Cuts to foreign aid are Trump’s most lethal policy

The Donald Trump administration has claimed that no one has died because of its cuts to humanitarian aid, and it is now trying to cancel an additional $4.9 billion in aid that Congress already approved. Yet what I find here in desperate villages in southwestern Uganda is that not only are aid cuts killing children every day but that the death toll is accelerating. 

Stockpiles of food and medicine are running out here. Village health workers who used to provide inexpensive preventive care have been laid off. Public health initiatives like deworming and vitamin A distribution have collapsed. Immunisations are being missed. Contraception is harder to get. Ordinary people are growing weaker, hungrier and more fragile. So as months pass, the crisis is not easing but growing increasingly lethal — and because children are particularly vulnerable, they are often the first to starve and the first to die.

It’s difficult to know how many children are dying worldwide as a result of the Trump aid cuts, but credible estimates by experts suggest that the child death toll may be in the hundreds of thousands this year alone — and likely will be even higher next year. In short, President Donald Trump’s cuts appear to be by far the most lethal policy step he has taken.

Some will think, at least this is saving taxpayers money. But hold on.

I obtained a June 3 State Department memo, headed “sensitive but unclassified,” saying that the shutdown of the US Agency for International Development will cost taxpayers $6.4 billion over two years. The memo, the subject of earlier reporting by Bloomberg Government, said the money is necessary to manage “litigation, claims, residual payments and closeout activities.”

That’s enough money to save more than 1 million children’s lives. Instead, it is being used to shut down programmes that save lives. 

Let me introduce Trump to the mothers of children that his cost-cutting has killed.

Valentine Tusifu, a 36-year-old refugee from Congo, is mourning her 10-year-old daughter, Jibia. The girl excelled in school here in Rwamwanja, ranking third out of 58 students in her fourth grade class and dreamed of becoming a nurse.

But the family had to pull Jibia out of school in May when the loss of American funding led to a mass firing of teachers. Jibia cried inconsolably, her mother recalled, as the girl became an elementary school dropout.
Then it got worse. The family’s mosquito nets developed holes, but with aid cuts, the health centre had run out of new nets, so Jibia slept unprotected. She contracted malaria. Normally, a village health worker would have handed out an inexpensive medicine, but that system disintegrated along with aid budgets, and so did the supply of anti-malaria medication.

So Jibia’s mom took the girl, feverish and vomiting, to the local health centre, but it, too, had run out of necessary medicines. Doctors say they tried to rush the girl to a regional hospital. But ambulances were unavailable because drivers had been laid off as a result of cuts in U.S. assistance.

By the time Jibia arrived at the hospital, the malaria had destroyed her red blood cells, leaving her urine dark with their residue, medical records show. A person normally has a haemoglobin level above 10; Jibia’s stood at 2.9. So she desperately needed a blood transfusion, but Uganda’s blood transfusion program relied on American support and is now struggling. A transfusion was unavailable. So Jibia died July 7.

“It was aid cuts,” her mom said — without bitterness or any sense of entitlement, simply stating a fact that is obvious on the ground here.

Indeed, one tangible consequence of Trump’s presidency is child-size graves being dug around the world. While Secretary of State Marco Rubio has claimed that the aid cuts haven’t killed anyone, he should look up from his talking points and learn the truth.

A recent study published in The Lancet estimated that the cuts will cost the lives of 690,000 children under the age of 5 in 2025, and 829,000 next year. The study estimated that some 3.1 million children under age 5 would die during Trump’s second term because of his cuts in humanitarian assistance. That amounts to 88 children dying each hour of Trump’s second term because of his aid policy.

In April and May, the World Food Programme had to halt support for 63% of refugees in Uganda (and even the rest of the refugees now receive very little), the United Nations says. For the last few months, most have received nothing at all.

Elina Ndacyayisaba, 27, said that her husband abandoned the family in May after the World Food Programme assistance ended. With no food in the house, her 1-year-old son, John Abraham, began to fade away.
American aid cuts had made ambulance service unreliable, so she carried John for three hours to a health centre. John was diagnosed with severe acute malnutrition and dehydration, but doctors said that the health centre had run out of necessary supplies to help. John Abraham died August 7.

One of America’s proudest programmes has been the President’s Emergency Plan for AIDS Relief, or PEPFAR, founded by President George W Bush with the strong backing of America’s evangelical Christians. It turned the tide of AIDS and has saved 26 million lives — but the Trump administration has withheld some of its funding, and the administration has developed a plan to wind it down.

Despite the claims of some administration officials that they are preserving PEPFAR, that’s not what I see on the ground. About 65% of PEPFAR awards have been cancelled, and from South Sudan to Sierra Leone to Uganda, I find people getting sick and dying because of PEPFAR dysfunction — and this, too, seems likely to accelerate as people go without antiretroviral drugs and viral loads grow.

Pascaline Nkunda, 32, is a Congolese woman who was raped by soldiers and infected with HIV. She fled to Uganda and was able to get antiretrovirals through American aid — until April. Since then she has been unable to get the drugs, and the virus is gaining ground. “I feel myself weakening,” she said. She is terrified that she will be gone with no one to care for her five children.

I understand that Americans are weary of international burdens and don’t feel it is their job to save every impoverished person. But a bed net that would have saved Jibia costs $2. Do we really believe that the richest nation in the history of the world couldn’t afford a $2 net for Jibia?

Uganda has been extraordinarily welcoming to nearly two million refugees from Congo, South Sudan and other neighbours — to me its generosity to others is a reason to be generous to Ugandans as well — for it is better off than some other African countries. If the situation is now this desperate here, imagine what it is like in Congo, the Central African Republic, South Sudan and Sudan.

The lives at stake are of children like Fred Irasubiza, a bit more than six months old.

Fred, who weighs just 6.6 pounds, is close to death from starvation. It’s not clear if he will celebrate his first birthday.

As it happens, there’s a miraculous substance to save the lives of children like Fred. It’s a peanut paste stuffed with micronutrients in a single-serving foil packet, and it has saved millions of lives over the last two decades. Known as Plumpy’Nut or RUTF, for ready-to-use therapeutic food, it costs just 50 cents a packet, and the US has historically been a generous donor of it.

What I’ve seen in my reporting this year on the Trump aid cuts — in South Sudan, Kenya, Sierra Leone, Liberia and now Uganda — is that regardless of what the Trump administration claims, these kinds of highly effective interventions are falling apart. This is maddening, for saving a child costs less than the $30 or so for the coffin in which he is buried.

Some readers may think: Of course it’s sad when a child dies, but we have our own problems. Let’s solve the challenges in our backyard before worrying about Africans.

So I’ll leave Safi Kalenga to respond. Kalenga, 39, cherished her first grader, Daniella, an 8-year-old who loved school and delighted in singing at church.

Yet in June Daniella caught typhoid and malaria. The ambulances weren’t running, medicines were out of stock and Daniella died. “If I’d had a little more support, my child would be here right now,” Kalenga said, speaking wistfully rather than angrily. And then she broke down. “I loved my child so much,” she said through tears.

I asked her what she would say to Americans who question why they should pay to save children like Daniella.

“It’s just a number to you,” she said. “But my child would be alive today if you could provide just a bit of medicine and food. We’re not helpless. We just need a bit of support, and for want of it we are losing our children.

“We cannot blame you,” she added. “But if only you could look at my child as you look at your own child, how would you feel?”

The New York Times