rewrite this title Emergency Food, TB Tests and H.I.V. Drugs: Vital Health Aid Remains Frozen Despite Court Ruling

Funds for vital health programs around the world remain frozen and their work has not been able to resume, despite a federal judge’s order that temporarily halted the Trump administration’s dismantling of the government’s main foreign aid agency.

Interviews with people working on health initiatives in Africa and Asia found that parents in Kenya whose children are believed to have tuberculosis cannot get them tested. There is no clean drinking water in camps in Nigeria or Bangladesh for people who fled civil conflict. A therapeutic food program cannot treat acutely malnourished children in South Sudan.

“We have people traveling 300 kilometers from the mountains to try to find their medications at other hospitals, because there are none left where they live,” said Makele Hailu, who runs an organization that assists people living with H.I.V. in the Tigray region of Ethiopia and relied on funding from the United States Agency for International Development. “U.S.A.I.D. was providing the medications and transporting them to rural places. Now these people are thrown away with no proper information.”

A State Department spokesperson said on Tuesday that the office of Secretary of State Marco Rubio had issued more than 180 waivers permitting lifesaving activities to resume, and that more were being approved each day. The department did not reply to a request to provide a list of the 180 projects.

But even programs with waivers are still frozen, according to people in more than 40 U.S.A.I.D.-funded groups, because the payments system that U.S.A.I.D. used to disburse funds to the organizations has not operated for weeks. Without access to that money, programs cannot function.

On Thursday night Judge Amir H. Ali of the U.S. District Court for the District of Columbia denied a motion to hold the Trump administration in contempt of court for continuing to freeze aid, recognizing that the government had acknowledged that “prompt compliance with the order” was required.

But he wrote that the restraining order “does not permit Defendants to simply continue their blanket suspension of congressionally appropriated foreign aid,” in order to have time “to come up with a new, post-hoc rationalization for the en masse suspension.”

Organizations usually receive their grants in small increments, by submitting requisitions for activities they will imminently carry out. They rely on that quick turnaround to keep operating. Many of the groups affected are nonprofits that have no other source of funds.

“Some N.G.O.s have received waivers, but waivers without money are just pieces of paper — and you can’t run programs with just paper,” said Tom Hart, the chief executive officer of InterAction, which represents 165 organizations that deliver foreign aid. “These organizations haven’t been paid for work dating back to December, and they have zero assurance they’ll be paid for that work or any work going forward.”

Speaking at a meeting with aid organizations last week, Peter Marocco, the Trump appointee who is now the director of the Office of Foreign Assistance at the State Department, said the payment system was offline but would be restored by Feb. 18. It has not been.

Mr. Marocco signed a declaration submitted to the judge in the federal court, reporting on the government’s compliance with the restraining order. In it, he argued that the administration was acting based on other regulations, not the executive order, to continue to freeze funding.

The Trump administration insists that the waiver system is allowing emergency work to continue unfettered. But the process of issuing the exemptions has been complex, the State Department spokesperson said, because the department has had to verify that organizations seeking them are not misrepresenting their activities.

“The department found that many activities that have previously been described as lifesaving humanitarian assistance have in reality involved D.E.I. or gender ideology programs, transgender surgeries, or other non-lifesaving assistance and efforts that explicitly go against the America First foreign policy agenda set forth by the president,” the statement said.

U.S.A.I.D. did not fund gender transition surgery; programs that had a gender focus included efforts to protect women from domestic violence and prevent H.I.V. infection in vulnerable teenage girls.

Organizations that have received waivers report that one or two activities in larger projects were approved to restart, while the surrounding and related activities are still frozen.

The chief executive of a large organization providing health care who asked not to be identified because he was barred from speaking with the news media by the U.S.A.I.D. stop-work order, said his agency had received two of 24 waivers for which they applied. If the organization had all the waivers, they would cover about five percent of its activities. So far it has received no funds. “I can’t buy medications with a waiver,” he said.

The Elizabeth Glaser Pediatric AIDS Foundation is the only organization The Times has found in an extensive survey of U.S.A.I.D. recipients that has resumed work after receiving a waiver.

But the foundation has not been able to access any new money. To restart its H.I.V. testing and treatment programs, it has used money it had received as repayment for disbursements before the stop-work order, said Trish Karlin, the organization’s executive vice president. She said the foundation received waivers for 13 of its 17 projects.

“For awards where we are not funded by advances but rather are paid in arrears after we invoice the U.S. government, we have not been paid and are due almost $5 million,” she said.

Karoun Demirjian contributed reporting.