The administration, for its part, denies causing widespread damage, even as it has made it difficult to measure the extent of the damage by stopping data monitoring and firing inspectors general who might have documented it. This is a common occurrence in cases of public man-made deaths. During Mao Zedong's disastrous Great Leap Forward, from 1958 to 1961, the Chinese government did not release accurate mortality data. Foreign observers realized that a famine crisis had already begun when China began importing grain, but the scale of the disaster was not known until the mid-1980s, when the first reliable census allowed historians to estimate that between twenty-three and thirty million people had died.
To more fully account for the impact of the closure, USAID will likely have to wait for an analysis of the UN's 2025 mortality statistics, which likely won't be available until 2027. But there are other ways to estimate the extent of the damage. With a team of documentarians that included both American and local journalists, I followed what was happening in Kenyan communities where USAID was working—in a ward for advanced HIV patients in Nairobi, in a primary health care center where malaria rates had plummeted, in a refugee camp, and elsewhere.
We chose Kenya because I did a lot of work there during my tenure and because it is on a familiar development path. Like India, South Korea and many Latin American countries that the U.S. helped transition from low-income aid recipients to higher-income trading partners, Kenya has reached the bottom rung of middle-income country status. The country has made leaps in developing health care capacity and increasing life expectancy through a variety of projects. USAID provided medicine, food, and personnel to some of the most desperate and vulnerable populations, and provided technical assistance and investment to accelerate the country's expertise in meeting needs ranging from HIV control to primary health care.
I was particularly concerned about what would happen to programs to combat childhood malnutrition, which have made extraordinary progress around the world over the past two decades. Instead of a system that waited for malnourished children to reach distant hospital wards, often hours away, we helped countries move the front lines to where they lived. A local health worker, carrying a tape measure and scales, could detect danger in the home in advance. A peanut butter nutrition pack can reverse fasting in the vast majority of severely malnourished children. Hospitals became the place to care for complications and the most severe cases, while communities worked to strengthen local food sources. The method was simple, frequent and at hand: measure the shoulder, check for swelling, provide supplemental nutrition, monitor for infection or worsening, return next week.
The results were impressive. Mortality rates from severe malnutrition, once twenty percent or higher, have fallen below five percent. In Kenya, the communities we worked with, including refugee camps, saw mortality rates drop to less than one percent. The United States played a central role in the development and production of the therapeutic supplement formula. USAID helped then UNICEFThe World Food Programme, local health systems and others are expanding this approach around the world. Globally, under-five child mortality has more than halved since 2000, thanks in large part to advances in treating malnutrition that have saved more than a million lives in 2023 alone. However, the majority of the world's undernourished children do not have access to these programs. But instead of trying to close the gap, we wash our hands of it and reverse the progress we've made.
In Kakuma, a huge refugee camp near the border with South Sudan, starting in the spring, our film crew followed doctors and families in the stabilization ward of Clinic 7, where the sickest children are admitted. Due to the withdrawal of US support, World Food Program supplies fell to forty percent of minimum requirements, and the incidence of acute malnutrition increased sharply. Two-thirds of the clinic's local health workers have been laid off, hampering the early detection system that once saved most children before they needed emergency care. At Clinic 7 we met Rowina Naboi, who fled South Sudan with her family. In our short film, she reveals what it was like trying to keep her terminally ill daughter Jane Sunday alive in a failing system.
There are valid criticisms of USAID. Sometimes it contributes to the development of addiction. This may not be effective. Too much of the funding went to international organizations rather than local ones. There are episodes in its history when aid was directed to achieve American military and political goals – in Vietnam, Iraq, Afghanistan and other places. However, no other US government agency has saved more lives per dollar. It has helped lift billions of people out of poverty. And he showed how to achieve results for all humanity, including Americans, through cooperation rather than coercion.
Destroying USAID will do nothing to improve this work. Instead we have a public, man-made death. And the brutality and death toll will only increase as the administration expands its rollback of public health advances at home. We cannot allow the people affected – health workers like the staff at Clinic 7 and families like Rovina Naboi's – to go unnoticed. And we cannot ignore the consequences.
