fragile edifice,” Christopoulou says. “What you’re building is so fragile that it may easily fall apart into pieces again.”Now, as funding dries up, and services from therapy to housing face being wrenched away in an instant, hard-earned trust that NGOs have taken years to build up vanishes with it.The shelter’s closure left Évodie once again sees everything as a threat and everyone as an aggressor. She is distrustful of those trying to help her. Melissa’s staff believe this will be a commonplace reaction as since the funding cuts began, needs have turned from healing to survival.“There’s a shift from more psychological requests to more practical, more urgent ones,” Portokaloglou says. “We’re going back to those very primal, basic requests.”The prospect of future funding cuts now risks the survival of the whole Greek humanitarian network. The only certainty is that no programmes will be left unscathed. “It’s vertical, horizontal, diagonal,” says Christopoulou. “Everybody’s impacted.”* Name has been changed to protect her identity More

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    ‘It’s back to drug rationing’: the end of HIV was in sight. Then came the cuts

    This year the world should have been “talking about the virtual elimination of HIV” in the near future. “Within five years,” says Prof Sharon Lewin, a leading researcher in the field. “Now that’s all very uncertain.”Scientific advances had allowed doctors and campaigners to feel optimistic that the end of HIV as a public health threat was just around the corner.Then came the Trump administration’s abrupt cuts to US aid funding. Now the picture is one of a return to the drugs rationing of decades ago, and of rising infections and deaths.But experts are also talking about building a new approach that would make health services, particularly those in sub-Saharan Africa, less vulnerable to the whims of a foreign power.The US has cancelled 83% of its foreign aid contracts and dismantled USAid, the agency responsible for coordinating most of them.Many fell under the President’s Emergency Plan for Aids Relief (Pepfar) programme, which has been the backbone of global efforts to tackle HIV and Aids, investing more than $110bn (£85bn) since it was founded in 2003 and credited with saving 26 million lives and preventing millions more new infections. In some African countries it covered almost all HIV spending.View image in fullscreenThere is a risk, says Lewin, director of Melbourne University’s Institute for Infection and Immunity and past president of the International Aids Society, of “dramatic increases in infections, dramatic increases in death and a real loss of decades of advances”.There is no official public list of which contracts have been cancelled, and which remain. It appears that virtually no HIV-prevention programmes funded by the US are still in operation, save a handful principally providing drugs to stop pregnant women passing on the infection to their babies. Countries report disruption to the most basic measures, such as condom distribution.Some treatment programmes have been spared, but not those whose focus conflicted with the Trump administration’s war on “gender ideology” or diversity, equity and inclusion (DEI), such as those working with transgender communities. Doctors, nurses and other healthcare workers have been laid off, while worried patients are hoarding drugs or stretching supplies, according to UNAids surveillance. UNAids itself has lost more than half of its funding.Even programmes that have survived the cull have faced turmoil since February, with instructions to stop work rescinded but with no certainty that funding will continue.View image in fullscreenIn only one example, the Elizabeth Glaser Paediatric Aids Foundation says it has had to halt HIV treatment for 85,000 people in Eswatini, including more than 2,000 children, and tests for thousands of pregnant women and babies to prevent transmission and begin life-saving medication.Access to drugs represents an “immediate crisis”, Lewin says. “If people with HIV stop the medications, then not only do they get sick themselves, which is tragic, but they also then become infectious to others.”As clinics on the frontline of treating the disease scrabble to secure access to basic drugs, scientists at this month’s Conference on Retroviruses and Opportunistic Infections in San Francisco were hearing that HIV might soon be preventable with a once-a-year injection.The drug lenacapavir was already generating huge excitement in the field, after trial results showed that a six-monthly jab could prevent HIV. New results from the manufacturer Gilead suggest that a tweak to the formula and how it is given could see its protective effects last even longer.Nevertheless, Lewin says, the mood at the meeting, packed with many of the world’s leading HIV specialists, was “dire”.As well as programme cancellations, there are “huge concerns around science and what’s going to happen to the [US] National Institutes of Health, [whose] funding of science has been so significant on every level”, she says.Some scientists in receipt of US funding have been told to remove their names from DEI-linked research, she says, even though DEI is fundamental to the HIV response.View image in fullscreen“I don’t mean that in a sort of touchy-feely way, I mean that’s what we need to do: you need to actually get those treatments to these diverse communities.”In 2022, 55% of all new HIV infections were within “key populations”, such as gay men, other men who have sex with men, sex workers, transgender people, prisoners and people who inject drugs.Prof Linda-Gail Bekker, of South Africa’s Desmond Tutu Health Foundation, has seen US funding for three trials of potential HIV vaccines involving eight countries cancelled and only reinstated after an appeal to the US supreme court.“We’re running around like chickens without heads to at least get one going, because the vaccines are sitting in the fridge and will expire,” she says.She led the lenacapavir trial that showed it offered 100% protection to young women in sub-Saharan Africa, but now worries about HIV/Aids prevention “falling off the radar completely”.The global community had been making headway towards the United Nations’ goal of ending Aids by 2030, she says, with a five-year plan to use “amazing new innovative tools and scale them up”, which would have led to “less dependence on foreign aid and more self-reliance” as new infections fell and attention shifted to maintaining treatment for people with HIV.“All of that is hugely at risk now because, without these funds, our governments will have to step up but they will concentrate on treatment,” she says. “We know they will do that, because that is what we did for the first 30 years.”Efforts to control Aids were entering “the last mile”, which was always likely to be more expensive, she says. “The people who were happy to come into health facilities, they would have come into health facilities.”It would be difficult to rely on government funding to reach the remaining groups, she says, not only because of fewer resources but also because in some countries it means targeting groups whose existence is illegal and unrecognised, such as sex workers or sexual minorities, and young girls may be reluctant to use government clinics if they are not supposed to be sexually active.“I feel like the odds are very stacked against us,” says Bekker, adding: “We’re obviously going to have to re-programme ourselves [and] formulate a different plan.”Pepfar had pledged funding to the Global Fund to Fight Aids, Tuberculosis and Malaria, to deploy 10m doses of lenacapavir in low-income countries. While the Global Fund has promised to maintain its commitment, it might receive fewer than the planned number of doses, Bekker fears.“Six months ago, I was saying the best thing we can do with lenacapavir is offer it to everybody in a choice environment. [Now] I think we’re gonna have to say who needs [injectable] prep,” she says, “and the rest have to do the best they can.“How do we make that decision? And what does that look like? It is back to sort of rationing.“When we started ARVs [antiretroviral drugs] way back in 2000,” Bekker recalls, “you would go, ‘you get treatment; you don’t, you don’t, you don’t’.“It feels terrible … but you have to get over that. You have to say it will be infection-saving for some people. And we’ve got to make it count.”View image in fullscreenFor Beatriz Grinsztejn, president of the International Aids Society, the disruption is critical and threatens many vulnerable people. But, she adds, it could present “an important opportunity for ownership – otherwise we are always left in the hands of others”.She worries about the impact of cuts to funding on younger scientists, with their potential loss from the research field “a major threat for the next generation”. But, she adds, the HIV community is “powerful and very resilient”.There have already been calls for new ways of doing things. It is “time for African leadership”, members of the African-led HIV Control Working Group write in the Lancet Global Health. There are now plans for Nigeria to produce HIV drugs and tests domestically.Christine Stegling, deputy director of UNAids, says it began “a concerted effort” last year to develop plans with countries about how their HIV programmes could become more sustainable domestically “but with a longer timeframe … now we are trying to do some kind of fast-tracking”.Governments are determined, she says, but it will require fiscal changes either in taxation or by restructuring debt.The goal of ending Aids by 2030 is still achievable, Stegling believes. “I think we have a very short window of opportunity now, in the next two, three months, to continue telling people that we can do it.“I keep on reminding people, ‘look, we need to get back to that same energy that we had when people were telling us treatment can’t be available in the global south, right?’ And we didn’t accept it. We made it happen.“We have national governments now who are also very adamant, because they can see what can happen, and they want to make it happen for their own populations.” More

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    WHO's Covid-19 inquiry is a shrewd move in a sea of disinformation

    In the world of epidemiology it’s sometimes said that pandemics are lived forwards and understood backwards.We encounter them head-on, chaotically, trying to fathom the disease in real time even while trying to mitigate its impact. Lessons generally come later as the evidence accumulates.What’s also true is public health, especially on a global scale, is rarely separable from politics. One of the complicating factors of the recently ended outbreak of Ebola in the Democratic Republic of the Congo, was the country’s long history of conflict and the toxic relationship between central government in Kinshasa and the affected population in the country’s east, which led to deep and sometimes violent distrust.One of the most depressing subtexts of the coronavirus pandemic is how these kinds of conflicts are now being writ large as a range of actors, including western ones, have used the crisis to spread disinformation.The past months have been marked by dodgy dossiers leaked to the media and conspiracy theories, pushed by US officials engaged in a struggle for global influence with Beijing, suggesting that the virus was deliberately cooked up in a Chinese lab. More