Mr. President, Foreign Aid Does Put America First

New York Times

12-02-2025

President Trump and Elon Musk were entirely right that America's aid programs merited scrutiny and reform. Yet so far what these two billionaires have achieved is to crush the world's poorest children in a cauldron of confusion and cruelty.
Having covered the United States Agency for International Development for decades, I reached out to my contacts around the world to get the real story of the Trump-Musk demolition.
In Sokoto, Nigeria, toddlers are starving because emergency feeding centers supported by U.S.A.I.D. have run out of the nutrient-rich paste used to save the lives of severely malnourished children. Nearby warehouses have the paste but can't release it without a waiver from the agency — which is in such Muskian chaos that it can't issue the waivers.
'Thousands of children can die,' said Erin Boyd, a former U.S.A.I.D. nutrition adviser who told me about the situation there.
An Ebola outbreak in Uganda has spread to three cities. The Ugandan government has pleaded with medical staff members previously paid by U.S.A.I.D. to 'continue working in the spirit of patriotism as volunteers.'
A doctor on the scene told me that with U.S.A.I.D. absent, there is a greater risk that Ebola will spread — and maybe even infect Americans. It's a reminder that a robust U.S.A.I.D. is a first defense against epidemics and pandemics, whether involving bird flu, Ebola or other diseases.
I cite those two examples because the former represents humanitarian values and the latter our national interest; U.S.A.I.D. is the agency that unites the two.
Accounts of mayhem are flowing in from around the world. My Times colleague Stephanie Nolen reported that the effective closing of the agency abruptly halted 30 clinical trials, leaving patients stranded. In South Africa, for example, women had been fitted with experimental internal rings meant to prevent pregnancy and H.I.V. infection — but now the participants are on their own. Women and children are the main beneficiaries of humanitarian assistance, so they are the biggest victims of what is unfolding. The cutoff is causing some 130,000 women to lose access each day to contraception, according to the Guttmacher Institute (condoms are now in short supply in Zimbabwe). If the aid freeze continues for three months and family-planning access is not restored this year, there will be 4.2 million unintended pregnancies and 8,300 deaths of women in pregnancy and childbirth, the institute estimated.
U.S.A.I.D. employees, who mostly joined the agency in hopes of making the world a better place, are in agony. 'We're just paralyzed,' an agency employee in Africa told me. 'No one is in charge.'
If antifreeze runs in your veins, you may be thinking, Well, too bad about kids starving to death and moms dying in childbirth, but how else can we clean out all those 'fraudsters' Musk referred to in what he described as a 'criminal organization'?
Unfortunately, Musk doesn't seem to have verified a single case of fraud so far. The only lawbreaking appears to be the Trump assault on a congressionally established agency that he had no legal authority to close; the destruction of U.S.A.I.D. may have violated a whole series of federal laws, not to mention the Constitution.
In fairness, Republicans have cited several examples of what they call waste that do indeed sound silly, although most of their examples turned out not to involve U.S.A.I.D. at all. But sure, let's concede the point that some aid money was not optimally used over the years.
In any case, Trump and Musk appear to have made the waste worse. More than $489 million in food aid has been left in limbo and is now at risk of rotting, the U.S.A.I.D. inspector general warned.
It gets more serious. The agency's counterterrorism staff has been told not to report to work, increasing the risk that aid will be diverted to terrorist groups, the inspector general added.
China has long criticized U.S.A.I.D., and the Chinese internet erupted in cheers at the agency's demise. That's because — as Senator Tom Cotton, an Arkansas Republican, observed in 2021 — agencies like U.S.A.I.D. are 'strategic instruments to beat China' in a global competition for influence.
Another senator noted that the agency is 'critical to our national security' and a powerful tool to 'counter the Chinese Communist Party.' Update: That senator, Marco Rubio, has since been elevated to a position where he can fight for the agency if he stands by his principles.
Above all, the demolition of U.S.A.I.D. is a human tragedy. One woman on the Myanmar-Thai border has already been identified as dead because of the cuts, because an agency-supported hospital could no longer treat her. And it's almost certain that the world's poorest are already dying because of decisions taken by the world's richest.
In Kismayo, Somalia, a hospital serving 3,000 people each month has had to close its doors, an aid worker told me, with patients carried away on donkey carts or in wheelbarrows. In Gadarif, Sudan, I'm told, the only hospital in the region that can perform C-sections may now close within the month — which would mean that women in obstructed labor might die or suffer fistulas.
I've had malaria and have seen countless people dying of it, so I had been delighted that Myanmar was on track to eliminate it. Without American support, malaria is expected to rebound, 'jeopardizing years of progress,' an aid worker told me. Pregnant women and children are the most likely to die.
I suspect that the assault on U.S.A.I.D. is a test run for an offensive against a lifeline for poor people here in the United States — Medicaid. Some Republicans would like to slash it to pay for tax cuts for the wealthy.
That makes it particularly important that Americans speak up for humanitarian assistance internationally, for this is where our interests and our values converge. Readers keep asking me what they can do. I tell them to call their members of Congress and the White House to urge them to reform U.S.A.I.D., not disembowel it. And if you're motivated to write a check, I have three suggestions.
First, Helen Keller Intl does an outstanding job combating malnutrition and blindness worldwide. Second, Muso Health is extremely cost-effective at saving the lives of children in countries where U.S.A.I.D. is now gutted. Third, a Sudanese 'lost boy,' Valentino Deng, who was settled in the United States and became the subject of the best-selling book by Dave Eggers, 'What Is the What,' returned to South Sudan to operate a school there through the civil war; I find his determination to use his good fortune to help others through his VAD Foundation an inspiring contrast to those who employ their wealth and power to gleefully grind the world's most unfortunate into ever greater misery.