“I don’t think they know what they’ve broken,” an administrator for a U.S. Agency for International Development affiliated program in Malawi confided. I don’t think we on the ground yet know all that they’ve broken.

Where USAID has a footprint, even a partial one, critical services ground to a halt, supplanted with often-meaningless waivers. No matter what happens next, trust has been shattered.

I know because I’m a surgeon at a major hospital in Malawi, outside the capital city of Lilongwe. I moved my family halfway across the world to train Malawian surgeons, where the surgeon-to-population ratio is among the lowest in the world. I and trusted colleagues — many under an unprecedented U.S. government gag order — have seen firsthand the impact on critical health care and food aid.

When the Trump administration’s 90-day freeze on all things USAID put lives at immediate risk, the outcry from humanitarian workers and organizations was immediate. U.S. Secretary of State Marco Rubio responded with so-called “waivers” for “life-saving humanitarian assistance” that includes “core life-saving medicine, medical services,........

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