Representatives from international Catholic and other faith-based humanitarian and health care agencies joined providers from clinics and services in the developing world in Rome in April. They convened for a two-day meeting sponsored by the Vatican Dicastery for Promoting Integral Human Development to work out strategies to respond to a glaring global deficit—one almost impossible to imagine in the affluent precincts of the planet where scenes of medical teams vigorously scrubbing up before gushing faucets can be taken for granted. But for many health care staff in the developing world, particularly in rural communities, that dependable access to abundant and clean water remains far out of reach.

Mary Haddad, R.S.M., the president and chief executive of the Catholic Health Association, in an address to the conference, “Committed to WASH in Healthcare Facilities: A Gathering of Faith-based Organizations and Allies to Accelerate Progress,” noted that nearly one‑third of all people worldwide “receive care in facilities without reliable water, sanitation or hygiene”—WASH is the specialist’s shorthand. That is a deficit that undermines “patient safety, infection prevention and quality outcomes, with devastating and often invisible consequences for marginalized communities.”

Faith‑based providers, she said, have a particular responsibility to address the problem. The Catholic Church is the “largest unified provider” of health care in the developing world, Sister Haddad said, where it sponsors as much as 40 percent of all health care facilities.

“For us, WASH is not merely a technical shortcoming but a moral one,” she said. “Our faith impels us to ensure the inherent dignity of every person. A facility without clean water or adequate sanitation falls short of that call to care for all.”

Water works

At some health care sites, pregnant women about to deliver their babies are required to bring 20 gallons of water with them to use during delivery and recovery. At others, the day begins only after long treks to streams, rivers or other surface water sites to collect water. Under such circumstances, it is not hard to appreciate how basic requirements for sterility and staff and patient hygiene that can prevent infection and save lives become hard, if not impossible, to meet.

The challenge for health care providers is one aspect of a vast water, sanitation and hygiene problem across the developing world, where one in four people—2.1 billion—still do not have access to safe drinking water and 3.4 billion lack safely managed sanitation systems.

The problem is real, the need is great and the total cost to address it is comparably small, but will advocates for improvements in water and sanitation at health care sites find the resources they need to succeed? Spending as little as $12 million to shore up W.A.S.H. systems at 151 Catholic health sites in 23 low-income nations might have been an easy ask not too long ago. But after a historic collapse of humanitarian and development assistance in 2025, finding new money to address such persistent problems may be more challenging.

“Sudden and severe cuts to bilateral aid” caused “huge disruptions to health systems and services in many countries,” the World Health Organization director general Tedros Adhanom Ghebreyesus said in February, describing 2025 as “one of the most difficult years” in the agency’s history.

An analysis from the Organization for Economic Co-operation and Development reports that “official development assistance” fell more than 23 percent in 2025, a reduction of more than $174 billion, “the largest annual contraction on record and a second consecutive year of decline.”

With the now infamous weekend dismantling of the 60-year-old U.S. Agency for International Development in January 2025, the United States led the way. According to O.E.C.D. researchers, the Trump administration was responsible for three-quarters of the overall decline in development aid, its humanitarian and development assistance falling by 57 percent from 2024, “the largest reduction in volume by any provider in any year on record.”

Erica Smith is the executive director of Hospital Sisters Mission Outreach and a co-chair of the Global Health Council for the Catholic Health Association. She allows that some reform of global health and humanitarian delivery may be well-intentioned. “There’s a lot of talk about sustainability, focusing on development instead of continual aid, and I think that those are things that we all could get behind.”

But, Ms. Smith says, “there was really nothing about U.S.A.I.D. that warranted that kind of destruction,” noting that the program’s abrupt termination did not appear to consider its impact on “human dignity or human health.”

“And the truth is that people will die,” she says. “People are dying, and as always, it’s the poorest and the most vulnerable among us who are suffering the effects of what really was a poor, hasty decision.”

Preventable deaths

Emily Doogue, the technical director for health for Catholic Relief Services, can find benefits and detriments in whatever means of humanitarian aid delivery the Trump administration eventually settles on. But “at the end of the day, my concern is that there’s just less funding overall.”

She keeps one prominent marker of global health in mind: progress on reducing the mortality of children under 5 years of age. A sharp reduction in childhood mortality since 2000 has been a significant accomplishment for humanitarian actors, but progress has slowed in recent years. Now she worries it is on the verge of reversing altogether.

She notes an analysis published in the venerable U.K. medical journal The Lancet, forecasting that in a “severe defunding scenario,” 5.4 million more children younger than 5 will perish by 2030. (It also projects 22.6 million additional deaths across all age groups.) The grim projection foresees an unraveling of progress against a gamut of communicable diseases, including H.I.V./AIDS, tuberculosis and malaria. The New York Times reported on April 25 that in Zambia, H.I.V./AIDS is already showing signs of a fierce return.

“We’re seeing infectious disease programs that don’t have the funding that they need to do their core activities,” Ms. Doogue says. “We’re trying to do these prioritizations when we know that to move the needle on infectious disease control, we really need to have a package of multiple interventions, but we’re not able to do that with the same geographic coverage because of funding constraints.”

People in the field “are faced with impossible decisions”: which children to administer antimalarial medications to, which families to provide mosquito netting, which communities to cut off altogether.

In some particularly troubled or impoverished countries, C.R.S. and other humanitarian providers do not merely supplement existing government health services; they may represent the country or region’s only reliable health programs. When these care sites shut down because of funding interruptions, there is nowhere else for people to turn, she says.

“Our programming in Sudan has been in flux, and we’re trying our best to maintain operations,” Ms. Doogue says. “We’ve been really grateful that we’ve been able to mobilize additional funding from new donors and from individuals that have allowed us to keep some of those primary health care clinics open, keep staff fully funded [and] keep essential medicines coming in.” But funding remains “unstable,” and it is unclear if the work C.R.S. is doing to confront perhaps the world’s worst humanitarian crisis can continue.

The new parsimony in aid is impossible to ignore, Bruce Compton, C.H.A’s senior director of global health, says. In the coming years, there will be little room for error or hazy strategy. “We have to be smarter now.”

If there is a bright side to the 2025 meltdown, Mr. Compton suggests it could be that it is “forcing us to have conversations that we’ve needed to have for a long time. How do we come together and leverage this together and get out of these [institutional] silos?”

He sees an opportunity for funders and service providers in the high-income world “to think about what’s our appropriate role” and to ask: “How did we get to the point where one donor [nation] could create this kind of havoc?”

Quid pro quo?

Under its new humanitarian funding regime, the Trump administration has been negotiating memoranda of understanding with governments in low-income nations before reauthorizing the delivery of humanitarian and development aid. It is Mr. Compton’s hope that funding for improvements in water, sanitation and hygiene sought by the C.H.A. and other Catholic humanitarian groups will be part of the memoranda, but the new process has created new worries.

Mr. Compton cites a lack of transparency and unusual quid pro quo agreements. In exchange for continuing its support of H.I.V./AIDS intervention in Zambia, for example, the administration is seeking expanded access to Zambia’s mineral resources.

“Everybody wants to do away with waste, fraud and abuse,” he says, “but we just need to understand that we’re not going to harm people in the process of eliminating those other things.”

Ms. Doogue sees in her work with C.R.S. a practical application of Catholic social teaching—responding to the preferential option for the poor and protecting the dignity of all people. “I find that teaching to be very motivating and central to the work that we are trying to move forward.” American Catholics, she suggests, are called to embrace “a global family” and promote integral human development.

But if that moral call remains insufficient motivation, there are practical benefits that result from the modest humanitarian outlays that have fallen into such disrepute in Washington. U.S.A.I.D. typically represented less than 1 percent of the federal budget, but its efforts helped stabilize nations, mitigated migration crises and interrupted the cross-border spread of dangerous diseases.

Mr. Compton points out that the world’s wealthy nations benefit in other ways from shoring up health services outside their borders.

Aid sent overseas helps train many thousands of health care workers, a good percentage of whom eventually make their way into medical professions in the affluent world, where the need for health care staff remains acute. “We’re benefiting from what these other countries are doing, the education that they’re providing to their people,” Mr. Compton says.

“Global health is a two-way street, and we’ve never really taken that into account.”

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Kevin Clarke is America’s chief correspondent and the author of Oscar Romero: Love Must Win Out (Liturgical Press).