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Terrific and insightful piece today by Nicholas Kristof, NY Times:

The 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. Immunizations 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 an even higher number next year. In short, President 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 U.S. 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 one million children’s lives. Instead, it is being used to shut down programs 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 the Democratic Republic of 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 center 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 center, 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 hemoglobin level above 10; Jibia’s stood at just 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 on July 7.

“It was aid cuts,” her mom told me — without bitterness or any sense of entitlement, simply stating a fact that is obvious on the ground here. “People are dying every day and night.”

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.

The mortality rate for newborn babies has doubled this year in both the refugee settlements in Uganda I visited, Nakivale and Rwamwanja, according to Medical Teams International, which is trying to provide medical care despite the cuts. The upshot is that about three additional newborns are dying each week in Nakivale alone — and that is just one of 13 refugee settlements in Uganda facing similar problems.

One reason for the crisis here: The United States slashed humanitarian aid to refugees in Uganda, from more than $200 million in 2024 to $38 million so far in 2025, according to U.N. figures, even as the number of refugees has surged. More is said to be on the way, and that will help. But aid cuts have meant that 20,000 medical workers have lost their jobs in Uganda in the last few months. Globally, some 86 percent of U.S.A.I.D. contracts have been canceled, according to the Center for Global Development.

Estimates of the death toll from the Trump cuts vary. One online impact counter maintained by an infectious disease expert puts the total at 330,000 children and 160,000 adults so far.

A recent study published in The Lancet estimated that the cuts will cost the lives of about 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 Program had to halt support for 63 percent 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, told me that her husband abandoned the family in May after the World Food Program 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 center. John was diagnosed with severe acute malnutrition and dehydration, but doctors told me that the health center had run out of necessary supplies to help.

John Abraham died on Aug. 7.

His mom is now eight months pregnant and caring for her three surviving children. It was afternoon when I interviewed her, and I asked her what she and her three children had eaten so far that day.

“Nothing,” she said.

“What did you eat yesterday?” I asked.

“Nothing,” she said. Two days earlier, she said a bit defensively, she and the children had each eaten several bananas that a neighbor had given them.

One of America’s proudest programs 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 percent of PEPFAR awards have been canceled, 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 H.I.V. 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 told me. She is terrified that she will be gone with no one to care for her five children.

Some AIDS medications also need to be taken with food, which is a problem for the starving population here even if H.I.V. patients can get the medicines. One woman, Denise Mukamusoni, confronted me on the dirt path as I passed her home; she wept as she explained that she was off her AIDS medication because she had no food to take it with. A doctor explained to me that with food and medicine simultaneously scarce because of the cuts, the winner is the virus.

Another reason the suffering is accelerating is that the cuts the United States imposed led other nations, including Britain and France, to slash assistance as well. One recent study estimated that less than half as much money will be spent on global health assistance this year as was spent in 2021.

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. The antiretrovirals that keep Nkunda alive cost less than 12 cents a day.

Do we really believe that the richest nation in the history of the world couldn’t afford a $2 net for Jibia?

It’s true, of course, that aid programs should be reviewed and assessed. I saw U.S.-financed dental clinics for refugees in Uganda that had been closed because of the U.S.A.I.D. shutdown, but U.S. taxpayers may not understand why they should pay for people in Uganda to get dental care when many Americans are in constant dental pain and can’t get care. Then again, it’s likewise true that aid historically has benefited Americans as well as foreigners, by reducing threats from diseases that spring up abroad and by winning friends overseas in ways that support national security.

Some Africans have chafed at the dependence that aid fosters and think this is an opportunity, albeit a dangerous one, for countries to take more responsibility for themselves. Dr. Ahmed Ogwell, an African health leader and now C.E.O. of a health nonprofit called Village Reach, says that the unraveling of America’s aid causes problems but also creates “an opportunity for the global south and particularly Africa to reorganize itself and deliver health care within its own context.”

Whatever one thinks of that argument, the thoughtless and rushed way in which the U.S. Agency for International Development was fed “into the wood chipper,” as Elon Musk described his work, is resulting in children dying at a pace that appears to be accelerating.

In June, I argued that some of the initial estimates of the death toll from aid cuts probably overstated the casualties because health ministries and relief organizations were able to cushion some of the cuts, and stockpiles of medicines and emergency food delayed the harshest impact. That cushion is disappearing. What I found in Uganda is that the devastation is now beginning to hit with full force.

Uganda has been extraordinarily welcoming to nearly two million refugees from Congo, South Sudan and other neighbors — 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 6 months old.

Fred, who weighs just 6.6 pounds, is close to death from starvation. He is a wizened child with sticks for arms and big eyes that look at the world with pain. It’s not clear if he will celebrate his first birthday.

Fred lives in the Rwamwanja settlement, where the number of children with severe acute malnutrition has more than tripled in the last few months as aid has been reduced, said Dr. Janney Oyugi, who runs health programs in the settlement. Oyugi, who works with Medical Teams International, used to have six nutritionists on hand to help starving children like Fred; four had to be laid off.

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 R.U.T.F., for ready-to-use therapeutic food, it costs just 50 cents a packet, and the United States has historically been a generous donor of it.

A severely malnourished child like Fred should get two packets of R.U.T.F. a day, but supplies are now so low that nurses can give him only half a packet a day. That saves 75 cents a day but may cost him his life.

As Fred starves, the Trump administration is sitting on huge stockpiles of R.U.T.F. purchased under the Biden administration. The State Department holds 300,000 cases in warehouses of Mana Nutrition, a Georgia company that makes it, and 185,535 more cases sit in the warehouse of another manufacturer, Edesia Nutrition, in Rhode Island, where we pay to store it

So, Secretary Rubio, why do you have taxpayers pay storage costs that amount to more than $600,000 so far for this lifesaving peanut paste, rather than rush it to children like Fred who may die for want of it? The storage bill is increasing by $10,000 a day.

Yet it’s also true that there are hints that the Trump administration is beginning to find some footing on aid. It has begun to place new orders for R.U.T.F. and has plans to move these stockpiles. It is preparing to hand over its food aid stockpiles to U.N. agencies to distribute to those in need. And it announced this month that PEPFAR will distribute lenacapavir, an important new drug that prevents AIDS transmission, in at least eight countries next year. These are real and positive steps; they just don’t make up for the larger pattern of chaos and cutbacks.

We’ve figured out over the last 25 years how to save children’s lives very cheaply, with R.U.T.F., vitamin A supplementation, mosquito nets, antiretrovirals and vaccinations. (Gavi, the Vaccine Alliance, a global partnership, has saved an astonishing 18 million lives, but the United States cut off funding for it this year.)

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.

“I’m selling more coffins than ever before,” Tonny Bauer, one of many coffin makers in Rwamwanja, told me. “It’s the busiest time in the 10 years I’ve been doing this.”

He used to sell about three coffins a week, he said, but since this spring he has been selling five or more a week. “I sold two just yesterday. But I’m not happy about it.”

For those wondering how they can help at a personal level, here are a few suggestions. First, Medical Teams International is working heroically in the areas I visited to provide medical care with diminished budgets. Second, R.U.T.F. is a miracle substance for severely malnourished children, so it’s worth supporting groups that make it, such as Edesia Nutrition and Mana Nutrition. Finally, since many of those I interviewed were Congolese refugees, a strong option is Panzi Foundation, led by the Nobel Peace Prize winner Dr. Denis Mukwege, who runs a hospital in Congo and stands up to warlords in an effort to achieve peace so civilians no longer have to flee.

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.

Safi Kalenga lost her 8-year-old daughter, 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 told me, 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?”