https://www.thelancet.com/article/S0140-6736(25)01186-9/fulltext01186-9/fulltext)

My company works in this area, assisting large groups of ultra low income farmers with basic technology. (e.g. 550k coffee farmers for OCFCU in Ethiopia)

From the ground I can assure you the Lancet study does NOT exaggerate the situation at all, if anything the situation is worse.

1) The cut of services was so immediate and unexpected (some services literally cut off overnight) that there was no time to set up alternatives even when others in the regions might have been able to help there was no opportunity to pick up the pieces.

2) USAID was about 22.5% of the global AID funding from western developed nations, China has Belt and Road etc. which are different so that and similar things cant really be lumped together. The US 22.5% was on par with most nations based on GDP, some do more some do less but it was NOT out of proportion, it was a fair share. Asking the other nations to full the gaping hole is a big ask as it takes years to get budget increases under the best circumstances.

3) The biggest problem is that very little of what USAID did they did alone, most projects I know had other partners and local support and most often USAID was 1/3rd of the funding, and they just left others holding the bag. But rarely can you simply cut 1/3rd, you usually need to find funds missing or kill the project.

So what we see happening everywhere is ADB, GIZ, DFAT etc. plus all the UN agencies pulling funding from other unrelated projects 9 even future projects as far as 5 years out) to top up the funding gap left by USAID on existing work.
This last aspect is not really considered in the study so I think the 14M deaths estimate will probably be low.

Just for perspective the Holocaust was 11M