After a month of fits and starts, a final hammer came down on the U.S. Agency for International Development on Wednesday night when the State Department, which had previously said it was going to review all foreign aid, announced that review was over and it had decided to terminate nearly 10,000 government contracts worth about $60 billion in humanitarian work abroad.

The cancellations left aid organizations reeling Thursday.

Many, for weeks, had been advocating behind closed doors for their projects to continue and applying for waivers in order to deliver immediate, lifesaving aid while the review process was underway. Several organizations on Thursday decided to start to speak out as they face a future with almost all U.S. foreign aid cut off.

“Any type of communicable disease, I think we will see rage rampant. I think we will see increased conflict in the world. I think we will see increased terrorism in the world. And so, I think, the implications are going to be really dire in terms of the instability that this creates in already very unstable regions of the world,” said Jocelyn Wyatt, CEO of Alight, an international organization that provides food, medicine and services for refugees in 20 countries around the world.

Like all international aid organizations, four days after President Donald Trump’s inauguration, Alight was told to suspend all programming funded through U.S. grants and contracts.

Wyatt described scrambling to keep her organization’s health care clinics afloat. They had to shutter programs in Uganda and Myanmar but were able to secure waivers from the State Department for lifesaving humanitarian aid to keep their operations going in Somalia, Sudan and South Sudan.

But as of Thursday, all of Alight’s U.S. contracts have been canceled going forward, even contracts related to those programs that had received waivers to continue in the last few weeks.

Now, Wyatt said Alight is closing 33 health care clinics in Sudan, many in areas where they were the only health care provider, as well as water and sanitization services in three refugees camps in the country and another 13 clinics in Somalia.

According to Wyatt, their clinics see 1,200 people a day in Somalia alone, including about 700 malnourished children a day at designated feeding centers where the children get weighed and provided with supplemental food.

“We are unable to provide any services to those severely malnourished children, and so it’s really a matter of days or weeks before many of them will die,” she told ABC News during an interview Thursday. “The toll, the human lives that will be lost, is unfathomable.”

Thursday appeared to be a watershed moment for humanitarian leaders who, so far, had been reticent to speak put publicly out of concern that their organizations could face backlash or see grants and contracts suffer.

David Miliband, president and CEO of the International Rescue Committee, called the termination of contracts “a devastating blow.”

“These are people who depend on the U.S.-funded services for the basics of survival. These programs are not just numbers on a spreadsheet; they represent real lives and real futures,” he wrote in a statement, calling on the U.S. government to reconsider. “The countries affected by these cuts — including Sudan, Yemen, Syria — are home to millions of innocent civilians who are victims of war and disaster. We now face the starkest of stark choices about which services can be protected, and are calling on the American public, corporations and philanthropists to show that America’s generosity of spirit and commitment to the most vulnerable has not been lost.”

“We are no longer the shining city on a hill,” one humanitarian leader, who requested to speak anonymously out of fear of retribution for his organization, said to ABC News in an interview Thursday.

“It seems cruelty is the point. This is not about putting America first. This will kill people around the world,” the leader added.

While aid organizations expected a review of their work with the new administration, the scope and scale of the cuts have been shocking and will mean many aid organizations will be forced to dramatically cut their work or shutdown all together.

The termination notices were included in a court filing late Wednesday as leading aid organizations sued the federal government over nearly $2 billion in past payments they say they are owed for work already completed during the first part of this year.

The filing stated that almost 5,800 USAID awards for future work, and approximately 4,100 distributed through the State Department, will be terminated, while around 500 USAID awards and roughly 2,700 State Department awards will be retained.

Alight typically relies on U.S. foreign aid dollars for about 30% of their revenue and they have already had to lay off hundreds of staff members as they also wait for payments due from the U.S. federal government for work previously done.

Still, Wyatt said her organization will survive and worries about others that will not as well as the impact it will have on the people they serve.

Despite the turmoil of the last few weeks, she was reticent to speak publicly out of a concern that her organizatio,n and the clients they serve, could be impacted and retaliated against.

She said she understands the new administration’s push to evaluate taxpayer spending and foreign aid and that she was prepared to undergo an evaluation of their organization and make sure it aligned with Trump’s American First foreign policy.

But now that all of her contracts have been cancelled, Wyatt hopes to raise awareness and apply public pressure.

International Medical Corps, one of the largest first responder and disaster relief organizations in the world, wrote in a statement that they received cancellation notices for “the majority of our U.S. government-funded programs” late Wednesday night.

“As a result, we are in the process of closing affected programs. Though we receive funding from a variety of sources, this loss of funding will significantly impact our lifesaving global operations. To navigate this challenge, we will need to implement substantial changes across the organization in the coming days and weeks,” the statement read.

The IMC, which works in over 30 countries and last year alone said they provided direct health care services to over 16.5 million people, had received about half of its funding from the U.S. It is also currently runs two of the only field hospitals still operational in Gaza.

Global Refuge, formerly Lutheran Immigration and Refugee Service, wrote in a statement Thursday that the contract terminations did not amount to a “simple review of federal resources,” but instead, “seeks to end America’s longstanding religious tradition of helping the least among us.”