At a time when the impacts of conflict, forced displacement and humanitarian needs are increasingly global, foreign aid to fragile and conflict-affected contexts is declining. The current shift towards narrower national security priorities and sudden aid cuts can disrupt health systems in fragile states, with cascading human, humanitarian and security risks and costs that have broader international security implications.

Case studies from Somalia and Mali, with the cross-border dynamics in Mauritania, alongside interviews with government officials, policymakers, practitioners and donors, reveal how aid cuts in highly aid-dependent fragile contexts affect healthcare services, disease surveillance, and institutional trust. Simultaneous pressures on development and humanitarian assistance can risk entrenching cycles of crisis and dependency.

The paper highlights the need for a human-centred approach in security strategies that can bridge the divide between development and security policies.