This story was originally published by ProPublica. Republished under a CC BY-NC-ND 3.0 license.

For decades, the U.S. Department of State gave money to groups protecting free speech, human rights and persecuted minorities in poor and authoritarian countries. 

To decide what to fund, staffers with deep expertise typically pored over reams of information on abuses under the most repressive regimes and held an open competition to fund groups to work in those countries. 

This year, Trump administration officials presented State Department workers with their own list of organizations that should be funded. To the shock of many staffers and lawmakers, they proposed at least a dozen grants that would bypass the normal open bidding process. They also sought to give taxpayer dollars to groups aligned with conservative and anti-immigration movements in Europe as well as advocates for white South Africans, according to interviews and documents reviewed by ProPublica. 

Among the organizations appointees have considered funding in recent months are a British free-speech organization that has fought against bans on “gay conversion therapy” and an Afrikaner group run by a controversial figure who has called for self-governance of the white ethnic minority within South Africa. 

This type of giving would mark a stark departure from the traditional aid that helped torture victims and documented rapes, political violence and other abuses in some of the most oppressive countries in the world, according to more than a dozen former State Department employees. One new program with $4.9 million of competitive funding available to groups to develop “civilizational self-confidence in Europe” is slated for “research, conferences, cultural engagements, and support for civil society” in wealthy democracies. The call for proposals says recipients should “not attempt to reform the legislative processes,” but experts and lawmakers have expressed concern that the U.S. is seeking to influence politics in allied countries.

That emphasis on Western nations was evident in a grant the State Department has been working on for months to a fledgling British American think tank dedicated to “renewing our Judeo-Christian culture and civilisational mission.” After pushback from Congress, the State Department abandoned those plans in recent days.

“I’ve never before seen U.S. government funding for such groups,” said William Allchorn, a senior research fellow at Anglia Ruskin University and an expert on radical-right extremism in the United Kingdom. “It’s crossing the Rubicon, isn’t it?”

A review of proposed grants shows several are being directed to more traditional human rights purposes, but even some of those have raised concerns in and outside the State Department.

Strict agency rules have long required an open bidding process whenever possible to guard against waste, fraud and abuse. Generally, the State Department is allowed to offer awards directly to a single entity or to a small group of potential grantees in rare instances, such as when only one organization is capable of the work or an emergency necessitates providing money so quickly that open competition is impossible. It has also used such “sole-source” and “limited-source” awards, which are not publicly announced, in highly sensitive countries where openly working on human rights can be dangerous.

None of those justifications appear to apply here, according to contracting experts and former staffers consulted by ProPublica. The situation is all the more concerning, they said, because Trump officials handpicked the potential recipients, decisions previously made by a panel of government experts who evaluated applicants based on the organizations’ experience and qualifications. 

“It’s not good governance to have political appointees give grants to individuals for unknown reasons,” one former bureau staffer said.

Directing awards to organizations in high-income countries further complicates the funding. The practice is so unusual that an internal waiver justifying the choice is typically required. 

The State Department did not answer when asked whether it had sought waivers for the grants to high-income countries. 

During private briefings this month, members of Congress expressed concern over both the list of potential recipients and the plan to award no-bid or limited-bid grants, according to officials familiar with the closed-door meetings who weren’t authorized to publicly discuss them. 

In response to a detailed list of questions about this story, the State Department sent a short written response, noting that “programs are still in active deliberation and receipt of a grant is not guaranteed to any organization that does not meet all requirement and standards for federal grants.” A State Department official who declined to be named stressed that the process for awarding grants was ongoing and that multiple offices provide input. They also said the administration has serious concerns about the human rights situation in South Africa that need to be addressed. 

Asked about the potential grants, Sen. Jeanne Shaheen, a Democrat from New Hampshire and the ranking member of the Senate Committee on Foreign Relations, said Congress expects the State Department “to invest resources to advance human rights, democratic institutions, civil society, freedom of expression and worker rights” and that the proposals are “an appalling departure from that practice and an affront to our democratic allies.”

“These awards suggest that the Department intends to select awardees for federal funding based on their political ideology,” Shaheen said, “not in the interest of American taxpayers or national security.” 

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Internal records and interviews show one of the key figures involved in the grants is Samuel Samson, a 27-year-old deputy assistant secretary of state who previously worked as a fundraiser for a group that aims to bring people with an “America first” worldview into government. 

On the day of President Donald Trump’s second inauguration, Samson started work as a senior adviser to the Bureau of Democracy, Human Rights and Labor, also known as DRL, the State Department unit that selects and distributes the human rights grants. 

Over the past 18 months, he has courted far-right leaders in Europe, an area with which he believes the U.S. shares a “common civilizational struggle.” In recent weeks, Samson has defended the agency’s grantmaking plans during private meetings with lawmakers.

One group expected to receive a no-bid grant is the Free Speech Union, a British organization founded in 2020 to counter “cancel culture.” The group often steps in to defend people accused of being transphobic and has created a petition opposing the U.K.’s proposed ban on discredited therapy practices that attempt to convert gay people to heterosexuality. It’s unclear if the grant would go to the British-based organization or its international offshoot. The $5 million grant is to be used to combat “digital overregulation,” provide support for individuals facing “deplatforming” and advocate against “restrictive online safety and hate speech laws,” according to a document reviewed by ProPublica. Trump officials met with the group during a European tour late last year, according to Politico. 

Scholars said the U.S. government’s support for these groups could give them a layer of legitimacy they wouldn’t otherwise have. 

“We see them as intellectualizing or sanitizing radical-right ideas that are then taken up by the parties in power,” said Allchorn, the U.K. extremism expert.

The Free Speech Union’s website says it is nonpartisan and does not take government funds. In response to questions from ProPublica about the potential grant, the organization’s founder, Toby Young, said, “We have neither applied for nor been awarded a grant from the US State Department or any other branch of the US Government.” He did not respond to criticisms about the award or his organization.

The largest award the bureau has put forward this year, $40 million, is for the Victims of Communism Memorial Foundation, which was created by Congress and signed into law by President Bill Clinton. The foundation’s goal is to memorialize those killed by communist regimes and pursue freedom for people still living under totalitarian rule. 

The proposed sum is staggering to people familiar with the State Department’s allocation practices and would dwarf the organization’s budget. Victims of Communism has received a handful of government grants in the past, but for much smaller sums. Its most recent publicly available tax forms, from 2024, show its total assets come to about $12 million. Four sources familiar with the foundation’s previous U.S.-funded work questioned its ability to manage such a large award. 

Samson has a personal connection to the organization. The foundation’s board chair, Elizabeth Spalding, is a visiting fellow at a graduate school branch of Hillsdale College in Washington, D.C.; Samson was enrolled in the same small graduate program of the Christian conservative college as recently as this year, according to his LinkedIn profile (which is no longer publicly available). Spalding’s husband, Matthew, is that graduate school’s dean, and Samson has taken classes with one or both of them, according to a State Department official.

The State Department official who declined to be named said Samson’s relationship with the Spaldings had nothing to do with the grant.

The foundation’s proposed award is to “amplify the voices of dissidents and political prisoners while educating global audiences about the dangers of communist and authoritarian regimes,” according to a document reviewed by ProPublica. 

In response to questions from ProPublica about the award and concerns about its ability to manage it, the foundation said it was not aware of the proposed funding, but “if true, the 100 million victims murdered by communism in the past, and another 1.5 billion men, women, and children still enduring communism today will rejoice.”  

The State Department declined to comment on awards in process but noted that Victims of Communism has long worked with the State Department. “As President Trump has said, communism is a mortal threat to American liberty — and as Secretary Rubio has repeatedly emphasized, America will not allow radical extremists to undermine our sovereignty and national security,” the agency said in a statement. “Our foreign assistance programming is aligned to support our strategic priorities.” 

Trump officials are also planning to finance at least one organization to research crime and atrocities against minority populations in South Africa. This spring, DRL staff were initially told to begin the process of awarding funds to Lex Libertas, a South African organization founded by a prominent member of the nation’s white Afrikaner movement. The group, which claims that white South African farmers are victims of racial discrimination and violence, is fundraising to place 3,000 white crosses on the National Mall in remembrance of attacks on South African farmers. 

The proposed award to fund the South African crime research was later widened to allow other invited groups to apply for a $1 million grant, according to people with knowledge of the process. The State Department declined to say whether Lex Libertas will be among those invited to compete, saying the grant is still under deliberation.

Extensive research shows white South African farmers are not victims of crime at higher rates than other groups. But Trump has argued there is a genocide of white South Africans and is using claims that white people are subjected to disproportionate violence to justify cutting off South Africa’s funding for HIV treatment and research. 

Former diplomats told ProPublica that it makes little sense to focus on the victimization of white South Africans given the enormous suffering elsewhere in the region. “It’s laughable to suggest that on the African continent, the prime issue of human rights concern is whites in South Africa,” one former agency official told ProPublica.

Lex Libertas did not respond to questions.

One of the most controversial grants that officials singled out for funds was recently dropped, the State Department official told ProPublica. The decision came after Democratic lawmakers raised objections during briefings last week about the months-old organization and its agenda. That grant was to 878, a British American think tank created this year focused on “existential threats to Britain, to America, and to our shared Judeo-Christian civilisation,” according to its website. The sole-source $7 million grant aimed to advance “Anglo-American values” in the U.K., Europe and “allied partner countries,” according to a document ProPublica reviewed.

878 did not respond to questions.

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Since creating a bureau to focus on human rights in 1977, the State Department has championed human rights and democracy in more than 100 countries. Its awards have sought to support documenting and investigating rapes committed during political violence in Burma; preventing torture in Tunisia and rehabilitating torture survivors in Syria; and combating pervasive sexual violence in Mauritania. 

Since at least 2011, as anti-LGBTQ+ laws and violence spread globally, the bureau added a specific focus on people persecuted for their sexual orientation or gender identity.

Throughout most of its existence, DRL has enjoyed bipartisan support. Democrats applauded its championing of international labor standards and marginalized communities, while Republicans favored its defense of democratic freedoms in China, North Korea, Cuba and other communist countries. As a senator, Marco Rubio was a strong supporter of the bureau and human rights broadly, once arguing from the Senate floor that safeguarding the freedoms of gay men who were persecuted in Chechnya — and all people — was in the national interest. In 2018, he urged the president to appoint an assistant secretary to oversee DRL, a post Trump had left vacant for over a year. 

But after Rubio became secretary of state in January 2025, the fate of DRL dramatically changed. Trump suspended all foreign aid in his first week in office. Within months, cuts by Trump’s newly installed Department of Government Efficiency decimated the bureau, and Rubio closed most of its offices. In April 2025, Rubio published a Substack post smearing the bureau he once championed as “a platform for left-wing activists to wage vendettas against ‘anti-woke’ leaders.”

Samson also sent shock waves through the bureau. In March, he traveled to the U.K., meeting an anti-abortion protester and the anti-immigration politician Nigel Farage. In his own essay on the State Department’s Substack, Samson lashed out at the U.K. for arresting anti-abortion protesters and at Germany for labeling its hard-right Alternative for Germany party “extremist,” likening the countries’ actions to the “censorship, demonization, and bureaucratic weaponization” used against Trump.

Meanwhile, DRL’s remaining skeleton crew was tasked with removing trigger words from documents. “We would try to talk about human rights defenders in talking points, only to have them struck,” said one former bureau employee, requesting anonymity for fear of retribution. 

“We went from having a real, dynamic appreciation for individuals and their human rights and fundamental freedoms to erasing that, especially if individuals were part of an underrepresented group or marginalized community,” the former employee said.

The bureau is working with a severely reduced budget — about $190 million compared with over $500 million in 2024. Now the administration is preparing to put money behind its new priorities.

“We’re just implementing the agenda of the president as we’ve been directed through the national security strategy and the White House,” the State Department official told ProPublica.

This story was originally published by ProPublica. Republished under a CC BY-NC-ND 3.0 license.

Frank Ssekamwa says the United States presented his country with an impossible choice. If it accepted the terms of a new health agreement, Uganda would have to give the U.S. access to the data of millions of his fellow citizens — a decision he worries would make their personal information more vulnerable to breaches and possible exploitation.

But if it refused, the East African nation would likely lose out on more than a billion dollars to address HIV, malaria, tuberculosis and other illnesses, even as its people face ongoing threats from Ebola and other deadly infectious diseases. 

So, on Dec. 10, it agreed.

“If you take the deal, you’re going to be exploited. If you don’t take it, you’re going to die,” said Ssekamwa, an attorney and digital rights expert in Uganda. “It’s the essence of digital colonialism.”

Across Africa, countries have faced similar dilemmas as the U.S. has held a series of closed-door negotiations in which lifesaving aid has been conditioned on access to citizens’ health data. The negotiations come in the wake of the dismantling of the U.S. Agency for International Development, which — in contrast with the new contracts — provided billions of dollars in aid with few strings attached. Officials in Zambia, Zimbabwe and Ghana have been so outraged by the demands that they rejected the initial deals. 

The demand to access health data is central to the Trump administration’s new America First Global Health Strategy, an openly transactional approach that seeks to leverage the desperate need for medical treatments abroad. Aid will now be given “in a way that directly benefits the American people and directly promotes our national interest,” Secretary of State Marco Rubio stated in September.

The State Department declined to publicly release global aid and data-sharing agreements it has signed with more than 30 countries as part of its new approach. But a ProPublica analysis of nine of the deals offers a window into the extensive U.S. demands for access to data — and the potential risks and vulnerabilities for the citizens of countries that have signed them. ProPublica also reviewed a data-sharing agreement struck with Uganda, which has not previously been reported; a data agreement with Kenya; six agreements over the sharing of pathogens that can cause pandemics that were made public by the State Department this week; generic templates of deals for sharing both data and pathogens that can cause pandemics; and an analysis of the documents the advocacy group Public Citizen shared exclusively with ProPublica. 

ProPublica also consulted more than a dozen experts in data privacy and global health, including several with direct knowledge of U.S. policy who said that the insistent demands for data access and other resources as a condition of aid are unprecedented. Without seeing the full suite of agreements, they could not identify all vulnerabilities. But they spotted some red flags: The terms of the deals are vague and lack language standard in most data-sharing agreements that adequately limits what data is collected and how it can be used. That increases the risk that individuals’ personal data could be exposed, misused or commercialized without their consent.  

In the Ugandan data deal, the U.S. will get direct, real-time access to nine of the nation’s health data systems for seven years, including the central repository that stores all of its health information, lab data, data collected by community health workers and, critically, its system for managing individuals’ electronic medical records. The agreement calls for the sharing of aggregated data with all personally identifiable information removed. It also says the data should be used for delivering and auditing healthcare services. 

But lawyers and digital privacy experts argue that the deal raises questions about who will have access to the massive cache of health data and whether it could be inappropriately accessed and exploited.

Some expressed concern that, because it is possible to reverse-engineer data that has been anonymized, people with HIV, tuberculosis and other diseases could have their records exposed.

Stephanie Psaki, who served as the U.S. coordinator for global health security under President Joe Biden, described the Trump administration’s approach as a “blunt instrument of ‘just give me the login to your data systems.’” 

“The U.S. would never agree to that,” she said, if the deal were offered in reverse.

In Uganda, the U.S. will provide up to $1.7 billion over five years for global health security and the treatment and prevention of deadly conditions such as malaria, tuberculosis, HIV and polio. In the past, the U.S. gave this aid without asking for direct benefits in return, saving an estimated 170,000 Ugandan lives per year. 

While a significant investment, it is less than the U.S. previously spent in Uganda and will decrease every year of the agreement. By 2030, the African nation will receive 45% less global health funding than when Trump retook office, according to an analysis by Vincent Lin of Partners in Health, which provides healthcare in poor countries. 

Several experts said there is broad support for some of the goals of the new plan for aid, including reducing African countries’ dependence on the U.S. for healthcare needs. But they worry the transactional nature of the approach could backfire by undermining trust or, in some cases, driving nations to reject deals altogether.

After withdrawing from the World Health Organization and losing access to its global network that tracks and combats disease outbreaks, the U.S. is attempting to obtain the information necessary to address potential pandemics through a patchwork of deals with individual countries. Each of the agreements ProPublica reviewed includes a section on responding to outbreaks. And some countries have signed separate pathogen-sharing agreements, which state that countries must “initiate sharing specimen(s) and related data” within five days of a U.S. request. The Trump administration is also planning unprecedented involvement of private companies to manage and process data.

The State Department told ProPublica that it needs access to the data to improve health outcomes in recipient countries and keep Americans safe. The new approach also requires countries to invest more in their own health systems in exchange for the aid, a promise many countries will likely struggle to fulfill. And, in some cases, including the deal with Uganda, it aims to boost local manufacturing through partnerships with American companies.

The State Department said it took multiple factors into account to ensure the required investments from other countries were “realistic and achievable.”

“The United States is investing billions of dollars in other countries’ health systems to fight infectious disease. In return, we expect governments to increase their own spending on health, so programs are sustainable and under genuine national ownership, not permanently financed by U.S. taxpayers. For the first time, both sides are putting skin in the game to ensure lasting impact,” a State Department spokesperson said in response to questions about the agreements.  

In response to follow-up questions from ProPublica, spokesperson Tommy Pigott said the agreements “share only the same kinds of aggregated, de-identified data that has been shared and used for years in the fight against HIV/AIDS, malaria, tuberculosis, and other diseases. All data sharing is consistent with each country’s laws and approvals. No personally identifiable information is being received or shared by the United States government.”

Uganda’s Ministry of Health, Ministry of Foreign Affairs, Personal Data Protection Office and embassy in Washington, D.C., did not respond to questions for this article. 

In the age of artificial intelligence, large health data sets have become so valuable they’ve been referred to as the new gold. The precise value of the health data of an entire nation is unclear, but it could be extremely valuable to AI-driven companies for training models. The industry of buying and selling such information troves is worth billions. And countries around the world have come to regard their citizens’ health records as national assets that deserve special protections and can confer economic and strategic advantages. 

Yet the agreements, which are part of a strategy the State Department openly states is intended to make America “more prosperous” and “promote American health innovations,” provide no guarantee that Africans subject to them will have a say in what happens with their data or receive a fair share of its benefits. “Once companies get this data, the value is being accrued. But there’s no way for the [African] population to know how companies will use it,” said Jane Munga of the Carnegie Endowment for Intenational Peace, who has argued that the agreements may violate African privacy laws.

Africans have also expressed concern that they will not be able to access and benefit from medicines and vaccines developed from pathogen samples shared with the U.S. Five of the six specimen-sharing agreements reviewed by ProPublica state that, in the event that a medical product is developed primarily from a specimen from the country, the U.S. government “shall prioritize” a request from that government behind the needs of the U.S. Only one of the agreements, with Nigeria, commits the U.S. to facilitating “priority access” to — and the donation of — any medical products developed using the specimens.

The phenomenon of extracting information and samples from less-resourced populations and failing to credit and compensate them for their contributions to medical developments is well known enough to have several names, including “parachute science.” Just a few years ago, countries, including some in Africa, hosted COVID-19 vaccine trials, only to later struggle to access the shots they helped to develop.

Each agreement includes “benefit-sharing provisions,” the State Department said in response to questions. 

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After the Trump administration dismantled USAID, the world’s largest provider of humanitarian assistance, it also drastically reduced funding for international health work done by the Centers for Disease Control and Prevention and severely scaled back the President’s Emergency Plan for AIDS Relief, which combats HIV globally. In addition to withdrawing from the WHO, the U.S. removed itself from international negotiations over a pandemic agreement intended to affirm countries’ sovereign rights to their biological resources and ensure equitable access to medical interventions.

Brad Smith, an entrepreneur who served in the first Trump administration, is now in charge of creating the system that would rise from the ashes. Before joining this administration, Smith founded three companies with business models that rest in part on using data to reduce healthcare costs, including CareBridge, a home care provider that sold for a reported $2.7 billion in 2024. During the presidential transition that year, Smith led the government efficiency panel that would become Elon Musk’s Department of Government Efficiency. After Trump took office, he presided over some $67 billion in sweeping cuts to the Department of Health and Human Services before being brought on as an adviser to the State Department. 

Although the humanitarian aid system had been largely dismantled, Congress required the executive branch to continue providing aid. So Smith and his team had to find new ways to get the funding to countries, ensure that it was being spent wisely and address potential pandemics — all without most of the international partners and staff the government had previously relied on to carry out this complex work. 

A Rhodes scholar known for his intense work ethic, Smith threw himself into the effort. State Department staff fielded calls from him at all hours of the night to explain budget items on spreadsheets. Through his personal lawyer, Smith referred questions to the State Department.

One of the greatest challenges lay in the handling of health data. In the past, PEPFAR, the HIV program, built its own systems to handle anonymized data, separate from government health records — a setup that Trump administration officials and others have criticized as inefficient.

The America First plan proposed standardizing data collection and processing within countries. The Ugandan data agreement requires the country to provide the U.S. — and its contractors — with logins “or other secure access mechanisms” to directly enter the country’s data systems. The new approach, U.S. officials say, will enable the U.S. to continue auditing programs and track outbreaks. 

The agreements ProPublica reviewed include statements about the U.S. government’s intent to ensure data security and say that the data is being accessed for the purposes of addressing diseases and auditing that work, but they leave open the possibility that sensitive information could be revealed, according to the data privacy experts ProPublica consulted. 

At particular risk are countries that don’t have national data privacy laws, such as Liberia, whose memorandum of understanding requires “interlinked and interoperable” data systems for “surveillance, laboratory, response, health, environment, agriculture.” That country’s main health agreement doesn’t require the U.S. to limit the amount of data it takes to the least needed, a standard clause in U.S. contracts, according to Abdoul Jalil Djiberou Mahamadou, a recent postdoctoral fellow focusing on bioethics at Stanford University. (Neither Liberia nor the State Department has released the supplemental data-sharing agreement.) “Once data is breached, it’s nearly impossible to get it back,” Mahamadou added.

The Liberian government did not respond to a request for comment.

The Ugandan data-sharing agreement says it will comply with the laws of both nations and permits the sharing of “sensitive personal data” if the consent of individuals whose data is shared is obtained, there is a compelling public health emergency of international concern and it is the only way information can be provided in a “timely and accurate format.”

Ssekamwa, the digital rights expert who also founded and runs the African Centre for Digital Justice, said there are important questions that haven’t been answered by the Ugandan government.

“Does the U.S. have appropriate data protections? Can the systems provide anonymized data? Are they really up to that standard?” said Ssekamwa. “If I’m someone who has had health issues, can you deny me a visa because of the health issues I’m having?”

Psaki, the former global health security coordinator, worried about the haste with which the changes to data access are happening. “Even in the best of circumstances, you can’t go from having parallel data systems that were established over 20-plus years to finding some way to integrate those data systems in six months.” 

Speed has been a hallmark of the America First global health effort. In September, just a month after Smith joined the State Department, it launched the strategy at an event co-sponsored by the U.S. Chamber of Commerce and five large pharmaceutical companies. By November, Smith was crisscrossing the African continent with a small team of negotiators, trying to persuade dignitaries to agree to deals. 

The State Department said the deals were “negotiated in a thoughtful and strategic way over many months.” 

On Dec. 4, Kenya became the first country to sign, during a triumphant celebration with Rubio and President William Ruto in Washington. Outcry over the agreement had already begun two days earlier, when a Kenyan activist named Nelson Amenya announced on the social platform X that he had seen a sample of the specimen-sharing agreement as well as a legal analysis that showed it would violate Kenyan law.

As a condition for receiving $1.6 billion in aid, the Kenyan government agreed to provide access to seven years’ worth of health records — two years longer than the U.S. would provide financial support. 

Although the Kenyan data-sharing agreement states that the U.S. will take “all reasonable measures to protect the confidentiality of information” and abide by American and Kenyan laws, Amenya worried that wouldn’t be enough. “Every HIV test, TB diagnosis, malaria case – accessible to US officials,” he wrote in the post, which now has one million views. “Your medical records, your children’s health data – all exposed.”

A few days later, a Kenyan senator named Okiya Omtatah sued members of the Kenyan government over the agreement, arguing that it poses a threat to citizens’ constitutional right to privacy by “allowing broad foreign access to sensitive data.” A Kenyan nonprofit also sued, and more than 50 groups weighed in on their side, describing the document as giving the U.S. “excessive access” to African data and raising the possibility of serious human rights violations. 

In court filings, the Kenyan government argued that it is obligated to achieve the “highest attainable standard of health” and that it is unable to do that on its own. After blocking the deal for months, in May, the Kenyan court temporarily allowed implementation of the agreement to proceed while it considers the case.

Since outrage bubbled up in Kenya, some other countries have negotiated shorter terms for sharing data and pandemic specimens, and have inserted additional protections, according to the Public Citizen analysis.

Still, groups across Africa have sounded alarms about dangers inherent in these provisions, including data breaches. Examples of such unauthorized access to personal data abound, including a recent case where the healthcare data of some 500,000 participants in the UK Biobank wound up listed for sale on the Chinese website Alibaba. 

Revealing whether someone has had an abortion, mental health condition, substance use treatment or sexually transmitted disease can be devastating anywhere. In Africa, research has shown it can lead to discrimination and violence. And even when personal information has been removed, individuals in “anonymized” data can be reidentified using AI and other tools. 

The Ugandan data-sharing agreement calls for the U.S. government to “promptly notify the Government of Uganda of any unauthorized access” in such cases and requires the parties to conduct a joint breach assessment and remediation plan afterward. But by that point, it may be too late, Ssekamwa fears. “Once the data gets out of Uganda, we are skeptical that the government of Uganda will actually have any power to control it,” he said.

The secrecy around both the negotiations and the agreements has raised further suspicions. The State Department has declined to share the agreements, telling ProPublica the agency will release them when negotiations with all partner governments are complete and describing its actions as “protecting sensitive negotiations—not ‘secrecy.’” In response to a public records request filed by ProPublica, the State Department said it planned to provide the documents in September 2027. The advocacy group Public Citizen recently filed suit against the federal government in an effort to obtain the documents. 

“Why are they hiding the agreement if they think the terms are OK?” asked Bernard Okpi, a Nigerian lawyer who sued his government in March, alleging that the deal violates the country’s constitutional right to privacy and promotes religious discrimination by prioritizing funding for Christian faith-based health facilities. That suit is pending, and the Nigerian government did not respond to questions from ProPublica.

The State Department said that the agreement with Nigeria “was negotiated in connection with reforms the Nigerian government has made to prioritize protecting Christian populations from violence.”

The Trump administration says that its new global health strategy is designed to save lives and keep the U.S. — and the world — safe from disease outbreaks. But ultimately its hard-driving and secretive negotiations may work against those goals.

While the administration aspired to strike agreements with 50 nations, including the three countries that walked away from negotiations in part over concerns about data sharing, it has fallen far short of that number. (In Zambia, officials also balked at U.S. demands for critical minerals.) The loss of aid in those countries is already proving to be devastating. 

Despite the Trump administration’s stated goal of putting “America first,” the U.S. may feel the consequences of those failed negotiations, too, as mistrust compounds the loss of long-standing systems that provided care and responded to disease outbreaks. 

“It’s in everyone’s interest to have a comprehensive approach to respond to an outbreak early,” said Psaki, who pointed to the quickly escalating number of Ebola cases in the Democratic Republic of Congo as evidence. While that country struck a healthcare deal with the U.S., five of the nine countries bordering it have not. “We need to get data and samples from all nine countries to collaborate effectively on that outbreak, and now we don’t have that.”

The State Department said the U.S. has responded swiftly to the outbreak and has provided over $270 million to the global fight against Ebola.

In Uganda, where people have also fallen sick and died from Ebola, Ssekamwa said that his country needs all the help that the healthcare deal can bring, including improved protection from outbreaks, but there needs to be more robust protection of people’s personal data.  

“We are happy to benefit from the technological advancement and the fruits of big data,” he said. Instead, he said, “the U.S. has left so many gaps within the agreement, which can be exploited in their favor.”

This story was originally published by ProPublica. Republished under a CC BY-NC-ND 3.0 license.

Rose Natabo needs to leave one of her starving sons behind. At dawn, she squeezes her firstborn goodbye, then wraps her youngest, Santo, to her back, his legs akimbo at her waist. Taking the hand of her middle child, James, she hurries away toward help, her pink plastic sandals clapping over the dry dirt.

A couple hours later, the trio are in the back of an ambulance speeding by soccer fields, slums and footpaths. They turn through an iron gate and into the only hospital in Kakuma, a sprawling refugee camp in Kenya’s northern desert. After running from wars and natural disasters, this camp, the third-largest in the world, is their home. They have nowhere else to go. Rose joins a crowd of other mothers checking into the pediatric malnutrition ward.

It is July 8. Rose ran out of food less than three weeks ago after the World Food Program cut rations across the camp. At the hospital, she learns why: WFP lost its funding from the United States, the program’s biggest donor. What she doesn’t know is that aid workers and government officials from both the U.S. and Kenya spent the previous months begging and warning Trump administration leaders that families like hers depended on that food to survive. But for months, nothing changed. So Rose and thousands of other mothers watched their children starve.

Trump’s aides say the funding cuts were necessary to reform America’s broken foreign aid system, and they’ve begun making new investments into Kenya. “What you’ve seen right now,” one senior official at the State Department explains, “is there’s always some period of disruption when you’re doing something that’s never been done before.”

For WFP, that disruption meant telling 300,000 refugees in Kakuma that a little more than half of them will receive a meager portion of rice, lentils and oil some time next month, in August. The rest will get nothing. Rose doesn’t know which group she’s in. And she doesn’t know if her sons will survive that long anyway, especially Santo, who is only 2 years old.

Under the fluorescent lights in the malnutrition ward, nurses try to get an IV into him. But Santo is so swollen with edema — a result of severe protein deficiency — they can only find a vein on his head. Drained of color, his skin peels off in patches like burns. They drip milk into his mouth because feeding too quickly can be fatal. “Their bodies have adapted to starvation,” a nurse explains.

At night, Rose and Santo lie on a small vinyl hospital bed surrounded by a mosquito net. The swelling abates after a few days, but the little boy shrinks to 14 pounds and disappears into a loose, unstrapped onesie meant for a 9-month-old. The nurses tell Rose that God has performed a miracle, but Santo is still a long way from recovery. This is not his first time in the malnutrition ward this year.

Days pass. On July 16, the hospital discharges James, her 5 year old with dark marble eyes. He has somehow overcome a bout of malaria, which can be nine times more likely to kill a severely malnourished child like him. Without other options, Rose decides to send him home to her eldest, 7-year-old Lino, who is still staying with neighbors and relatives, even though she knows they have little food to spare. She has to stay behind at the hospital just a little bit longer, she tells James. Santo needs her.

---

July turns to August, and Rose becomes a fixture in the clinic. Five-foot-nothing and soft-spoken, she often enters and leaves rooms without notice. Every day, she sees other panicked mothers come to the clinic with sick children, a dozen a day on average. Some leave alone, after their children die.

Rose does laundry, bathes Santo and tidies up around their bed to stay busy. She wonders who, if anyone, is looking after James and Lino and what, if anything, they are eating. She starts asking staff any chance she gets if today is the day they will discharge Santo.

Some of the other mothers are so desperate to check on their children they sneak out at night and walk hours back home. Others abscond altogether. At least one baby died this year after her mother took her from the clinic before she was ready.

Rose considers leaving, too. “I don’t want my kids to suffer alone,” she says as her fingers work over black and white beads of a necklace she’s making for Santo, a traditional charm popular in South Sudan. Rose separated from her husband, who she says abused her, and now raises her boys alone. She inflates her cheeks and presses her face nose-to-nose with Santo. She’s the only one who can make him laugh.

Rose fled her home for Kakuma as a teenager in 2018, after South Sudan’s civil war found her village and left few survivors. She’s now about 23 — she doesn’t know her exact birthday — but still feels like an orphan in need of help.

On Monday, Aug. 4, a young, gentle nurse named Mark Kipsang walks through the pediatric malnutrition ward with a clipboard. Medical staff had promised Rose before the weekend that she and Santo would be discharged soon.

When Kipsang reaches their bed, Rose sits the boy upright and encourages him to greet their visitor. Kipsang offers a hand for a high five, but Santo doesn’t budge. His little feet dangle from the bed, still swollen with edema. Kipsang is worried Santo’s condition will worsen at home and that he’d quickly end up back at the hospital. This year, Kipsang’s ward has seen about six relapses every week on average.

“Has he had diarrhea?” he asks, inspecting the loose skin on Santo’s backside.

“No,” Rose lies.

“Can he walk?”

Rose nods and places Santo on the cold concrete, his shirt slipping from his shoulders. When he stands motionless, Rose holds his hands above his head and wills him forward, his feet barely shuffling. Santo starts to wail, and Rose sighs and lifts him back into her lap.

Santo is not ready to leave. Just then, Kipsang looks at Rose sitting cross-legged and notices what she has kept to herself all this time. Rose is pregnant.

---

Kipsang sends her straight to the hospital prenatal offices. She pads across the courtyard clutching a worn purple book that shows her first and only checkup was months ago. Rose speaks three languages but cannot read or write. Staff take her blood and conduct other tests and then explain the results as they jot them down in the book. She is extremely anemic, which means she is at risk for fainting, strokes or a preterm birth.

A third of the women in the hospital’s maternity ward have life-threatening complications that could be treated simply with food. They suffer from anemia like Rose, as well as dangerously high blood pressure. Their babies are born early, weighing too little and with underdeveloped lungs.

Jane Atim, a solicitous nutrition counselor, tells Rose that in order to avoid a dangerous birth, she needs to address her iron deficiency. Rose nods but otherwise sits still on a plastic chair, her fingers laced together. Atim flips through a ledger of two dozen other pregnant women she had seen in recent weeks, all with the same problem. There’s a diagram of a balanced diet on her desk. “How many times a day do you eat?” Atim asks.

Three, Rose lies again. She wants to end the conversation and figures there’s not much point in being honest or complaining. Instead, she lists peas, greens and lentils as her typical daily fare.

Atim knows it isn’t true, but she doesn’t think it does much good to despair alongside the starving mothers. So she tells Rose what she tells everyone: “The best thing for you to do is eat.”

---

The next morning, three days shy of one month in the hospital, Rose comes apart. “I am leaving today,” she shouts to a group of hospital workers who had gathered around her. The other mothers turn on their beds to watch. Her face is wet with tears. She tells them she doesn’t know who’s taking care of her other kids.

Her doctor relents and signs the discharge papers. “This is not ideal,” he says. He’s worried Santo might have contracted tuberculosis as well. But he says it’s better to discharge Santo than let Rose leave against medical advice and risk her ignoring their recommendations for treatment at home.

Later, Rose collects all of their belongings into the plastic wash basin she’s been using for laundry: two dresses, blankets, soap in an empty powdered milk tin, the iron tablets the prenatal ward had given her and papers describing Santo’s treatment plan. She doesn’t know what the files say, but she organizes them into neat piles anyway. The hospital had prescribed Santo 11 ready-to-use therapeutic food bars, and Rose keeps the packaging of one he just finished. She saves the empty wrappers to prove Santo has eaten them. Some mothers resort to selling theirs.

Rose ties Santo to her back with a blanket printed with monkeys, balances the basin atop her head and cups her lower belly with her free hand. “God help you,” another mother says.

As Rose reaches her sister’s house, Lino and James bound around the corner, through an open gate and beneath a clothesline made of concertina wire. Flanked by a posse of other children all coated in a film of dust, the boys beeline for Santo. They coo over their little brother before liberating a nutritional supplement wrapper from his hands to lick it clean. Rose inspects Lino’s dirty fingernails and picks up James, his brittle arms reaching around her neck; his body feels like an empty bookbag. He has a bad cough.

They look rough, Rose thinks, but they are alive.

It takes more than an hour to walk back to their house. James lost his shoes at some point after leaving the hospital. He struggles to stand, much less walk under the blinding East African sun. “He became so thin this year,” says Rose, whose own sandals have broken. “He’s usually fat.”

Strapped to her back, Santo falls asleep. Rose agonizes over being a mother unable to feed her children, with a pain so deep that she feels something like remorse for having had them at all. “There’s no happiness in it,” she says later.

They walk past the occasional house stripped to a husk. Those families, Rose explains, sold their clothes, chairs and even roofs to afford a ride over the border to South Sudan — a place they had not long ago fled for their lives.

Kakuma once felt like her only possibility for a future. She hoped to go into business for herself, selling food of all things. She’d raise money in case she and the boys were ever granted asylum in the U.S., where her sons could receive a good education.

But she’s abandoned that plan. Now she instead imagines joining those returning to South Sudan instead. “This sickness that came upon her baby has broken her,” Rose’s sister Sunday says, using a camp colloquialism for malnutrition.

“The only time she scared me,” Sunday adds, “was when she told me she wanted to take her kids back to South Sudan.”

---

On the morning of Aug. 11, Rose disappears into a crowd of hundreds of refugees under a pavilion about the size of a basketball court. Children lie across concrete benches while their mothers crane their necks toward the front, struggling to hear over the din. There, a small team of Kenya Red Cross workers holding clipboards call names on a bullhorn. One at a time, the mothers come forward to lift their kids onto a scale.

This outdoor clinic is functionally a pediatric malnutrition referral center. Community health workers fan across Kakuma to measure the circumference of children’s arms. Any kids in the area with arms thinner than 13.5 centimeters below the shoulder are sent here. They’ve made almost 12,000 malnutrition referrals this year.

Rose sits with James and Santo on either side of her, both half asleep despite the noise. Behind a folding table at the front of the crowd is a harried young Red Cross nutritionist. He said on a previous visit that the turnout shows how far malnutrition has spread. “It’s worse than last year,” he added, “because the food has been cut.”

Rose plops Santo on the scale: about 15 pounds. James is 21. Both weigh more than they did last check up, but still far less than what healthy children would at their ages. Each of their arms measures less than 12 centimeters, meaning the aid workers should prescribe them both therapeutic food.

The nutritionist tells Rose to follow him. He unlocks a heavy steel door that opens into a vault typically filled with nutritional supplements. Now, save for a couple boxes torn open on pallets, the room is empty. “We don’t have Plumpy’Nut anymore,” he says. (U.S. funding cuts disrupted the global supply chain that moves therapeutic ready-to-use food all over the world, The New York Times reported, stranding it in warehouses and at shipping companies.) He hands Rose a few bars of what remains for Santo and a different, less dense, supplement for James. They head back home.

---

Rose gives birth to her first girl two months later, on Oct. 5. It’s a Sunday, which is what Rose names the baby.

Her family still struggles to get food, even though WFP has started giving out more rations after a recent grant from the U.S. She rests under a tree with the children outside their dark, squat home, watching them sit listless in the heat.

All three of her boys have backslid. Lino and James are even thinner. The color has again drained from Santo’s skin and the edema returned to his legs, arms and face. He has lost 1 pound since the August weigh-in with the Red Cross.

Still wearing the black-and-white necklace his mom made him, Santo can hardly open his eyes or sit upright. It’s clear he needs to go back to urgent care. But she’s afraid to risk bringing her newborn to the hospital, where she might catch an infection.

They’ll all stay at home for now. This time, Rose has to choose baby Sunday.

This story was originally published by ProPublica. Republished under a CC BY-NC-ND 3.0 license.

On July 18, a mild, overcast night in Nairobi, Kenya, a team of President Donald Trump’s top foreign aid advisers ducked into a meeting room at the Tribe Hotel, their luxury accommodations in the city’s diplomatic quarter, for a private dinner. 

The visitors from Washington included Marcus Thornton, a former Border Patrol agent known for a series of public lawsuits against the Biden administration’s COVID-19 vaccine mandate; Kenneth Jackson, a former oil executive who had done a stint in government under the first Trump administration; and Laken Rapier, who’d previously managed communications for the city of Fort Worth, Texas. This year, all had been appointed to leadership roles in the U.S. Agency for International Development, the premier government humanitarian agency in the world. 

Five months earlier, some of the visiting aides had celebrated USAID’s destruction over cake and speeches in Washington. With that job done, they’d embarked on a world tour of half a dozen cities, including the Kenyan capital. They were granted special permission to fly business class “to help ensure maximum rest and comfort,” according to an internal memo. Thornton alone received authorization to expense more than $35,000 in taxpayer money for the trip. The plan was to conduct exit interviews with USAID’s top experts, who were being forced out of the agency amid the administration’s stated commitment to austerity. 

When the U.S. embassy in Nairobi learned of the visit, officials there arranged the dinner with a goal in mind. It would be their last opportunity to explain, face-to-face, the catastrophic impact of Trump’s drastic cuts to foreign aid. 

A top concern: the administration’s failure to fund the World Food Program’s operation in Kenya, where about 720,000 refugees, among the most vulnerable people on earth, relied on the organization to survive. After providing $112 million in 2024, the U.S. abruptly cut off money in January without warning, leaving the program with no time to find adequate support or import the food needed for the rest of the year. 

For months afterward, U.S. government and humanitarian officials warned Washington that the cutoff had led to increasingly dire circumstances. They begged Trump’s political advisers, including Thornton, to renew WFP’s grant and give the money it needed to avert disaster. The embassy in Nairobi sent at least eight cables to the office of Secretary of State Marco Rubio, explaining the situation on the ground and projecting mass hunger, violence and regional instability. 

Those warnings went unheeded. Rubio, facing pressure from lawmakers and humanitarian groups, nevertheless publicly asserted that the agency’s mass cuts had spared food programs — even as the administration failed to fund WFP in Kenya behind the scenes. “If it’s providing food or medicine or anything that is saving lives and is immediate and urgent, you’re not included in the freeze,” Rubio told reporters on Feb. 4. “I don’t know how much more clear we can be than that.” 

By the spring, WFP still had not received funding, ran low on supplies and would be forced to stop feeding many of Kenya’s refugees. In Kakuma, the third-largest camp in the world, WFP cut rations to their lowest in history, trapping most of the 308,000 people in the camp with almost nothing to eat. 

They began to starve, and many — mostly children — died because their malnourished bodies couldn’t fight off infections, ProPublica found while reporting in the camp. Mothers had to choose which of their kids to feed. Young men took to the streets in protests, some of which devolved into violent riots. Pregnant women with life-threatening anemia were so desperate for calories that they ate mud. Out of options and mortally afraid, refugees began fleeing the camp by foot and in overcramped cars, threatening a new migration crisis on the continent. They said they’d rather risk being shot or dying on the perilous route than slowly starving in Kakuma.

To press the urgency of the situation in East Africa at dinner, the embassy officials enlisted Dragica Pajevic, a WFP veteran of more than two decades. Pajevic arrived at the Tribe Hotel early. She brought props. The bag slung over her shoulder held a collection of Tupperware containers with different amounts of dry rice, lentils and oil. 

As they ate, she placed each container on the table. The largest represented 2,100 daily calories, what humanitarians like her consider the minimum daily intake for an adult. The next container showed 840 calories. That is what a fifth of refugees in Kakuma were set to receive come August. Another third would get just over 400 calories. Then she showed an empty container. The rest — almost half of the people in Kakuma — would get nothing at all.

Pajevic ended her presentation by relaying a truism that she said a government official in Liberia had once told her: The only difference between life and death during a famine is WFP and the U.S. government, its largest donor. 

“The one who’s not hungry cannot understand the beastly pain of hunger,” Pajevic said, “and what a person is willing to do just to tame that beastly pain.”

The response was muted, according to other people familiar with the dinner. Jackson, then USAID’s deputy administrator for management and resources, said the decision to renew WFP’s grant was now with the State Department, and gave no indication he would appeal on the organization’s behalf. Thornton, a foreign service officer who ascended to a leadership post under Trump, did not speak. Instead, he spent much of the meal looking at his cellphone.

The dinner plates were cleared and the visitors headed to the airport. “They just took zero responsibility for this,” one of the attendees said, “and zero responsibility for what’s going to happen.” 

The details of this episode are drawn from accounts by six people familiar with the trip, as well as internal government records. Most people in this article spoke on the condition of anonymity for fear of reprisal. This year, ProPublica, The New Yorker and other outlets have documented violence and hunger due to the aid cuts in Kenya’s camps. But the scale of suffering throughout Kakuma — and the string of decisions by American officials that contributed to it — have not been previously reported. 

The camp had seen similar spikes in pediatric malnutrition in recent years, but they were tied to natural causes, such as malaria outbreaks, extreme drought or COVID-19, according to staff of the International Rescue Committee, a U.S.-based nonprofit that operates Kakuma’s only hospital. 

This was something different: an American-made hunger crisis. So far this year, community health workers have referred almost 12,000 malnourished children for immediate medical attention.

“What has come with Trump, I’ve never experienced anything like it,” said one aid worker who has been in Kakuma for decades. “It’s huge and brutal and traumatizing.”

In response to a detailed list of questions, a senior State Department official insisted that no one had died as a result of foreign aid cuts. The official also said that the U.S. still gives WFP hundreds of millions a year and the administration is shifting to investments that will better serve both the U.S. and key allies like Kenya over time. “We just signed a landmark health agreement with Kenya,” the official said, pointing to recent endorsements by government officials there. “That’s going to transform their ability to build their domestic capacity, to take care of their populations, to improve the quality of health care in Kenya.”

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The day of the dinner, 370 miles from the Tribe Hotel, Mary Sunday sat on a vinyl bed in the pediatric malnutrition ward of Kakuma’s hospital, cradling her 7-month-old baby, Santina. The name means “little saint” in Italian, and Mary could only pray that God would save her baby’s life. 

Slender, with close-cropped hair and arresting eyes, Sunday had rushed Santina to the hospital four days earlier after the infant developed severe diarrhea. Her husband, Juma Lotunya, had stayed behind to care for their 2-year-old, Grace.

Devout Christians in their early 20s, the couple fled to Kakuma together from South Sudan. They considered parenthood a sacred responsibility — especially Sunday, whose own mother died when she was young. As their family grew, Lotunya had hoped to start a small shop so he could afford to send their daughters to school. “I had that simple dream,” he said. 

But in June, when Santina was 6 months old, WFP cut the camp’s food rations. Families like theirs were allotted just a small amount of rice and lentils — 630 daily calories per person — which they were expected to make last until August. Sunday and Lotunya stretched it as long as they could, eating one small meal per day. But the food ran out before the end of June. Sunday stopped producing enough breastmilk to feed Santina, and their chubby baby began to waste away. By the time they arrived at the hospital, Santina weighed only 11 pounds. Staff noted in her charts that she was severely malnourished, her eyes sunken.

Sunday watched helplessly under the clinic’s fluorescent lights as hospital staff pumped her baby with medicine and tried to reintroduce more calories.

On the clinic’s walls, next to decals of butterflies, monkeys and seahorses, loomed dry-erase boards with columns of data tracking how many children and babies had died in the room this year. Sunday spoke no English, but she knew what the numbers meant: One row listed admissions to the pediatric malnutrition ward — about 400 per month on average, including the highest number of edema cases, a key marker of severity, in years. 

Another row on the whiteboards tallied those who never left the clinic: At least 54 children have died in the hospital with complications brought on by malnutrition in 2025 alone, including a surge in the spring when families first began rationing their food because of the USAID cuts. Worldwide, this year is the first in decades that early childhood deaths will increase, the Gates Foundation recently reported. Researchers said a key factor is the cuts to foreign aid.

In the hospital’s courtyard, another mother, 20-year-old Nyangoap Riek, leaned against a tree with her two children at her feet and said she was considering an extreme solution. “The thing I think about is committing suicide,” she told ProPublica, “because I heard the U.N. takes care of the kids when the parents are gone.”

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Kakuma has been a sanctuary in East Africa since the United Nations and Kenyan government began accepting refugees there in 1992. People have come fleeing deadly violence in some two dozen countries — mainly from South Sudan like Sunday and Lotunya — but also as far away as Afghanistan. Covering an area about half the size of Manhattan, Kakuma is a loose constellation of head-high mud and thatch neighborhoods and corrugated metal slums, like a macabre oasis in a desert, stitched together by rutted motorcycle trails.

Its sheer scale has drawn political figures, Olympic gold medalists and Hollywood celebrities on humanitarian visits. Movies have been made, including a documentary about the “Lost Boys of Sudan,” a group of unaccompanied minors escaping war and conflict. Angelina Jolie opened a school there. 

A high-ranking Republican-appointed diplomat from the U.S. once called Kakuma the hottest, driest land on earth, “a place that is very close to the edge of Hades.”

“We are sustaining life,” she said, “by helping fund the World Food Program.”

In the past, USAID gave WFP’s global operations billions every year, including the funds to feed refugees at camps in Kenya. The aid is one end of a bargain to bring stability to the region. Countries like Kenya take in refugees from a host of other countries fleeing violence, famine or natural disasters. In exchange, the U.S., along with other wealthy nations vested in saving lives, help foot the bill for essential services. Without food, experts say, refugees would likely spill out of Kenya into other countries. Conflicts may last longer, claim more lives and create new refugees. 

USAID has been ubiquitous in Kakuma for so long that it’s a literal building block in the camp; millions of old cans of cooking oil bearing the agency’s letters have been flattened and repurposed as lattice fencing.

When the Trump administration froze thousands of USAID programs during a putative review of the agency’s operations in January, Rubio insisted food programs would be spared. 

But then Rubio’s lieutenants failed to extend WFP’s Kenya funding, blowing up the typical timetable the organization needed in order to ship food to Kakuma by summer.

WFP was blindsided. The organization’s leaders had received no notice ahead of the cuts and no communication about whether the Trump administration would ever renew their grant. “There was zero plan, except causing pain,” said one U.N. official. “And that is not forgivable.” 

Even before the second Trump administration, funding shortfalls in recent years had forced the organization to drop rations by around 20% to 40% throughout the camp. To adjust for the long term, WFP was planning to reform its model in Kenya to make sure the small minority of people with some income, like small-business owners, didn’t receive food. 

Thousands of Refugee Families in Northwest Kenya Starved After USAID Funding Cuts

In August, food rations were cut to historic lows. Almost half the Kakuma camp got nothing at all.

But this year, WFP’s leaders were forced to stretch their remaining supplies from last year. They made the drastic decision to cut rations to their lowest in Kakuma’s history. They also reduced distributions to once every other month instead of monthly. 

In August, the handouts would become even more austere, as WFP rushed to prioritize families based on need. They determined only half the population would receive food. Most people learned which half they were in from a number stamped on the back of their ration card.

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Across the world in Washington, the fate of places like Kakuma was in the hands of a select few political appointees, including Thornton, who was named the agency’s deputy chief of staff on March 18. Thornton first worked beneath Peter Marocco, Rubio’s head of foreign assistance, and later under Jeremy Lewin, initially an Elon Musk hire. Besides Rubio, none of them were subject to Senate confirmation. 

As pleas poured in from government officials in Washington and abroad to restart aid operations in Africa, including WFP in Kenya, the appointees often failed to act, records and interviews show. 

On March 18, USAID’s political leadership invited career government aid officials from the agency’s major bureaus to pitch the handful of programs they thought were most critical. It was the only time the agency’s Africa bureau had an opportunity to make a full-throated case for its development programs across the continent. They had just 45 minutes to do it.

In the room was Thornton, a member of the Ben Franklin Fellowship, an organization that champions “the primacy of American sovereignty.” Thornton said in podcast appearances that his campaign against President Joe Biden’s vaccine mandate for federal workers introduced him to a government bureaucracy “that is not reflective of the values of the people that it serves” and requires “fear and accountability” to come to heel, Mother Jones reported. 

As part of the meeting, Brian Frantz, acting head of USAID’s Africa bureau and a diplomat with nearly 25 years of experience, pitched Kenya as an important trade and national security partner. At one point when discussing another country, Frantz mentioned the U.S. Trade and Development Agency, using the acronym TDA. Thornton perked up, according to two attendees. Then he asked: Was TDA a reference to the Venezuelan criminal organization Tren de Aragua?

The USAID officials were stunned. “That was the one thing he said in that meeting,” one of the attendees recalled. “There was just zero interest in the subject matter.” 

In a blistering memo circulated around the agency before he was laid off in late summer, Frantz upbraided political leaders. He detailed how they had prevented lifesaving programs from coming back online by refusing to pay for services already rendered and restricting access to USAID’s payment systems. He said they had frequently changed the process for how to appeal program terminations, burying their subordinates in paperwork for months.

“We were given make-work to keep us spinning our wheels,” another former official recalled.

Months before the last-ditch appeal at the Tribe dinner, embassy staff in Nairobi had also tried unsuccessfully to get funding restored to WFP. In March, Marc Dillard, the acting U.S. ambassador, went to Kakuma for a tour of the hospital where Sunday and Santina would later check in. 

After seeing the stakes firsthand, Dillard signed a series of cables to Washington documenting the chaos and death in Kakuma and other camps caused by the sudden funding cuts to WFP. On May 6, the embassy wrote that declining food assistance had “already contributed to several deaths and could result in escalating instability in Kenya.”

At one point, a group of teenagers and young men in Kakuma splintered off from a protest and set fire to WFP’s tents. Kenyan police responded by shooting at them, wounding at least two, including a teenager who was hospitalized with a gunshot wound to the head. Ordinarily considered among the most peaceful refugee camps in Africa, Kakuma went into lockdown. Aid workers hid inside their compounds.

Sexual assault, violent protests and other crimes would only increase without aid, Kenyan government officials warned the embassy, according to another cable. They predicted the cuts could destabilize one of America’s closest allies in Africa, “undermining Kenyan willingness to host thousands of refugees, many of whom would likely otherwise join the illegal migration flows bound for Europe and the United States.”

At a roadside staging area, some of those fleeing Kakuma hired smugglers to take them the 70 miles to the South Sudan border — the same country where they had escaped violence. As many as two dozen women, children and babies contorted inside cars with their belongings piled on the roof. “It’s hunger that chased us,” one woman said through the cracked window of a car about to depart. “It’s hunger that’s making us leave.”

In mid-May, USAID’s humanitarian assistance bureau in Washington delivered a memo again requesting the political appointees approve funding for WFP Kenya. “Without this additional assistance,” the appeal stated, “the WFP-provided food rations will reduce from normal levels of 60% to 20%, putting nearly 1 million people at risk of starvation and death and likely triggering additional insecurity within the refugee camps.” 

Records show seven advisers in the chain of command signed off on more funding for WFP in Kenya. When the request got to Thornton, who by then had been promoted to USAID’s chief of staff, he did not. No money went through at that time. “Thornton became a real road block,” a former USAID official said. 

Thornton did not respond to a request for comment. In response to questions about episodes like this, the senior State Department official said the Office of Management and Budget, not USAID or the State Department, has ultimate authority to approve new foreign aid money. They said they worked closely with OMB to review all of the funding requests. “In order to make an obligation like that,” the official said, “you need to have apportioned funds from OMB.” 

When ProPublica asked about the funding delays and the State Department’s explanation, OMB’s communications director Rachel Cauley said in an email, “That’s absolutely false. And that’s not even how this process works.” She did not clarify what was false. 

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Santina declined rapidly in the days after arriving at the clinic. Hospital staff tried everything. They gave her IV fluids, put her on oxygen support and updated the diagnosis to marasmus, a severe form of malnutrition where the body starts to eat itself. Pneumonia gripped her lungs. Santina’s color faded and she struggled to breathe. She became unresponsive to pain.

Cradling her baby, Sunday thought about her oldest daughter back at home. Two-year-old Grace wore a little bell around her ankle because she was prone to wandering off. Sunday thought: What will Grace eat today? Tomorrow? Will she end up here too?   

Just after 5 a.m. on July 21, hospital staff pronounced Santina dead.

A doctor and nutrition specialist with the International Rescue Committee said Santina almost certainly would have survived if she weren’t malnourished. To Lotunya, the cause was clear: After starving for weeks, his wife could no longer breastfeed, which is why Santina had become so tiny and weak. “That is why she died,” he said.  

Santina was transferred to the hospital’s morgue, a squat concrete building at the edge of the compound. Lotunya borrowed $10 to bury his daughter in Kakuma’s cemetery, just on the other side of the hospital fence.

Once proud to be the mother she’d grown up missing, shame washed over Sunday. “I felt I wasn’t mother enough,” she said later, nearly in a whisper.

---

In early August, Sunday came home after helping to harvest the sallow greens a neighbor was growing out of dry, cracked earth. In exchange, they had given her a few handfuls of the vegetable wrapped in fabric. It was the family’s only food. 

The August food distribution was supposed to come any day; the camp was tense. WFP’s new rankings determined that only half of Kakuma would receive food, a decision most refugees deeply opposed. Lotunya, Sunday and Grace were among those who would get nothing. 

Someone had stolen the roof off the family’s single-room mud house, so Lotunya had used tarp and cardboard for a makeshift cover, which was disintegrating in the hot sun. Grace played on the dirt patio, the bell on her ankle chiming as she moved between her parents, clinging to their legs and crawling into their laps.  

Doting on her, they said, was the only way to cope with losing Santina. They have just one picture of their youngest child: a fuzzy, black-and-white image on the family’s refugee registration. “But,” Sunday said, looking at her oldest daughter asleep on Lotunya’s shoulder, “I have Grace.”

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In late September, the State Department signed an extension to WFP’s Kenya operation. This year, the U.S. gave $66 million, which is 40% less than it received last year and, critically, the funds arrived nine months into the year. 

WFP has told refugees it plans to provide food through at least March. Even then, most families are set to receive between one-fifth and three-fifths of the recommended minimum daily calories. 

Sunday, Lotunya and Grace would each get the equivalent of 420 calories a day.

This story was originally published by ProPublica. Republished under a CC BY-NC-ND 3.0 license. The original has additional imagery which is worth checking out as well.

On the one-month anniversary of President Donald Trump’s inauguration earlier this year, a group of his appointed aides gathered to celebrate.

For four weeks, they had been working overtime to dismantle the U.S. Agency for International Development, freezing thousands of programs, including ones that provided food, water and medicine around the world. They’d culled USAID’s staff and abandoned its former headquarters in the stately Ronald Reagan Building, shunting the remnants of the agency to what was once an overflow space in a glass-walled commercial office above Nordstrom Rack and a bank. 

There, the crew of newly minted political figures told the office manager to create a moat of 90 empty desks around them so no one could hear them talk. They ignored questions and advice from career staff with decades of experience in the field.

Despite the steps to insulate themselves, dire warnings poured in from diplomats and government experts around the world. The cuts would cost countless lives, Secretary of State Marco Rubio and the other Trump officials were told repeatedly. The team of aides pressed on, galvanized by two men who did little to hide their disdain for the agency: first Peter Marocco, a blunt-spoken Marine veteran, and then 28-year-old Jeremy Lewin, who, despite having no government or aid experience, often personally decided which programs should be axed. 

By the third week in February, they were on track to wipe out 90% of USAID’s work. Created in 1961 to foster global stability and help advance American interests, USAID was the largest humanitarian donor in the world. In just a month’s time, the small band of appointees had set in motion its destruction.

In a corner conference room, it was time to party. They traded congratulatory speeches and cut into a sheet cake.

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Days later, on a remote patch of land in South Sudan, a 38-year-old man named Tor Top gathered with his neighbors outside the local health clinic. Surrounded by floodwaters, their hamlet of thatch and mud homes had been battling a massive outbreak of cholera, a deadly disease spread by poor sanitation. Around the country, it had infected 36,000 people in three months, killing more than 600, many of them babies. Top’s family lived in the epicenter.

The clinic, one of 12 in the area run by the Christian, Maryland-based humanitarian organization World Relief and funded by USAID, provided a key weapon in the fight: IV bags to stave off dehydration and death. The bags cost just 62 cents each, and in three months, the clinics had helped save more than 500 people. 

Now, Top, who lived with his wife, children and mother in a one-room house less than 50 feet from the clinic, listened as World Relief staff shared grim news: The Trump administration had stopped USAID’s funding to World Relief. Their clinic, their lifeline, was closing.

Top’s usual gentle demeanor broke down. Why would the U.S. just cut off their medical care in the middle of a deadly outbreak?

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By now the broad story of USAID’s ruin has been widely told: The decree handed down by Trump; Elon Musk, who led the new Department of Government Efficiency; and Russell Vought, who holds the purse strings for the administration as the head of the Office of Management and Budget, to scuttle the agency and undo decades of humanitarian work in the name of austerity. Publicly, the administration tried to temper international backlash by promising to keep or restore critical lifesaving programs. 

But that promise was not kept. Instead, a cast of Trump’s lesser-known political appointees and DOGE operatives cut programs in ways that guaranteed widespread harm and death in some of the world’s most desperate situations, according to an examination by ProPublica based on previously unreported episodes inside the government as well on-the-ground reporting in South Sudan. In some cases, they abandoned vital operations by clicking through a spreadsheet or ignoring requests in their inboxes. 

The abrupt moves left aid workers and communities with no time to find other sources of funding, food or medicine. Borrowing from a phrase used to describe the U.S.’ overwhelming military campaign during the Iraq War, political appointee Tim Meisburger told senior USAID staff that the strategy was “shock and awe.” (Meisburger declined to comment.)

Tibor Nagy, a veteran diplomat who was Trump’s acting undersecretary of state for management until April, has long been a critic of the vast networks of nonprofit organizations funded by American taxpayers. But he told ProPublica the administration never cared to differentiate between the “fluff” and vital humanitarian programs. “It was the most harebrained operation I’d seen in my 38 years with the U.S. government,” Nagy said, referring to the methods used this year. “Who knows how much damage was done.”

In public statements and congressional testimony, Rubio has repeatedly insisted that no one died because of cuts to U.S. foreign aid and that his staff had reinstated lifesaving operations. But ProPublica found that those claims were a charade: Lifesaving programs remained on the books, but the flow of money didn’t restart for months, if at all. Lewin blocked funding requests for programs like tuberculosis treatment in Tajikistan and emergency earthquake response in Myanmar, records show. 

This meant that dozens of supposedly “active” operations were dormant throughout most of the year. Rubio’s advisers let other critical programs, which typically run on one-year grants, expire without renewing them. 

Few places were hit harder than South Sudan, the youngest and poorest country in the world, as well as one of the most dependent on American aid. 

After Trump’s inauguration, career USAID and State Department staff spent months warning top officials that the funding cuts would exacerbate a historic cholera epidemic ripping through the country. They needed less than $20 million to fund lifesaving health programs, including cholera response efforts, for three months at the beginning of the year — an eighth of what Trump recently approved to buy private jets for one cabinet secretary and just 3% of USAID’s budget in South Sudan last year. But Rubio, Marocco and Lewin failed to heed their own agencies’ assessments, according to internal records and interviews. 

As a result, people in South Sudan died.

By denying and delaying those funds for months, Trump’s appointees incapacitated the fragile nation’s emergency response systems at the very moment when doctors and aid workers were scrambling to contain cholera’s spread. “We had to start rationing lifesaving interventions,” said Lanre Williams-Ayedun, the senior vice president of international programs for World Relief. “To have something like this happen in a place like this, where there aren’t mechanisms for backup, just means people are going to die.”

Villages and towns that had been reining in the outbreak suddenly lost essential services. Cholera came roaring back. “The trend was going down,” said a former U.S. official. “When we stopped the funding, it just surged.”

This summer, ProPublica journalists hiked and boated across Rubkona County, the epicenter of South Sudan’s outbreak and home to the country’s largest refugee camp, to interview families that the U.S. cut off from help. We collected medical files, diaries, meeting notes and photographs documenting cholera’s devastation after essential services stopped.

ProPublica also interviewed more than 100 government and aid officials and reviewed enormous caches of previously unreported memos, correspondence and other documents from inside the Trump administration. Many were granted anonymity due to fears of reprisal.

In response to a detailed list of questions, a senior State Department official said fast, drastic changes to foreign aid were necessary to reform a “calcified system.” The world, especially U.S. interests, will be better for it in the long run, the official said, despite “some disruptions in the short term.”

The official also said that Rubio was the final decision-maker for all aid programs. They also contended that they had a limited budget to work with, “which required some tradeoffs on what programs to continue,” saying OMB has ultimate control over new humanitarian funds. 

The official maintained that nobody died as a result of the funding cuts. “That’s a disgusting framing,” the official said. “There are people who are dying in horrible situations all around the world, all of the time.” 

“Who is responsible for the suffering of the people of South Sudan?” the official added. “The South Sudanese [government leaders] who take their oil revenues and buy private jets and fancy watches and don’t see to their own people? Or the United States? Are we responsible for every poor person all around the world?”

Officially, the death count in South Sudan is nearly 1,600, making it the worst cholera epidemic in the country’s history. But that toll is a dramatic undercount. ProPublica found newly dug, unmarked graves alongside roads and in backyards. In one town, community leaders showed reporters an informal cemetery with at least three dozen people who they said did not make it to medical facilities in time. 

Tor Top’s mother, Nyarietna, was one of the uncounted. In March, the clinic doors had been padlocked for two weeks when she developed vomiting and diarrhea. Top bundled her into a rented canoe and began paddling toward the nearest hospital, eight hours away. Less than halfway into the journey, long after they had stopped reassuring one another that she would be OK, Nyarietna died. 

Top turned the canoe around and made his way back home, where he buried his mom in their backyard. Now he alone tends the small garden where she grew corn and okra for their family. “If there was medicine here,” he said later, “maybe her life would have been saved.”

Aid to South Sudan 

For years, Sudan’s Arab-led central government waged a campaign of brutal violence against its Christian minority in the south. Their persecution became a cause celebre of the American Evangelical movement, which convinced President George W. Bush’s administration to help broker a peace agreement that led to independence 15 years ago. Since then, the U.S. has given the fledgling nation nearly $10 billion in aid, according to federal data. That money subsidized virtually every corner of the health care system, among other institutions.

Still, South Sudan remains undeveloped. Political instability, corruption and dysfunction are rampant. The transitional government hasn’t paid public employees’ salaries for most of the last two years. U.S. officials had long been on alert to South Sudanese aid workers siphoning resources. Deadly political violence — left over from the civil war and threatening a new one — besets much of the country. 

Well before Trump took office this year, the international community had broadly agreed that it was necessary to end the nation’s dependence on foreign aid, and U.S. officials were working on strategies to force its leaders to take responsibility for its citizens.

Some of the most vulnerable among them live in Rubkona County, an oil and cattle hub larger than Rhode Island near Sudan’s border. There, a refugee camp formed in 2014 during the nation’s civil war when thousands of people fled behind a United Nations peacekeeping mission to escape a massacre in the nearby town of Bentiu. As South Sudan’s political turmoil continued to spiral, tens of thousands more fled to the camp. In 2020, Rubkona was hit by a series of catastrophic floods that submerged the majority of the county. Generations of people are now essentially trapped there with nowhere else to go.

Previously, USAID gave the U.N.’s International Organization for Migration $36 million for work in South Sudan, which included keeping the Bentiu camp habitable and making critical repairs to the dikes that surround the camp and hold back the rising floodwaters. The group maintained the drainage system and paid people to pick up garbage and clean the latrines — essentially performing sanitation services for 110,000 people.

Despite those efforts, cholera began spreading late last year as new refugees poured in from neighboring Sudan. Rubkona County quickly became the outbreak’s epicenter. In a matter of days, hundreds of infections turned to thousands and the death toll mounted. U.S.-funded organizations raced to set up treatment units in the camp and surrounding communities. 

The situation was dire, and people had few viable options to leave Bentiu, U.S. Ambassador Michael Adler reported back to Washington after USAID staff visited the camp to assess the outbreak in early December. The U.S.-funded cholera clinics and other programs were necessary given the “explosivity” of the illness’ spread, he wrote.

It was the kind of routine crisis response that USAID was renowned for handling. The last cholera outbreak in Rubkona, in 2022, lasted seven months, and government statistics say that just one person died while about 420 were sickened. An aggressive sanitation campaign, largely funded by the U.S., was crucial to containing the disease.

Now faced with a new outbreak, the embassy’s staff rushed to get the aid organizations in Rubkona more money, according to the organizations and former officials. By early January, humanitarians were preparing to expand operations. World Relief planned to expand its mobile clinics, Williams-Ayedun said. USAID told Solidarités International, which repaired water pipes, provided sanitation services and distributed soap, to aggressively spend the money it had to combat cholera, with the understanding that the agency would immediately review a proposal for more funds, according to two former officials. An additional $30 million for the U.N.’s migration office — which planned to use the money to continue maintaining the refugee camps — was already committed.

Then Trump took office, signing an executive order on day one to freeze all foreign aid pending a review of whether it aligned with the administration’s stated values.  

“Just Throw Them in the Pot”

Days later, Rubio issued sweeping stop-work orders to aid programs worldwide. Musk declared that his DOGE team had fed USAID “into the woodchipper.” After a swift backlash from aid organizations, foreign governments and U.S. ambassadors overseas, Rubio announced that lifesaving operations would continue during his review. Marocco told lawmakers as much during briefings.  

It wasn’t true. Behind the scenes, Marocco and his lieutenants repeatedly obstructed USAID’s Africa, humanitarian aid and global health bureaus from restarting programs critical for responding to disease outbreaks, according to interviews and memos obtained by ProPublica. The money aid organizations in South Sudan were expecting by February didn’t come. Meanwhile, the appointees suspended nearly all of USAID’s staff, and those remaining said their bosses blocked payments even for approved programs.

Marocco was meant to be “the destroyer, and then someone else would come in to rebuild,” one former official said a senior political appointee had told her. “I guess the one thing happened, but not the other.” (Marocco did not respond to multiple requests for comment.) 

The cuts were so frenetic that, for a brief time, the U.S. government stopped paying for the fuel that ran the electricity for the American embassy in Juba, including the security compound, just as violence was surging throughout South Sudan, according to former senior officials.

In response to questions about the episode in Juba, the senior State Department official denied it was a mistake or that Rubio’s review wasn’t careful. “Going back and looking at things again doesn’t mean that you’ve made a mistake,” the senior official said. 

At one point in February, Marocco tried ordering the immediate return of foreign service officers stationed abroad. Several senior USAID officials protested, citing safety and logistical concerns for staff in war zones. During one meeting that month, Lewin responded, “You don’t want to get to know the lobsters. Just throw them in the pot,” according to an attendee and meeting notes. 

Lewin joined the government via Musk’s DOGE and later took over for Marocco. He seldom came to the USAID office or met with his own staff experts, officials said. Publicly, he called the agency an “unaccountable independent institution” where secrets leak so quickly “we have to hand-walk memos around like we’re in the ’40s.”

In the weeks that followed, DOGE and Trump appointees forbade those who remained at USAID from communicating with aid groups and discouraged discussion internally, telling staff abroad not to approach ambassadors to advocate for programs, emails show. 

Senior staffers said they were prohibited from meeting with congressional delegations to share basic information, which was critical to Congress’ oversight capabilities. The government’s health experts feared that taking any action to save lives could be a fireable offense. 

Still, some spoke out. 

“The consequences on lives lost and funding squandered will grow exponentially and irreversibly in many cases,” Nicholas Enrich, then an acting assistant administrator at USAID, warned in a Feb. 8 email to agency leaders, including Joel Borkert, the chief of staff, and Meisburger, who led the humanitarian affairs bureau. They did not respond to his plea, and Enrich was later put on administrative leave. 

Crucially, even when USAID’s new bosses did approve organizations to resume lifesaving work, they at times denied requests for the money that would allow them to do so, internal records show. Other proposals to fund existing grants or reverse terminations languished in limbo.

The official responding on behalf of the State Department said Trump’s OMB ultimately has more control over approving new grants and extensions, but that it was never the administration’s intention to keep all of the lifesaving programs forever. 

When ProPublica asked about the funding delays and the State Department’s explanation, OMB communications director Rachel Cauley said in an email, “That’s absolutely false. And that’s not even how this process works.” She did not clarify what was false, and the State Department did not address when Lewin sought funds from OMB for South Sudan’s cholera response. 

In early February, embassy staff in South Sudan provided Adler, the ambassador, with a list of the most critical operations there, warning that funds had not been released and lifesaving programs would cease when their money ran out. 

A career foreign service officer appointed to his post by the Biden administration, Adler had long been critical of the government of South Sudan for ongoing violence and deserting its own people, according to embassy cables and interviews with people familiar with his thinking.

Still, early on he appeared to recognize that without U.S. intervention, the most vulnerable people in the country did not stand a chance against cholera. In a Feb. 14 memo addressed to the leadership of the State Department’s Africa bureau, Adler asked the administration to release money to keep people alive. 

“Lifesaving medicine and medical care, as well as emergency water and sanitation services, play a critical role in controlling disease outbreaks,” the embassy wrote, “notably a severe cholera outbreak in South Sudan’s border regions hosting the greatest number of refugees.”

Adler declined to meet with ProPublica in South Sudan and did not respond to a detailed list of questions. 

Death by Spreadsheet 

As humanitarian groups racked up unpaid bills, they began to file lawsuits challenging the foreign aid freeze. A federal judge ordered the administration to reimburse the organizations. But on Feb. 26, the Supreme Court temporarily paused the lower court’s order. 

In a meeting with senior agency staff the next day, Lewin, who at that time was not yet in charge of USAID programs, indicated that he interpreted the recent legal decisions as a potential license to dispense with one of the key review processes for unfreezing operations, according to two attendees and meeting notes. One of those attendees took Lewin’s remarks to mean that “he had no intention to review contracts or implement lifesaving programs.”

In response, the senior State Department official told ProPublica, “No one meant that or said that.”

The next night, a Friday, staff at the Bureau of Humanitarian Assistance, the division of USAID that dealt with emergencies and ran nearly all of the programs in South Sudan, were working late, scrambling to keep emergency programs operational. Suddenly, they noticed Borkert making changes to a key spreadsheet. 

To create the spreadsheet, DOGE had sidestepped career staff, pulling information from databases made for project management. It was so rudimentary that it was often impossible to tell what a program did from descriptions as vague as “extension No. 4” or “allocation of funds,” according to people who saw the spreadsheet.

Rubio and his aides had already terminated hundreds of programs in preceding days. Staff were bracing for another round of cuts, but many of the line items remaining in the file were for programs that provided food, clean water or essential medicines.

Veteran USAID officials watched as Borkert scrolled down the spreadsheet, turning rows red, yellow or green every few seconds, never asking a single question. Realizing the red programs were slated to be cut, they frantically started editing descriptions so that Borkert would at least know what those programs did. Within minutes, he’d flagged dozens of them for termination. (Borkert declined to comment.)

A senior staff member in the group raced upstairs and begged Borkert to reinstate them, according to two officials familiar with the episode. He relented on several. But the next day, Marocco and Lewin told the group they’d kept far too many programs, emails show. Lewin ordered 151 additional awards terminated, writing that he would “have strong objections to these awards being turned on.” Marocco followed up by email at 11:30 p.m. saying the reactivations were “far too broad,” indicating several more line numbers and writing “sound like terminations,” next to them, ultimately canceling even more programs.

On March 10, Rubio announced on X that the review was over. In response to lawsuits, Trump officials told the courts that the review was a careful examination of USAID’s operations.

More than 5,000 programs had been canceled, and fewer than 1,000 remained — a figure that many officials told ProPublica was arbitrary but binding. In reality, the administration still wasn’t releasing money and many of the surviving programs had no funds, according to interviews with humanitarian groups and government officials, as well as memos and spreadsheets documenting those decisions.

When asked about the current status of the 1,000, the senior State Department official criticized USAID’s former vetting procedures and said the administration is in the process of creating new programs. 

Soon after the review ended, the cholera response in South Sudan came crashing down.

“God Is With Us”

Rebecca Nyariaka and Koang Kai were shrouded in grief throughout the upheaval in Washington. Their only child, 4-year-old son Geer, had been one of the first victims when cholera inundated the Bentiu camp in December. 

The couple met in secondary school at a refugee camp in Kenya and got married after they’d both returned to their homeland in 2013. After violence broke out, they fled to Bentiu, finding occasional jobs working with health clinics. 

Now, in early March, they prodded one another to stay hopeful: 28-year-old Nyariaka was once again pregnant.

In the refugee camp, the couple could see the signs of the funding cuts everywhere. Uncollected garbage barricaded the drainage ditches that encased their neighborhood. Human waste spilled out of the overflowing communal latrines near Nyariaka’s house and into the fetid water filling the culverts. Toilets crawling with rats, maggots and flies became so noxious that neighbors began defecating on the surrounding dirt roads. The stench was overwhelming. “Those who washed the latrines have gone,” Kai said. “And we are left here all alone.”

The U.N.’s new sanitation contract had been committed before Trump took office, but it hadn’t received any money since last year. On March 12, USAID staff in the region sent Washington field notes about the conditions in the camp, where health services faced “closure or severe cutbacks” because of the funding shortfall. Officials at the organization pleaded behind the scenes as well. They repeatedly called and met with embassy leaders to request help, to no avail. “What we have now is survival of the fittest,” one U.N. official told ProPublica.

When Nyariaka gave birth to a healthy baby boy, cholera was rampant throughout the camp. Neighbors were dying around them, and Kai was worried for his wife and new baby. “When cholera enters your home, you know the chances of survival are very low. Very few people survive it,” he said later. 

Nyariaka named the baby Kuothethin, “God is with us.” In her first days back from the hospital, her body still healing, the new mom used the bathroom frequently, teetering back and forth to the overflowing latrines close to her house. She soon developed violent vomiting and diarrhea, the hallmark symptoms of cholera. 

Kai, tall and muscular, picked her up in his arms and raced to the camp hospital, but it was too late. Nyariaka died just after they arrived.

She had been nowhere except her house and the latrines since coming home from the hospital, Kai said. He’s certain the toilets are to blame for her death. Depressed and unable to care for their newborn, he sent the baby across the floodwaters to live with his mother-in-law on another side of the state.

Kai and Nyariaka had been best friends for years before they started dating, their lives intertwined for nearly two decades. “Her whole way of life was good. She loved our children and cared for them,” Kai said. “I am heartbroken.”

As the disease ripped through the camp, more services shut down, including transportation for the dead. Kai’s neighbor, John Gai, lost his father to cholera. Gai had to take him to the cemetery himself in a wheelbarrow, his father’s head bobbing at his knees. “Nobody should have to carry a dead body among the living,” Gai said.

“Gross Neglect”

On March 28, Rubio notified Congress that he was officially shuttering most USAID operations and transferring programs that survived his review, including several in South Sudan, to the State Department. 

Staffers spent the next weeks repeatedly appealing to Lewin — who by then had replaced Marocco as Rubio’s top foreign aid official — for authority to perform the mundane tasks needed to keep the programs operating. In late April, the agency’s humanitarian bureau submitted a blanket request to fund grants that Lewin had already approved. Lewin refused, records show, and the humanitarian bureau had to submit country-specific proposals for consideration. That process dragged on for months.

In June, just before USAID was shut down for good, Lewin finally approved some of the funding the staff had advocated for. But by then it was too late. The officials had run out of time to transfer money already appropriated by Congress to remaining programs.  

On June 26, R. Clark Pearson, a supervisory contracting officer at USAID, sent a scathing email to USAID offices around the world in response to an email from the top procurement officer for the agency listing the hundreds of programs that were meant to be active. He said there was no one who could manage the awards, which he called “gross neglect on an astonishing level.” 

“In a time of unimaginable hubris, gross incompetence and failures of leadership across the Agency, this has to be one of the most delusional emails I have seen to date,” Pearson wrote. “Lives depend on these awards and for the [U.S. government] to simply not manage them because of an arbitrary deadline is inexcusable.”

That same day, a senior humanitarian adviser informed Adler that payment extensions for several programs, with the exception of food aid, weren’t processed because the “approval was received late.” 

In September, the Supreme Court issued another emergency ruling that let the administration withhold nearly $4 billion that Congress earmarked for foreign aid. 

Later that month, OMB released some new foreign aid funds. That’s when World Relief finally began to receive funding, allowing the clinic in Tor Top’s community to reopen, even though the administration claimed the program had been “active” for almost seven months. 

The U.N.’s migration program has not received a new South Sudan grant.  The organization will run out of money for dike maintenance in Bentiu by February, after months of some of the most severe flooding in years.

A spokesperson for the U.N.’s migration program said the organization was still in discussion with the State Department and “continues to engage with donors about the critical humanitarian needs in South Sudan.”

The Uncounted 

During the first months of the cholera outbreak, a mobile health team run by the International Rescue Committee, a U.S.-based nonprofit that works in crisis zones around the world, visited Nyajime Duop’s remote village on the edges of Rubkona County twice weekly. The team brought soap and transported sick people to IRC’s nearby clinic for care. 

At 27, Duop’s youthful face belied a life marked by war and poverty. She had arrived just a few months earlier, fleeing violence in Khartoum, Sudan, with an infant and toddler in tow, when Trump officials terminated IRC’s $5.5 million grant. 

The IRC suspended its operations in the village in the spring. When Duop’s 1-year-old baby, Nyagoa, fell ill with cholera in July, on a day IRC would have visited, there was no one to help her. By the morning, Nyagoa was unconscious. She died that day, the Fourth of July.

Cholera has spread to nearly every corner of South Sudan, infected at least 100,000 people and killed 1,600, though cases began abating this fall. The true death toll is impossible to know, in part because clinics that would have cared for people and counted the dead were shuttered. The Trump administration also cut funding to the World Health Organization, which helped the South Sudanese government gather accurate data on the outbreak. 

In a pasture a short walk from IRC’s clinic, ProPublica found at least three dozen mounds covered in sticks — the makeshift graves, village leaders said, of those who died of cholera before reaching the clinic. The clinic’s security guard told reporters he saw one man collapse and die just yards from the front gate.

“There are many more cases,” said Kray Ndong, then acting minister of health for the area, “many more deaths.”

The Trump administration recently announced a new era of foreign aid, where the U.S. will prioritize “trade over aid.” South Sudan, with a gross domestic product one-tenth the size of Vermont’s, has little to offer. 

“The administration says they are committed to humanitarian needs,” one aid official in South Sudan said. “But we don’t know what that means, only that it will be transactional.”