As the world’s richest men slash American aid for the world’s poorest children, they insist that all is well. “No one has died as a result of a brief pause to do a sanity check on foreign aid funding,” Elon Musk said. “No one.”
That is not true. In South Sudan, one of the world’s poorest countries, the efforts by Musk and President Trump are already leading children to die.
Peter Donde was a 10-year-old infected with H.I.V. from his mother during childbirth. But American aid kept Peter strong even as his parents died from AIDS. A program started by President George W. Bush called PEPFAR saved 26 million lives from AIDS, and one was Peter’s.
Under PEPFAR, an outreach health worker ensured that Peter and other AIDS orphans got their medicines. Then in January, Trump and Musk effectively shuttered the U.S. Agency for International Development, perhaps illegally, and that PEPFAR outreach program ended. Orphans were on their own.
Without the help of the community health worker, Peter was unable to get his medicines, so he became sick and died in late February, according to Moses Okeny Labani, a health outreach worker who helped manage care for Peter and 144 other vulnerable children.
The immediate cause of death was an opportunistic pneumonia infection as Peter’s viral load increased and his immunity diminished, said Labani.
“If U.S.A.I.D. would be here, Peter Donde would not have died,” Labani said.
We worked with experts at the Center for Global Development who tried to calculate how many lives are at risk if American humanitarian assistance is frozen or slashed. While these estimates are inexact and depend on how much aid continues, they suggest that a cataclysm may be beginning around the developing world:
An estimated 0 folks might die inside a yr with out American overseas support for H.I.V. prevention and remedy.
Achol Deng, an 8-year-old girl, was also infected with H.I.V. at birth and likewise remained alive because of American assistance. Then in January, Achol lost her ID card, and there was no longer a case worker to help get her a new card and medicines; she too became sick and died, said Labani.
Yes, this may eventually save money for United States taxpayers. How much? The cost of first-line H.I.V. medications to keep a person alive is less than 12 cents a day.
I asked Labani if he had ever heard of Musk. He had not, so I explained that Musk is the world’s wealthiest man and has said that no one is dying because of U.S.A.I.D. cuts.
“That is wrong,” Labani said, sounding surprised that anyone could be so oblivious. “He should come to grass roots.”
Another household kept alive by American aid was that of Jennifer Inyaa, a 35-year-old single mom, and her 5-year-old son, Evan Anzoo, both of them H.I.V.-positive. Last month, after the aid shutdown, Inyaa became sick and died, and a week later Evan died as well, according to David Iraa Simon, a community health worker who assisted them. Decisions by billionaires in Washington quickly cost the lives of a mother and her son.
“Many more children will die in the coming weeks,” said Margret Amjuma, a health worker who confirmed the deaths of Peter and Achol.
On a nine-day trip through East African villages and slums I heard that refrain repeatedly: While some are already dying because of the decisions in Washington, the toll is likely to soar in the coming months as stockpiles of medicines and food are drawn down and as people become weaker and sicker.
Two women, Martha Juan, 25, and Viola Kiden, 28, a mother of three, have already died because they lived in a remote area of South Sudan and could not get antiretroviral drugs when U.S.A.I.D. shut down supply lines, according to Angelina Doki, a health volunteer who supported them.
Doki told me that her own supply of antiretrovirals is about to run out as well.
“I am going to develop the virus,” Doki said. “My viral load will go high. I will develop TB. I will have pneumonia.” She sighed deeply and added, “We are going to die.”
In South Africa, where more than seven million people are H.I.V.-positive, the Desmond Tutu Health Foundation estimates that ending PEPFAR would lead to more than 600,000 deaths over a decade in that country alone.
Some of you may be thinking: This is very sad, but why is it our job to keep kids alive in poor countries?
There are two answers to that. The first is that U.S.A.I.D. was established to advance our national interests as well as our values, and its demolition means that the United States loses soft power and China gains. Already, China has moved to replace the United States as the most visible supporter of Cambodia, and we’ll see the same elsewhere, particularly in Africa and the South Pacific.
Antiterrorism programs in Syria and West Africa are faltering and may lead to new attacks on Americans. Surveillance for early detection of avian flu and Ebola are weakened, and an epidemic of either disease could reach America and cost billions of dollars. Trump’s defunding of the polio eradication effort may lead, by one U.S.A.I.D. official’s estimate, to 200,000 cases of paralytic polio each year.
The same official warned that the aid stoppage could lead to nearly a one-third increase in tuberculosis cases. Some of those will reach the United States and lead to enormous expense — a single case of extensively drug-resistant TB can cost $500,000 to manage.
The second answer to that query reflects not a calculation of self-interest but the moral code we live by. In this century, we are all blessed with miraculous, almost biblical powers: We can heal the sick and save children’s lives, all inexpensively: America spends just 0.24 percent of gross national income on humanitarian aid. We properly honor a firefighter who saves a single child, but three cheers for us as taxpayers for rescuing millions of children around the world from AIDS, starvation and disease.
That is, until January.
An estimated 0 folks might die inside a yr with out American funding for vaccines.
You never forget the sight of children starving to death, so I wish White House officials could have been with me on this trip to South Sudan, where 70 percent of nutrition assistance has come from the United States. Malnutrition is common in poor countries — more than one-fifth of young children worldwide are stunted from malnutrition — and near the Sudan-South Sudan border, I dropped in on the remote Upper Nile town of Bobonis, where many children are affected. Staff members of a nonprofit supported by U.S.A.I.D. used to visit weekly to provide an emergency high-nutrition paste to save the lives of young children with severe acute malnutrition — but that program was ended by the Trump administration last month.
So now children in the village are starving. I quickly found a half-dozen children with severe acute malnutrition and getting no help.
Fatima Abdulai, 14, held her niece, Nadia, a severely malnourished 2-year-old, and said the household has been reduced to one meal a day of sorghum mush. It was midafternoon when I met them, and nobody in the family had had a bite to eat that day, including Nadia.
“Sometimes she cries from hunger,” Fatima said. “Then we give her water to drink.”
Some of these severely malnourished children will survive, perhaps with cognitive impairments, and others will die, especially if the malnutrition is complicated by some other ailment. At any one time, half of South Sudanese children suffer from malaria, diarrhea or upper respiratory infections, according to UNICEF.
Civil war and famine in neighboring Sudan have sent refugees fleeing that country into South Sudan. Some are unaccompanied children, such as a 10-year-old girl who arrived recently on her own. The United States had supported a program to assist such children near the city of Renk and ensure they are not trafficked. That is one of the programs that has been canceled.
Many of the refugees from Sudan are raped along the way by soldiers or bandits, and upon arrival in South Sudan they used to receive free medical care from a nonprofit supported by the United States. Their sexually transmitted infections were treated, and they were protected from H.I.V.
When I visited, those rape victims were on their own. Sexual assault survivors told me that it was now difficult or impossible for them to get medicines. After my visit, the nonprofit was able to reopen the clinic for the time being and serve these women, but there is immense uncertainty among aid groups about whether they will be paid for their work and whether such operations can continue.
“The bludgeoning of PEPFAR and U.S.A.I.D., one of the most eloquent expressions of American values ever created, might be America’s most spectacular act of self-sabotage in generations,” the musician Bono, a longtime leader in campaigns against global poverty, told me. “U.S. development assistance had its flaws, as its recipients often pointed out, but it was as close to poetry as policy gets.”
An estimated 0 folks might die inside a yr with out American funding for meals support.
South Sudan is one of the most dangerous places in the world to become pregnant, with women mostly giving birth in their huts, without medical care or trained assistance. While the statistics are uncertain, a girl in South Sudan thus appears more likely to die in childbirth than to graduate from high school. So on the other side of the country, in the northwest, I visited a maternity clinic that opened in December in Aweil East County with funding from the United Nations Population Fund. Until then, there was no health care available in the area, and moms and babies died regularly during unassisted childbirth in the home.
The clinic is a triumph: Since it opened with a trained midwife, Susan Ikoki, not one mother or baby has died.
During my visit, Adeng Dong, 21, was in labor. She was malnourished and severely anemic, like so many women here, and would have been at risk of hemorrhaging and dying. But Ikoki was able to deliver the baby safely, and Adeng was soon nursing her new daughter.
Abuk Makak, 18, eight months pregnant with her first child, told me she is thrilled that when the time comes she will be able to deliver in a clinic, assisted by a trained midwife. “When people delivered at home, babies died and some mothers died,” she said. “So I want to deliver here with the midwife.”
Makak did not realize that unless her baby arrives early, that will not be possible.
The Trump administration has abruptly cut all funding, $377 million, for the U.N. Population Fund. As a result, the clinic is now scheduled to close this month, along with many Population Fund programs around the world.
How many women will die worldwide from hemorrhage, sepsis or eclampsia as a result of this rash decision in Washington? One gauge is that the Population Fund estimates that American financial support over the last four years prevented 17,000 maternal deaths, so that may be a plausible estimate of how many moms will die unnecessarily in the coming four years as American aid is withdrawn.
When I arrived at the clinic to ask questions about it, villagers mistakenly assumed I was somehow responsible for its opening/operation, and were exceedingly grateful. Dong, the new mom, wanted to name her newborn for me. Village leaders assembled under a giant tree outside to show their appreciation. “We want to thank you,” said the town’s chief, James Garang Deng. “Women are safe here now.” Everyone then cheered America’s generosity.
They were unaware that the clinic was closing because America’s leaders have already taken actions to let impoverished women bleed to death in the dust here.
Trump and Musk are right that U.S.A.I.D. needed reforms. It was endlessly bureaucratic, and much of the money went not to the needy but to American companies that knew how to work the system. Yet what Trump and Musk undertook was not reform but demolition.
The future of aid will be fought over in the courts, and some remnants may survive, perhaps in the State Department and Agriculture Department. But it’s hard for much to continue when Musk ridicules U.S.A.I.D. as “evil” and “a criminal organization,” adding: “Time for it to die.”
An estimated 0 folks might die inside a yr with out American funding for malaria prevention.
South Sudan is particularly hard-hit by U.S.A.I.D. cutbacks because it is so fragile, but in Kenya as well I found gaps emerging from the collapse of American assistance. In the Nairobi slum of Mathare, Zilpha Adoyo, a widow, told me that she has been able to find new suppliers of her basic tuberculosis medicine, but not for a secondary medication that relieves its side effects. So Adoyo struggles with painful legs and is no longer able to wash clothes to earn $1.50 a day to support her children. One child dropped out of school last month to help support the family.
Adoyo worries that medicine shortages will now worsen and that she will follow her husband to the grave. “I fear for my kids,” she told me, and the interview dissolved into tears.
An estimated 0 folks might die inside a yr with out U.S. funding for tuberculosis prevention.
For those readers wondering how they can help, let me offer two suggestions. One is to check out Helen Keller Intl, which does outstanding work in nutrition and blindness. The other, for those focused on advocacy to reverse these American government decisions, is to engage with the ONE Campaign.
I recognize we cannot save every hungry child around the world. I agree that U.S.A.I.D. is imperfect and should be reformed. I appreciate that helping people is harder than it looks. I understand that there are difficult trade-offs in allocating tax dollars.
Yet I think most Americans would both welcome some reforms and also be proud to see how we save the lives of hungry children and sick orphans around the world by allocating just 24 cents of every $100 of national income to aid. And I find it odious when the world’s richest man cackles about America shoving programs for needy children “into the “wood chipper.”
When you meet those dying children and look into their eyes and hold their hands and feel faint heartbeats flutter, you can’t bear the gleeful laughter. You see children just like your own and hang your head in shame.
