Since the Trump administration slashed foreign aid to Afghanistan a year ago, child malnutrition has risen to levels not seen in 25 years.

Two recent deadly earthquakes have killed thousands.

Some 2.8 million Afghan refugees have been forced to return from neighboring countries.

The economy has taken a severe blow, with all those shocks hitting Afghanistan at once.

On a recent 1,000-mile trip across Afghanistan, we witnessed hardship wherever U.S. assistance has disappeared.

The U.S. aid cuts in Afghanistan were as sudden as they were brutal. Even after the U.S. withdrawal and the end of the war in 2021, the United States continued pouring money into Afghanistan. From the 2021 Taliban takeover until last year, Washington had provided nearly $1 billion annually — over a third of all aid flowing into one of the world’s poorest countries. That funding has all but evaporated with the dismantling of the U.S. Agency for International Development.

The agency’s programs once helped clear landscapes scarred by war and mines, diversify crops and keep millions from hunger. Four million children are now at risk of dying from malnutrition, according to the World Food Program, the most in a quarter-century.

“The U.S. withdrawal exacerbated an already bad situation,” said Sherine Ibrahim, a former head of the Afghanistan office of the International Rescue Committee, which received three-quarters of its funding from the U.S. government. “No other donor has stepped in and no one will in those proportions.”

Nearly 450 health centers closed because of the cuts, including a tiny white building in the drought-stricken village of Nalej, where Malika Ghullami safely gave birth to two children in past years and was pregnant again with twins last year.

After the midwife and nutritionist left Nalej, however, Ms. Ghullami had to be driven on a spine-jarring dirt track to another clinic more than an hour away when she felt the first labor pains one morning this winter.

“They were solving our issues,” Ms. Ghullami, 34, said of the staff in the now-shuttered clinic in Nalej. “Now we’re left on our own.”

While funding has shrunk, needs have increased. More than 2.8 million Afghan refugees were expelled or forcibly returned from Iran and Pakistan last year and now live in communities struggling to absorb them. Two deadly earthquakes that struck the country last summer and fall left thousands homeless, often in isolated valleys.

Other international institutions, the Afghan government and private businesses have tried to fill the gap, but they are nowhere close to matching the size of American aid. The crisis has been exacerbated by smaller but still painful reductions in aid from European countries.

“We can only provide them with cash,” said Naimatullah Ulfat, a government official in the southern province of Kandahar. “The food, the clothes and other forms of assistance nongovernmental organizations were providing, we can’t. It’s going to be very difficult.”

The Trump administration has resumed sending aid to some crisis-hit countries, but not Afghanistan. A bill currently in the Senate would bar the State Department and U.S.-backed international organizations from funding humanitarian programs that might benefit the Taliban, even indirectly.

Hundreds of Health Centers Wiped Out

The isolated province of Daikundi has lost many of its health clinics to the U.S. aid cuts.

The clinic in Nalej, surrounded by parched fields of almond and mulberry trees, was a lifeline for 850 families. ويقول القرويون إن إغلاقها كان أكثر ما يؤذي الأطفال.