On the edge of a lush jungle here in West Africa, the heavy metal doors of a warehouse creak open. Inside are boxes piled high with millions of doses of medicines donated by Merck and other pharmaceutical companies for a United States aid program. Yet the medications are gathering dust, and some are approaching their expiration dates and may have to be destroyed, at immense expense.
It’s an excellent example of the waste that President Trump claims was rife in the United States Agency for International Development. (“Absolutely obscene,” as he put it in February.) But this waste of drugs exists only because his administration shut down U.S.A.I.D. and canceled plans to distribute these medicines, even though the pills cost America nothing and are ready to use.
Each tax dollar invested in mass administration of drugs like these leverages $26 in donated medicines, making the effort astoundingly cost-effective. One of the medications languishing in this warehouse is sufficient to protect 7.6 million children and adults from a parasitic disease called river blindness. Other donated medicines in the warehouse would rid more than two million children of worms, plus protect 1.4 million kids from a debilitating parasitic ailment called schistosomiasis that causes pain, weakness and bloody urine.
These medicines also have the side benefit of protecting against worms that cause elephantiasis, a disfiguring and humiliating ailment.
“People come to ask for these drugs,” Tamba Koroma, the warehouse’s watchman, told me. “We tell them we can’t distribute them.”
I’ve been traveling through Sierra Leone and Liberia to gauge the impact of Trump’s closing of U.S.A.I.D., to see how bad things have gotten since an earlier trip through South Sudan and Kenya. Here’s what I see: Children are dying because medicines have been abruptly cut off, and risks of Ebola, tuberculosis and other diseases reaching America are increasing — while medicines sit uselessly in warehouses.
After Elon Musk boasted about feeding U.S.A.I.D. “into the wood chipper” over a weekend, he claimed that no one had died as a result. Secretary of State Marco Rubio repeated that claim just last month.
So I challenge them both: Come with me on a trip to the villages where your aid cuts are killing children. Open your eyes. And if you dare to confront actual waste and abuse — the kind that squanders lives as well as money — join me in the village of Kayata, Liberia, where in April a pregnant mother of two, Yamah Freeman, 21, went into labor.
Freeman, a lively woman known for her friendliness to all, soon hemorrhaged and began bleeding heavily, so villagers frantically called the county hospital to summon an ambulance. U.S.A.I.D. previously supplied ambulances to reduce maternal mortality, but this year the U.S. stopped providing fuel, leaving the ambulances idle. Ambulance crew members said they’d be happy to rescue Freeman, if someone would only come and buy them gas.
It’s more than 10 miles through the jungle on a red mud path from Kayata to the hospital, but villagers were determined to try to save Freeman’s life. The strongest young men in the village bundled her in a hammock and then raced down the path, shouting encouragement to her as she lay unconscious and bleeding. They didn’t make it: She died on the way, along with an unborn son.
So when I hear glib talk about waste and abuse in U.S.A.I.D., I think of how we American taxpayers purchased ambulances for Liberia at a cost of more than $50,000 each and then abruptly cut off gasoline funds, leaving a young mom to bleed to death.
Freeman is buried in an unmarked grave on the edge of the forest. Her two daughters, ages 3 and 6, weep for their mother. “The three of us sit together and cry,” said Freeman’s younger sister, Annie.
One of the most dangerous things a woman can do in a poor country is get pregnant. The Guttmacher Institute estimates that American assistance has prevented some 34,000 maternal deaths per year around the world. That suggests that ending such aid may lead women to perish in pregnancy approximately once every 15 minutes.
Come also to the village of Vonzua in western Liberia, where a woman named Bendu Kiadu is mourning her child Gbessey, who was just 1 year old.
Gbessey caught malaria in March. In normal times, a community health worker would have administered simple medicines for malaria, and the United States noted just last year that it provided “vital” and “critical” support to fight malaria in Liberia. But the closing of U.S.A.I.D. led to the collapse of some supply chains, so health workers had no malaria medicine to offer Gbessey.
Kiadu rushed the child to a clinic, but it, too, had run out of malaria medicine. The next day, Gbessey died.
Now Kiadu’s youngest child, Osman, is also seriously ill with malaria, and the community health workers and the clinic still have no malaria medicine. She worries that she will lose two of her children within months.
“Our children are dying because of a lack of medicine,” Kiadu told me.
How often does this happen? The Trump administration is also dismantling data collection, making it difficult to count the deaths it is causing. By one American economist’s online dashboard, about 350,000 people worldwide have died so far because of cuts in American aid. My guess is that the figure isn’t so high, partly because it takes time for children to weaken and die, but that the rate of deaths will accelerate.
We can’t save every child in the world, I realize, and it’s fair to note that not every U.S.A.I.D. program was brilliant and lifesaving. The agency could have used reforms. Yet it’s also true that at a cost of only 0.24 percent of gross national income, we provided humanitarian aid that saved about six lives every minute around the clock, based on rough estimates from the Center for Global Development. That is what we have undone.
One of America’s most heroic achievements in the past half-century was turning the tide of AIDS and saving, so far, some 26 million lives through the President’s Emergency Plan for AIDS Relief, or PEPFAR, started by President George W. Bush in 2003. In particular, PEPFAR made much less common the horror of H.I.V.-positive women inadvertently infecting their babies during childbirth.
And now mother-to-child transmission may be rising again.
At clinic after clinic that I visited in Sierra Leone, staff members reported that they were out of H.I.V. test kits and could no longer test pregnant women for the virus. And if doctors and nurses don’t know which women are H.I.V.-positive, they can’t block transmission during childbirth.
In May two children were born with H.I.V. here in the town of Makeni, health workers told me. One, Ibrahim Koroma, died within days. The other, whom I won’t name because of stigma surrounding H.I.V., is alive.
In Totota, Liberia, midwives are caring for three pregnant women with H.I.V. but have only enough medicine to prevent mother-to-child transmission for one of them. They don’t know what they will do or what to tell H.I.V.-positive people worried about whether antiretrovirals will continue to be available.
“I asked my supervisor what to do,” said Telmah Smith, one of the midwives. “And he said, ‘Pray that U.S.A.I.D. will come back.’”
Rubio claims that most of PEPFAR has been preserved, but the American aid system is now in such chaos that even many programs that have nominally been preserved are dysfunctional. I’ve already reported on AIDS orphans dying in South Sudan because the community health workers who brought them medicine have been laid off. And near Bo, Sierra Leone, I spoke to H.I.V.-positive people who told me that antiretrovirals ran out for them from March through May.
Now they again have access to medicines, but in the meantime, three people died for want of antiretrovirals: Gbossay Conteh, a 39-year-old woman; James Kamara, a 32-year-old man; and Mommy Kargbo, a 27-year-old woman.
Jonathan Gassama, a gaunt 39-year-old with AIDS who has a 2-year-old son, deteriorated sharply when he couldn’t get medication and is extremely frail. He hopes that with medicines restored, he may recover but isn’t sure.
“I think of death all the time,” he told me. I said America’s secretary of state had claimed no one had died because of aid cuts, and he shook his head weakly. “It is a lie that no one has died,” he said. “And maybe I will die because of medical decisions in Washington.”
Another factor that risks a resurgence of H.I.V. is a lack of condoms. The U.S. had committed to supply six million condoms to Liberia this year, a majority of the country’s total, and without them, there will be more H.I.V. infections, unplanned pregnancies and sexually transmitted infections, said Leonard Kamugisha of the U.N. Population Fund in Liberia.
The abruptness of Trump’s moves made the situation worse, leaving no period to adjust. Officials described how U.S.A.I.D. committed to upgrading a medicine warehouse in eastern Liberia. Contractors removed the roof, and then the agency sent an immediate stop-work order. So instead of benefiting from aid, Liberians now have to deal with a medicine warehouse that has no roof.
Some readers may think: Of course it’s sad that children are dying, but why is it our job to save their lives?
To those unmoved by moral arguments, I’d note that President John F. Kennedy created U.S.A.I.D. in 1961 to advance our interests as well as our values. We confront China not only with warships but also with aid programs in Africa that build soft power and international support. The collapse of American aid programs is a gift to Beijing, which has been reaching out to some African countries now in desperate need.
“We are in touch with China,” said Dabah Varpilah, the chair of the health committee in the Liberian Senate. “China is making a lot of inroads into our country, with infrastructure and so on, but until now we have depended mostly on the U.S. for health.”
Aid programs also protect Americans from a threat that aircraft carriers are helpless to combat: disease. U.S.A.I.D. and the World Health Organization (which the United States is now withdrawing from) track outbreaks of diseases like Ebola to extinguish them before they can spread.
So aid cuts are at a level where they undermine our national interest as well as corrode our souls. They are a braid of recklessness, incompetence and indifference — and “indifference” is generous, for the disregard is so deliberate that it bleeds into cruelty.
How else to describe the cutoff of programs keeping young H.I.V.-positive children alive with medicines costing less than 12 cents a day?
We have been better than this, and I think we still are. Republicans in Congress will have to search their consciences as they decide in coming days whether to back a rescission package that would slash foreign aid that they previously approved; they should note that there is still time for them to blame Musk for the aid shutdown and work with Rubio to limit the number of children dying unnecessarily.
I know my readers will be asking how they can help, and one route is advocacy. Groups like Results.org offer excellent resources for encouraging members of Congress to do the right thing.
For those wishing to donate, one nonprofit to consider is Helen Keller Intl, which works to prevent blindness and to provide better nutrition and was meant to distribute the drugs in that warehouse in Sierra Leone. If it can raise the money privately, it can go forward so at least some children will be protected from blindness, worms and Washington’s savage indifference.
Another excellent option is a rapid response fund of urgent and vetted suspended U.S.A.I.D. projects, prepared by a team at the Center for Global Development in Washington. These include projects in Sudan, Haiti and Myanmar.
We can all take inspiration from the no-nonsense health workers I’ve seen responding to the funding crisis. In one Liberian village, I met John Flomo, a lean, graying community health worker offering simple medicines and techniques to save children’s lives in rural villages. He worked for an impressive nonprofit called Last Mile Health, which was founded in Liberia by American health workers and Liberian civil war survivors, but then U.S.A.I.D. cut these health workers loose and stopped paying them.
Flomo hasn’t been paid in months but still wears his U.S.A.I.D. vest and helps children survive malaria or malnutrition.
“I will continue to save my people,” he told me.
Do we really mean to abandon dedicated health workers like Flomo who are struggling to help sick or starving children — kids as precious as our own? Have our hearts grown so icy that we don’t care as the world’s richest men crush the world’s poorest children?
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Nicholas Kristof became a columnist for The Times Opinion desk in 2001 and has won two Pulitzer Prizes. His new memoir is “Chasing Hope: A Reporter’s Life.” @NickKristof
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