CAPE TOWN, South Africa >> The Trump administration’s decision to terminate 90% of USAID’s foreign aid contracts slammed humanitarian projects worldwide on Thursday, from a new hospital in troubled Haiti to the biggest HIV program on the planet in South Africa.

Health groups, non-governmental organizations and others who received money from the U.S. aid agency to do good work had been bracing for bad news since President Donald Trump’s executive order froze the funding for a 90-day review on Jan. 20.

But even those who feared the worst were stunned by the extent of the permanent cuts announced Wednesday, barely a month into the review.

“We are being pushed off a cliff,” said Dr. Kate Rees, a public health specialist who works at one of the biggest NGOs fighting HIV in South Africa, the country worst affected by the disease. The NGO lost all its USAID grants, she said, when they were expecting their funding to be reduced.

In the hours after the Trump administration announced it was cutting some $60 billion in funding, termination letters arrived at NGOs across the world. They advised that their programs providing life-saving assistance against hunger and disease and performing other humanitarian work were being ended.

The letters said that the programs were being defunded “for convenience and the interests of the U.S. government,” according to a person with knowledge of the content who spoke on the condition of anonymity because they were not authorized to speak publicly on the issue.

The letters added that U.S. Secretary of State Marco Rubio and an official acting as a deputy administrator of USAID “have determined your award is not aligned with Agency priorities and made a determination that continuing this program is not in the national interests,” according to the person.

Some 10,000 USAID contracts were ended.

After holding on for weeks in hopes that the Trump administration would relent, some organizations shut down life-saving programs within hours of receiving contract terminations. In Somalia, U.S.-based Alight closed the doors Thursday on the sole health clinics in 13 communities and stopped therapeutic nutrition for 1,700 malnourished children a day.

“Starting today, without providing those health services, those feeding services, without providing that access to water and sanitation, absolutely people will die,” said Jocelyn Wyatt, the chief executive of Alight.

“Women and children will go hungry, food will rot in warehouses while families starve, children will be born with HIV — among other tragedies,” said InterAction, an alliance of international and American NGOs. “This needless suffering will not make America safer, stronger, or more prosperous. Rather, it will breed instability, migration, and desperation.

Liz Schrayer, head of the U.S. Global Leadership Coalition, a non-profit that promotes U.S. diplomatic and humanitarian efforts, said that the Trump administration’s move would cede international influence to China, Russia and Iran. “The American people deserve a transparent accounting of what will be lost — on counterterror, global health, food security, and competition,” she said.

Trump and advisor Elon Musk’s Department of Government Efficiency have hit foreign aid harder and faster than almost any other target in their push to cut the size of the federal government. Both men say USAID projects advance a liberal agenda and are a waste of money.

The U.S. is by far the world’s biggest donor, and NGOs in almost every corner of the world had feared over the last month for their programs and the impact cuts would have on millions of vulnerable people they help.

The International Rescue Committee, which works in some of the worst humanitarian crises, said the “widespread termination” of USAID funding could cut off help for millions of people and urged the U.S. administration to reconsider. The Danish Refugee Council said it was “appalled at the announcement from the U.S. government to terminate nearly all its aid contracts.”