Millions of the world’s most vulnerable people are facing the coronavirus pandemic with worse health care than they had just a few years ago because of the choices of one man: President Donald Trump.

Trump’s changes to U.S. foreign aid ― a tiny portion of the American government’s budget but traditionally the largest source of funding for many international charities ― forced some clinics to close and reduced supplies for others. His policies left key medical teams understaffed in countries where the highly contagious coronavirus is expected to spread rapidly. And now, as the pandemic extends its reach, he’s doing even more to block global health aid.

Last week, Trump dealt his latest blow to the global health system: suspending U.S. funding for the World Health Organization. He accused the body of “mismanagement” in addressing the spread of COVID-19, the disease caused by the virus. But his own pre-coronavirus policies are likely making the pandemic worse than it would otherwise have been ― more deadly, more damaging to societies worldwide, and slower to wind down.

In 2017, Trump enacted an expanded version of the “global gag rule,” a policy tying U.S. aid to a promise from recipients not to perform or promote abortion. That move cut off more than $150 million in funding for medical charities over the following year, according to the Government Accountability Office. Months later, he ended support for a United Nations agency providing reproductive health care globally. Trump further weakened the U.N. health system in 2018 by cutting U.S. aid to the agency responsible for Palestinian refugees’ primary health care.

The president used executive authority to make those moves without the approval of Congress, where lawmakers, including Republicans, have rejected his sweeping proposals to further reduce foreign aid. If Congress hadn’t prevented other Trump efforts to slash international assistance, the situation would be even worse.

Still, the damage he’s done is clear, global health experts say, and has disproportionately reduced medical assistance to people who were already disadvantaged: refugees, women and girls, men who have sex with men. Health care professionals argue that the consequences of Trump’s decisions made their work harder even before they were asked to confront the challenge of COVID-19.

“We are all witnessing that the absence of U.S. leadership in the way that we’re used to seeing is having real implications,” said Sheba Crocker, a former State Department official now with the charity CARE USA, which addresses health care among other needs of the global poor.

Expanding The Gag Rule ― And Limiting Vital Help

President Ronald Reagan first imposed the global gag rule on abortion. Also known as the Mexico City Policy, it has since been revoked by every Democratic president and reinstated by every Republican president. Until Trump, however, the policy was only applied to the portion of U.S. aid that went to family planning services. The Trump administration first broadened it to a restriction on all global health funding, not just money for reproductive care, and then expanded it further in 2019 to cut support for groups simply for donating to organizations that mention abortion.

The wide-ranging results of Trump’s version of the rule are visible in places like Kibera, a slum in the Kenyan capital of Nairobi that is home to at least 170,000 people.

A group called Family Health Options Kenya used to run three to four outreach clinics each month in various parts of Kibera. But Trump’s policy meant it lost $1.5 million in aid. The organization can no longer afford to operate the clinics in Kibera ― removing one of the few health services available to residents in an area that is expected to get hit especially hard by the coronavirus because of how difficult it is to socially distance in such cramped living conditions.

For some of the world’s poorest communities, sexual health organizations are essential for more than family planning services. In some areas, they provide the only affordable medical care, covering not just essential reproductive services like abortions and testing for sexually transmitted infections, but also immunizations, nutritional care, tuberculosis treatment, HIV services, maternal-child health care, and clean water and hygiene resources.

So when funding is cut off from these organizations, it’s not just reproductive health care that’s lost. The “policy is undermining the entire health system,” said Jonathan Rucks, senior director of policy and advocacy at PAI, an international group that promotes reproductive health care.

Rucks told HuffPost that the global gag rule will have especially dire effects on rural and other hard-to-reach communities as the coronavirus crisis hits them. “You’ve really hamstrung any ability to respond in that timely and holistic fashion,” he said. “The U.S. is going to be expected to provide a lot of support to these countries that are not going to have the providers to work with. You have communities without care. You have undermined your mobile outreach to hardest-to-reach populations.”

“All of this is going to make the impacts of COVID-19 so much worse because there are communities quite literally without providers,” he continued.

Meanwhile, global family planning services that were already weakened under Trump are at risk of receiving even fewer resources as funds are shifted to battle the pandemic, which could put millions of vulnerable women and girls at even greater risk.

“The expanded global gag rule has harmed many trusted health care providers worldwide, weakening health care systems and disrupting access to services for communities who rely on them,” Monica Kerrigan, executive director of Planned Parenthood Global, told HuffPost. “These very providers are now fighting to respond to the COVID-19 pandemic and continue to provide essential services with inadequate resources.”

Andrew Caballero-Reynolds/AFP via Getty Images Activists from the Population Connection Action Fund project a protest message onto the Trump International Hotel in Washington on Jan. 23, 2019.

The Zimbabwe branch of Marie Stopes International, a British reproductive health nonprofit, had already lost 70% of its funding after Trump reinstituted the gag rule. It went from serving 1,200 villages and communities in rural areas to 500.

Although the organization offers a wide range of services ― from HIV/AIDS treatment to maternal and child health care ― the majority of its work is post-abortion care. Abortion is illegal in Zimbabwe, but that doesn’t stop women from needing the procedure. Around 60,000 to 70,000 unsafe abortions are performed every year in that country, and Marie Stopes Zimbabwe is one of the few resources available to women and girls who have undergone botched procedures.

The group now expects to lose even more funding and resources as COVID-19 reaches Africa, director Abebe Shibru told HuffPost. Shibru worries that the remainder of Marie Stopes Zimbabwe’s funding, which currently comes from the British and Swedish governments, will be diverted to COVID-19 prevention and treatment ― leaving a “huge gap” in lifesaving services for Zimbabwean women and girls, he said.

“COVID-19 prevention shouldn’t be at the expense of women’s health,” said Shibru.

The global gag rule has been harming people for years. At the very least, it should be put on hold now amid the current crisis, Rucks said.

“Why would the U.S. want to limit its ability to support countries that need care and get ahead of the COVID-19 response in a way that we didn’t in the U.S.?” Rucks said. “There is no ethical, logical reason to cut out providers who are willing, ready and able to respond at this moment in time.”

Cutting Funds To The Most Vulnerable

Trump’s foreign policy has been defined by his disdain for international cooperation and his efforts to mold that policy to domestic political interests. His approach has been especially damaging for two important global health care providers associated with the United Nations: the U.N. Population Fund and the U.N. Relief and Works Agency for Palestine Refugees in the Near East.

Trump blocked $32 million in aid to the U.N. Population Fund soon after taking office. It was a gift to conservative activists, who have long argued that the organization supports coercive abortion through its cooperation with the Chinese government. Like previous U.S. officials who have also ended support for the family planning agency, the Trump administration had to admit it had no evidence for that notion.

The U.N. Population Fund provides vital services worldwide, including in difficult settings like warzones and refugee camps. The year before Trump’s blow, U.S. support saved more than 2,300 women from dying during pregnancy and childbirth and stopped nearly 300,000 unsafe abortions, said Sarah Craven, the director of the agency’s Washington office.

The agency’s work ranges from training midwives to providing reproductive health medicines. Since losing U.S. aid, the U.N. Population Fund has had to downsize some programs because of insufficient replacement funding or worsening conditions that have increased its costs, thereby depriving people of their medical lifelines.

Yemen is a stark example. Since the start of a U.S.-backed military intervention there in 2015, half the health care facilities in the country of 30 million have stopped functioning ― and only 35% of maternal health facilities are operational. The U.N. Population Fund is key to Yemeni reproductive health services and is responsible for distributing U.N. food and hygiene supplies to people who are hard to reach, Craven said.

The agency had only 35% of the funding required for its work in that wartorn country in 2019 and expected that it would need $100 million for 2020 ― “before COVID-19,” Craven noted. The virus officially reached the country earlier this month. Days earlier, Trump had suspended another part of U.S. aid to Yemen.

Because of its reduced funding, the agency has had to close 100 medical facilities in the country even as the civil war has continued with American involvement, U.N. Population Fund director Natalia Kanem told Politico in March.

“We really lament the posture of the current U.S. administration,” Kanem said.

Washington’s withdrawal hits programs like the U.N. Population Fund particularly hard because securing funds for women’s concerns is a notoriously tough part of the already difficult campaign to raise money for critical international needs, and such spending is consistently too low, said Crocker, the CARE USA official and former diplomat.

“When you face a situation where a donor like the U.S. pulls back, women are going to suffer,” she added.

Risking Health To Apply Political Pressure

Trump cut off funding for the U.N. Relief and Works Agency for Palestine Refugees in the summer of 2018, during his campaign to pressure Palestinians to soften their position on a future settlement of their conflict with Israel. The U.S. had previously been the biggest donor to UNRWA, providing a quarter of its budget ― money that went to education, food assistance and a network of 144 health facilities serving more than 5 million refugees across five different jurisdictions.

Other nations increased their contributions, and UNRWA officials prioritized keeping medical centers open. But the funding shortfall persisted and the ramifications of Trump’s moves are still being felt, Akihiro Seita, UNRWA’s director of health, told HuffPost.

His team has reduced its holdings of medicine, keeping less “safe stock” ― the amount purchased in case of problems in the supply chain, a perennial possibility in a tense region. The agency is now buying only 12 months’ worth of needed drugs at a time and so no longer has the backup supply it used to have on hand.

Majdi Fathi/NurPhoto via Getty Images Palestinian employees at the U.N. Relief and Works Agency for Palestinian Refugees prepare food aid rations that will be delivered to people's homes due to the COVID-19 pandemic.

That kind of seemingly minor change can have major consequences in an emergency situation like the current pandemic. Almost half of UNRWA’s clients are over 60 years old and 23% are older than 70. Many of them also have diabetes, one of the existing health conditions that increase people’s vulnerability to COVID-19. As one response to the coronavirus, the agency has been giving clients two months of insulin instead of one to reduce their travel to its clinics, Seita said. But that strains its already diminished stocks.

UNRWA is also nervous about its access to personal protective equipment amid rising prices worldwide, Seita said. And it knows that the communities it serves might become viral hotspots because of their congested conditions and that they will almost certainly become poorer because of the economic impact of the pandemic lockdowns.

The agency has launched a $14 million emergency appeal to help it deal with COVID-19.

Congress has pressed Trump about UNRWA’s plight and related problems in Palestine, most recently in a March letter from eight senators noting both the president’s offers of coronavirus aid to U.S. adversaries like Iran and North Korea and lawmakers’ approval last year of $75 million in aid to Palestinians that the Trump administration has not yet spent.

“President Trump’s decision to withhold financial support to UNRWA has weakened already fragile public health systems in the West Bank and Gaza, putting Palestinians’ health at further risk as a result of the coronavirus pandemic,” Sen. Elizabeth Warren (D-Mass.), who led her fellow senators’ latest push for action, said in an email to HuffPost.

It’s signs like those that the U.S. might change course that aid officials worldwide keep a close eye on, for the immediate benefit of the people they serve and with the hope of being better prepared before the next global crisis.

“We consider the leadership position of the United States to be irreplaceable both from a funding perspective but also generally from a diplomatic leadership perspective,” said Crocker of CARE USA.