US Secretary of State Marco Rubio on Tuesday widened exemptions in a sweeping freeze on foreign assistance, saying the United States would keep funding humanitarian items such as shelter and medicine.

President Donald Trump on returning office last week ordered a 90-day pause to review assistance by the United States, the world’s largest donor in dollar terms.

Rubio followed up by freezing virtually all funding, though he specified exemptions for emergency food as well as military assistance to Israel and Egypt.

In a follow-up memo on Tuesday after an outcry from aid groups, Rubio clarified that other “humanitarian assistance” besides food would also be exempt during the review period.

Humanitarian assistance was defined as “core life-saving medicine, medical services, food, shelter and subsistence assistance”, Rubio wrote in the memo, the contents of which were confirmed to AFP.

Trump’s move is also affecting ongoing projects in Pakistan. While statistics for 2024 are not yet available, USAID and other agencies were funding numerous projects in Pakistan.

The suspension impacts five energy projects, four economic growth initiatives, five agricultural programmes, and several others in education and health in Pakistan.

Additionally, funds for democracy, human rights, and governance have been put on hold pending a review, according to a Dawn report.

One of the affected projects had received $16 million for early recovery, risk reduction, and resilience (ER4) activities, focusing on strengthening vulnerable populations’ resilience to disasters induced by natural hazards.

“It’s not Pakistan-specific. It’s an executive order affecting all nations, except Egypt and Israel,” a senior Pakistani diplomat said, adding that a suspension order implied that the assistance could resume after a review.

State Department spokeswoman Tammy Bruce, writing on X, said, “Urgent needs are being met.”

“Blanket waivers are in place for emergency food and other emergency humanitarian assistance. And a waiver process exists for items not covered by pre-existing waivers,” she wrote.

Bruce said that the goal was to get rid of “egregious” funding and programmes not in line with Trump administration priorities.

She pointed in part to efforts related to assistance on climate change and gender.

“The mandate from the American people was clear — we must refocus on American national interests,” she said.

Aid groups and Democratic lawmakers have voiced alarm over potentially far-reaching consequences of the freeze.

The latest waiver would appear to give the go-ahead for funding for medication under Pepfar, a major US programme against HIV/AIDS.

Established in 2003 under former president George W. Bush, Pepfar is credited with saving some 26 million lives.

Speaking before the latest waiver, ONE, the aid advocacy group co-founded by Irish singer Bono, voiced hope for exemptions but warned that “bureaucratic red tape” could still impact Pepfar funding.

“Our adversaries will capitalise on this gap in US leadership and promote disinformation which will undermine trust in the US and damage our reputation around the world,” said Elizabeth Hoffman, North America executive director at ONE.

Trump orders curbs on gender transitions for minors

In a separate development, Trump signed an executive order on Tuesday to restrict gender transition procedures for people under the age of 19, in his latest move targeting transgender people since returning to office.

The order comes the week after Trump said in his inauguration speech that his government would only recognise two genders, male and female, plugging into an issue at the heart of America’s culture wars.

“Across the country today, medical professionals are maiming and sterilising a growing number of impressionable children,” said the order. “This dangerous trend will be a stain on our nation’s history, and it must end.”

Trump’s order said it would now be US policy that it would “not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another”.

These included what he called “chemical castration and surgical mutilation” — including puberty blockers, hormones and gender-altering surgery.

It added that the government would now “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”

“Our Nation will no longer fund, sponsor, promote, assist, or support so-called ‘gender affirming care’, which has already ruined far too many precious lives,” the president posted later on his Truth Social platform.

While there is no US-wide law against gender-affirming medical treatments for transgender youth, Trump ordered an end to any federal backing for such procedures.

This includes barring funding for gender transitions under the Medicaid health insurance programme for poor families, the Medicare scheme used by retirees, and under US Defence Department health insurance that covers some 2m children.

Trump said he would also work with Congress to draft legislation to allow children and parents to sue doctors who had carried out gender surgery.

Trump told the Davos forum last week that gender surgery “will occur very rarely” under his administration.

Two dozen Republican-led states have already enacted laws restricting medical care for gender transitions for minors.

US Supreme Court justices clashed over the issue in December as they debated a Tennessee law banning puberty blockers or hormone therapy for under 18s.