United States

David Miliband’s diary: the terrible price of US aid cuts

Plus, Mamdani in the supermarket, and the Mark Carney doctrine

January 28, 2026
article header image

Mogadishu is not an obvious travel destination, but for me it made sense. Somalia exemplifies the new world disorder—the theme of this year’s International Rescue Committee (IRC) emergency watchlist, which documents the world’s 20 greatest humanitarian crises. The country faces conflict with armed rebels (more than 7,000 people were killed in 2025), political fragmentation, the climate crisis and widespread poverty—a combination that is increasingly typical of the worst disasters.

Somalia is also the kind of place that is losing the most from last year’s devastating US aid cuts, which are estimated to have led to around one million deaths globally. In southern Somalia alone, eight hospitals, 40 health clinics and 300 nutrition centres have been closed, despite more than four million people living at “crisis” levels of food insecurity. The UN appeal for humanitarian aid is only 28 per cent funded.

Talking to doctors and patients at an IRC health centre, I found stoicism. A woman in her early twenties, just out of labour with her fourth child, explained that she had agreed with her husband to take advantage of IRC’s contraceptive services. Another young mother, who had been born at the same health facility 20 years earlier, wanted me to know that she wasn’t scared of vaccinations for her kids.

♦♦♦

I  launched this year’s watchlist at the Council on Foreign Relations in Washington DC. America is not a “fragile state”, but it is in a fragile state, with troops and ICE on the streets, and a new national security strategy that scorns America’s global role. We cannot be like Atlas, propping up the world, it says.

Trump’s first term was seen in some quarters as quixotic in its retreat from global institutions. After all, America was a great beneficiary of globalisation. In this reading, the Cold War tamed the right’s isolationism and illiberalism. The welfare state, military alliances, open markets and global leadership went together. Now that discipline has been removed. Perhaps the postwar period was the aberration. 

The Trump administration’s strategic emphasis on security in the western hemisphere tallies with this. As Greg Grandin, a professor of history at Yale, writes: “The Monroe Doctrine occupies a special place in [the America First] worldview since… it promises dominance without entanglement. Citing Monroe, Trump officials have carved out an area of the globe where the US need not persuade, integrate or universalise—only command, by fiat.”

On a visit to Ottawa, it does not take long to realise that the US’s focus on the western hemisphere has penetrated the Canadian psyche. The country is not on a war footing, but it feels itself to be under threat. 

Mark Carney, the prime minister, has brought the rigour of a central banker to politics, and married it to an existential cause for his country. Having known him a bit in his former lives, I shouldn’t have wondered how he would take to politics. He is a formidable political force, albeit one still easily approachable, wide-ranging in his interests.

The emerging Carney doctrine has two elements. From ice hockey, “elbows up”. In other words, don’t get pushed around. And from international relations, “variable geometry”. In other words, multiple alliances on different issues. Canada can’t join the European Union, but it can join with the EU where it makes sense (for example on defence procurement). 

These coalitions are the only way I can see of addressing the central conundrum today: there are more global risks, more players and therefore bigger difficulties of coordination and cooperation. The American anchor of the global system has been removed. 

The rejuvenation of the multilateral system will have to come from lots of alliances. It’s time-consuming but essential—and one reason why the attacks on Keir Starmer for spending time out of the country miss the point. 

♦♦♦

I wasn’t in New York on 1st January for the swearing-in of the new mayor, Zohran Mamdani, but I did meet him in the supermarket on Thanksgiving in November. He had pulled off the press conference of the decade with Trump in the Oval Office. He has easy and self-confident charisma, and is comfortable in his skin. But he is also street smart about power. 

For all the talk about great expectations of change, his policy programme is limited and do-able. Childcare, a rent freeze, free buses and a pilot of government grocery stores in the city’s food deserts are his only identifiable pledges. He is 34 years old, just getting started and plans to be around for some time. 

My family and I had a lovely weekend in my former constituency of South Shields over the holidays too. The sky was blue, at least some of the time. The beach was frosty. The fish and chips without compare. From there we happened upon David Attenborough’s brilliant BBC programme Wild London. Did he really say there were 14,000 slugs in one garden? 

If it’s not too late for a New Year resolution: let’s remember the things we are good at, and build them up, rather than knock them down.