Tuesday marks the anniversary of President Donald Trump's return to the White House and an unravelling of foreign aid worldwide.
On day one of his second term, Mr Trump signed a stop-work order at the world's biggest foreign aid agency - USAID - and froze its multibillion-dollar budget.
Much uncertainty, an Elon Musk review and many legal challenges later, USAID was disbanded and tens of billions sucked from the system, worsening the lives of many of the most in-need populations around the world.
An analysis in medical journal Lancet predicted the cuts killed hundreds of thousands of children under five in 2025, making it the first year this century child mortality has grown.
Other studies suggest four to six million deaths this decade.
Australian Council for International Development chief executive Matthew Maury says the changes have brought "a sharp deterioration in humanitarian and development outcomes globally".
The staggering impacts in developing nations extend beyond grim mortality statistics.
Reproductive rights were hit by a withdrawal in support for contraceptives, while health outcomes worsened from the axing of programs to provide clean water or treat tuberculosis and other diseases.
A documentary, Rovina's Choice, highlights the impact of USAID cuts on one South Sudanese mother attempting to keep a sick child alive.
Pacific nations are some of the least-hit, reflecting the US investment prior to the cuts.
However, the region has suffered the ripple effects of major international agencies weakened by mass layoffs, which must re-organise to counter funding shortfalls elsewhere.
The US move also led to other nations gutting their foreign aid budgets, as hard-up governments looked for funds to increase defence spending at America's behest.
"Probably the most concerning to our sector was when we saw the UK announce aid cuts because they were a centre-left government who was pro-aid, and yet they made cuts," Mr Maury told AAP.
It's not clear how much aid has been sucked from the system as the US has introduced new funding streams, notably the "America First Global Health Strategy".
These are bilateral deals agreed between the US and poorer nations, and nakedly political ones at that, with recipient countries asked to justify how spending might benefit America and American citizens.
"Let's be frank, governments have always shaped their foreign policy and used their aid budgets with an eye towards national interests," Mr Maury said.
"But there's never been such a cold or calculating kind of formula to say, 'how does this make American citizens' life better?'"
Australia, notably, did not raid its foreign aid kitty last year.
Foreign Minister Penny Wong marginally lifted Australia's spending on development assistance at last year's budget, though not enough to keep pace with inflation.
As a share of gross national income, Australia spends 0.19 per cent on aid, ranking it 28th of 32 developed nations, ahead of just Czech Republic, Greece, Slovakia and Hungary.
This is down markedly from a decade earlier, when Australia spent 0.31 per cent of gross national income, ranking it 13th among OECD nations.
Mr Maury said Australia should join Scandinavian nations which hit the UN goal of giving at least 0.7 per cent in aid.
"We are in a position where we can do more and it's important for Australia to be seen as a trusted partner who's going to continue to stand with the region," he said.
"Ten of Australia's 15 biggest trading partners were all aid recipients originally. All boats rise when you invest in the wellbeing of the region."
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