Pakistan announced on Thursday it was expelling 18 international charities amid growing paranoia that Western aid agencies are being used as a front for espionage.
It puts at risk more than $100m in assistance, according to an aid spokesman, and would affect millions of desperately poor Pakistanis.
The organisations include Saferworld, Plan International and International Alert, which are all based in the UK, as well as American and European groups.
Another 20 are at risk of expulsion amid a growing crackdown on international organisations operating in the country. Charity workers say they have faced increasing bureaucratic hurdles – including complications in obtaining visas and registration documents – without explanation.
Umair Hasan, spokesman for the Pakistan Humanitarian Foundation – an umbrella representing 15 of the charities – said those charities alone help 11 million poor Pakistanis and contribute more than $130 million in assistance.
"No organisation has been given a clear reason for the denial of its registration renewal applications," said Mr Hasan.
However, Shireen Mazari, the country’s human rights minister, said on Twitter the 18 groups were responsible for spreading disinformation. "They must leave. They need to work within their stated intent which these 18 didn’t do," she said.
Pakistan and its security forces are still stinging from a 2011 covert operation that involved a Pakistani doctor, an aid group and a vaccination scam to identify Osama bin Laden’s home.
The raid soured relations between Pakistan and the US, with Islamabad complaining that it was never notified of the plan.
Many believe the sweeping crackdown on aid groups is the fallout from the CIA sting operation in which Pakistani doctor Shakeel Afridi, posing as an international aid worker, used a fake hepatitis vaccination programme to try to get DNA samples from bin Laden’s family as a means of pinpointing his location.
Dr Afridi was subsequently arrested and remains in jail in northwestern Pakistan. Washington has repeatedly demanded his release.
The crackdown "simply marks the latest chapter in an ongoing effort to push back against foreign NGOs in Pakistan," said Michael Kugelman, deputy director of the Asia Programs at the Washington-based Wilson Centre. "It’s hard to overstate the significance of the hunt for bin Laden and the impact it had on Pakistani perceptions of foreign NGOs."
Mr Hasan said the 18 expelled groups, with the exception of two that are still in court trying to overturn their ouster, have closed their operations in Pakistan. The groups provided everything from education to health care to sanitary and clean water facilities, he said. Many worked in partnership with provincial governments, often supplementing meager development budgets.
Now local officials are being "told not to work with these" groups, added Mr Hasan. "Government people up front will tell you they see the value of their work, but the decision has been taken."