The dismantling of USAID

Before 2025, USAID delivered most U.S. foreign aid: about three of every five aid dollars in fiscal 2023, according to the Pew Research Center. Its workforce totaled more than 10,000, about two-thirds of it overseas, and it managed more than $35 billion in fiscal 2024, according to the Congressional Research Service. All U.S. foreign aid together came to 1.2% of federal spending in fiscal 2023.

On his first day in office, President Trump signed an executive order pausing U.S. foreign development aid for 90 days. Four days later the State Department, led by Secretary of State Marco Rubio, ordered work stopped on existing aid programs. The order exempted emergency food aid and military aid to Israel and Egypt.

On January 28, 2025, the White House press secretary said $50 million was about to be spent on "condoms in Gaza." Musk shared the claim on X the same day with the comment "Tip of iceberg." CNN found the claim false: federal figures show USAID's condom aid totaled about $8 million worldwide in fiscal 2023. Asked about it in the Oval Office on February 11, Musk said: "Some of the things that I say will be incorrect, and should be corrected."

On February 2, 2025, Musk wrote on X: "USAID is a criminal organization. Time for it to die." He was sharing a post about two USAID security officials who, the Associated Press reported, were put on leave after they refused to give his team access to classified material. Shortly after midnight he said on a live X audio event that USAID was "not an apple with a worm in it, but we have actually just a ball of worms," and "beyond repair." He said he had gone over it with President Trump "in detail, and he agreed that we should shut it down." He then posted: "We spent the weekend feeding USAID into the wood chipper. Could gone to some great parties. Did that instead."

USAID's website went offline on February 1, 2025. Early on February 3, a member of Musk's DOGE team emailed all USAID staff that the Washington headquarters would be closed that day, a federal judge later wrote. On February 23 the administration told all but a fraction of the staff worldwide that they were on leave and notified at least 1,600 of those based in the United States that they were being fired. On March 28 it moved to terminate nearly all the employees who remained. The Government Accountability Office found that USAID's staff fell 98%, from about 13,600 in January 2025 to 241 in April 2026. The judge found that senior USAID officials approved the decisions to put staff on leave.

On January 28, 2025, Rubio exempted "life-saving humanitarian assistance" from the freeze, and the HIV program PEPFAR received a limited waiver on February 1. USAID's inspector general reported on February 10 that confusion over the waivers "has caused payment delays and decisions by aid organizations to suspend work." In a memo dated February 28, the USAID official in charge of global health wrote that, according to two State Department officials, the agency's payment system "had been completely turned off by DOGE," and that groups cleared to fight an Ebola outbreak in Uganda "were never able to draw down funds." The memo is one official's account, filed in court by groups suing the government. The State Department said the Ebola waiver "was quickly reinstated."

USAID's inspector general reported on February 10, 2025 that, according to agency staff, uncertainty after the freeze had put more than $489 million of food aid "at risk of spoilage, unanticipated storage needs, and diversion." He also wrote that the freeze and staff cuts had undermined two checks meant to keep aid money accountable. The White House fired him by email the next day. His office said no reason was given.

At a Cabinet meeting on February 26, 2025, Musk said of USAID: "one of the things we accidentally canceled very briefly was Ebola prevention." He said it was restored immediately and "there was no interruption." NPR reported the next day that public health experts said U.S. support had "not been fully restored." The former official who ran USAID's response to the 2014 Ebola outbreak said of the agency's outbreak team: "Virtually all of those people have been pushed out of the agency, and they have not been brought back."

On March 10, 2025, Secretary of State Marco Rubio announced on X: "we are officially cancelling 83% of the programs at USAID," about 5,200 contracts. He closed with: "Thank you to DOGE and our hardworking staff who worked very long hours to achieve this overdue and historic reform." Musk replied: "Tough, but necessary. Good working with you." On July 1, 2025, USAID stopped running foreign aid programs and what remained moved to the State Department. The Government Accountability Office later counted about 6,780 of USAID's 7,510 awards as terminated by March 2026.

White House chief of staff Susie Wiles told Vanity Fair of Musk's handling of USAID: "I was initially aghast." She said Musk "decided that it was a better approach to shut it down, fire everybody, shut them out, and then go rebuild. Not the way I would do it." She added that "no rational person could think the USAID process was a good one." After the article ran, Wiles called it a "hit piece" and said context had been left out.

In September 2025 the administration released a new plan for health aid, built on direct agreements with individual countries. KFF counted 36 signed agreements as of October 2026 and calculated that U.S. health funding to those countries will fall by $8.1 billion over five years, a 34% drop. For fiscal 2026, Congress funded the main global health account at $9.4 billion, 6% less than the year before. The agreements have not been made public.

Impact Counter, a model built by Boston University health economist Brooke Nichols, projects 781,343 deaths in the first year after USAID funding stopped: 262,915 adults and 518,428 children. Its largest categories are child pneumonia, adult HIV, child malnutrition and child diarrhea. The model started from the assumption that all USAID programs were cut. Nichols told NPR in 2025: "The error bars are huge, because we don't know what gaps are being filled and by whom."

A peer-reviewed study in The Lancet estimated that USAID funding prevented about 91.8 million deaths from 2001 to 2021, including 30.4 million children under 5. It projected that the 2025 cuts could cause more than 14 million additional deaths by 2030, 4.5 million of them children under 5. The projection assumes the cuts stay in place and USAID funding ends from 2026, which the authors call a worst-case scenario. A State Department official said such studies "are based on incorrect assumptions."

A second peer-reviewed study, in The Lancet Global Health, modeled cuts in development aid from all donor countries, not only the United States. It estimated 695,238 additional deaths in 2025, and 9.4 million by 2030 if the cuts continue at their current pace.

The Gates Foundation's 2025 Goalkeepers report projected that deaths of children under 5 would rise in 2025 for the first time this century, from 4.6 million to an estimated 4.8 million. The modeling was done by the Institute for Health Metrics and Evaluation. It reflects aid cuts by 24 donor governments, the United States among them. The foundation's next report, in September 2026, did not repeat the projection and said child mortality "has been slowly declining," to 36 deaths per 1,000 live births in 2025.

Researchers at the Center for Global Development estimated in December 2025 that 500,000 to 1,000,000 lives may have been lost in fiscal 2025 from cuts to U.S. health and humanitarian aid. In April 2026 the same authors wrote that the toll "is likely to be much lower than implied by our earlier forecast," except possibly in humanitarian crises, because spending fell less than expected and HIV treatment recovered. One of them wrote in September 2026 that deaths from the humanitarian cuts were "quite plausibly in the tens of thousands or more, but there simply isn't the data to make a reliable estimate."

What has been measured is the loss of money and services. USAID's spending fell 23% in fiscal 2025, the Center for Global Development found. A peer-reviewed analysis of the U.S. HIV program's own data found that in one year the number of people on HIV treatment fell 1%, HIV testing fell 18%, new starts on preventive medication fell 33%, and the program lost 62,541 frontline health workers, a 24% drop. The World Health Organization reported that funding cuts in 2025 affected 5,687 health facilities in humanitarian crises, and that 2,038 of them suspended operations. A study of four aid groups in Uganda and Zimbabwe that lost U.S. funding found "large, sustained declines" in their HIV prevention, testing and treatment services, in data running to March 2026.

Counts of actual deaths are scarce, and what exists is mixed. UNAIDS estimates that 570,000 people died of AIDS-related illnesses in 2025, down from 1.3 million in 2010, and a UNAIDS official called it the lowest figure in 30 years. UNAIDS also warned that interrupted treatment "will mean rising deaths and rising new infections." A household survey in eastern Congo, not yet peer-reviewed, estimated about 165,000 excess deaths after early 2025, with a range of 64,000 to 267,000. Its authors attribute the rise to aid withdrawal and a rebel takeover of the region, which happened at the same time.

NPR reported the deaths of three children whose care had depended on USAID funding. Abdullahi Ibrahim, 10, of northern Nigeria, died of an asthma attack after his clinic said his medicine was no longer free. Ibrahim Garba, 8, of central Nigeria, died of typhoid four days after his family was told they would have to pay for antibiotics. Purity Wamboi, 16, of Nairobi, Kenya, died of tuberculosis that was diagnosed late, after the community health workers who made home visits stopped working. The State Department "didn't address the specifics of their deaths."

New York Times columnist Nicholas Kristof went to South Sudan after Musk said no one had died. He reported that Peter Donde, 10, died after losing the community health worker who brought him his HIV medicine, and that Achol Deng, 8, died after there was no case worker to help her keep receiving hers. He also named Jennifer Inyaa, 35, and her son Evan Anzoo, 5, who died a week apart after the aid shutdown. The accounts came from local health workers. When a congressman's staff showed photos of people said to have died, Secretary of State Rubio called the claim "false."

Babagana Bukar Mohammed, 7, who had sickle cell disease, died in northeastern Nigeria in February 2025 after his mother took him to a USAID-funded clinic and found it closed by the stop-work order, NPR reported. Pe Kha Lau, 71, a refugee from Myanmar who depended on oxygen, died on February 2, 2025, four days after a U.S.-funded hospital in her camp in Thailand sent her home, her family told Reuters.

The Washington Post reported that Suza Kenyaba, 5, died of malaria in Lubumbashi, Congo, on February 19, 2025. The medicine she needed had reached the country in December, but the aid freeze delayed its delivery from a regional warehouse less than 10 miles away. Gilbert Kayombo, 7, who had HIV, died in Kolwezi on March 24, 2025, after the hospital that got his medicine from USAID ran low and gave him a partial supply. The Post found that medical shipments worth nearly $76 million, due by the end of June 2025, were not delivered. The State Department told the Post that the "most critical elements of our global health response continue to operate."

The Associated Press reported that Mohammed Hashim, 2, died on May 7, 2025 in an internment camp in Myanmar's Rakhine state. The World Food Programme, which the AP described as "kneecapped by the funding cuts," had stopped food aid to one million people in Myanmar that April, and his family's meals fell from three a day to one. In Nepal, Kabita Mukhiya, 20, died while pregnant, of complications of eclampsia, after a program that sent health workers to visit pregnant women at home was canceled in the U.S. cuts. Her baby also died. The State Department told the AP: "The rest of the world needs to contribute more and share the burden."

ProPublica reported that at least 54 children died in 2025 with complications of malnutrition in the hospital at Kenya's Kakuma refugee camp, after the United States cut off its funding to the World Food Program there and rations were cut. One was Santina, 7 months old, who died on July 21, 2025. In South Sudan, ProPublica documented cholera deaths after U.S.-funded health services stopped, including Nyagoa, a 1-year-old girl who died on July 4, 2025. A senior State Department official told ProPublica that nobody had died as a result of the funding cuts.

Refugees International, an advocacy group that opposes the cuts, surveyed 555 health workers in Afghanistan and reported at least 161 "high-confidence, preventable deaths" after U.S.-funded health services shut down, 80 of them of mothers and 30 of newborns or unborn babies. The count is of deaths the health workers themselves reported. The group says the research "was not designed to estimate nationwide mortality." PBS reported that the State Department did not directly address the deaths.

The State Department confirmed that it destroyed about 500 metric tons of emergency food aid that expired in a warehouse in Dubai. Reuters reported that aid workers had lobbied for weeks to ship the high-energy biscuits after the cuts stalled them, and calculated that the destroyed food could have fed about 27,000 people for a month. The department said the amount was less than 1% of the food aid the United States supplies each year.

USAID ordered the destruction of about $9.7 million of contraceptives stored in Belgium in June 2025, its inspector general reported. The order was reversed that September, after most of the supplies had been moved out of temperature-controlled storage. About $8 million of them are now "largely unviable," and $1.7 million were still usable as of April 2026. Reuters reported that storing them costs almost $25,000 a month. As of July 2026 USAID had not said what should be done with them.

Musk has said several times that the cuts killed no one. On March 3, 2025: "No one has died as result of a brief pause to do a sanity check on foreign aid funding. No one." On May 30, 2025: "Zero people have died!" On June 28, 2026, he wrote that critics "cannot cite a single name of someone who died," and the next day: "Deaths in Africa DECREASED after USAID funding was cut." In an interview published in July 2026 he told The Economist that the claims were "nonsense, absolute nonsense."

At a House hearing on May 21, 2025, a congressman asked Secretary of State Marco Rubio: "Has anyone died in the world because of what Elon Musk did?" Rubio answered: "No one has died because of USAID." When the congressman began to speak of people who had died, Rubio said it was "a lie." The Washington Post Fact Checker gave Rubio Four Pinocchios. NPR reported that at a later hearing he said: "No children are dying on my watch."

Bill Gates told the Financial Times in May 2025: "The picture of the world's richest man killing the world's poorest children is not a pretty one."

In a sworn court filing on February 17, 2025, a White House official said Musk "has no actual or formal authority to make government decisions himself" and "is not the U.S. DOGE Service Administrator." Two weeks later President Trump told Congress that DOGE "is headed by Elon Musk."

On March 18, 2025, U.S. District Judge Theodore Chuang ruled that the shutdown of USAID "likely violated the United States Constitution in multiple ways." He wrote that the evidence so far favored the conclusion that "Musk made the decisions to shutdown USAID's headquarters and website even though he 'lacked the authority to make that decision.'" Ten days later an appeals court paused his order. Two of its three judges wrote that "no record evidence shows" Musk directed those decisions without the approval of USAID officials. The third judge agreed to the pause only because the workers had sued the wrong defendants, and wrote that his vote was not "an endorsement of the Executive's likely unconstitutional actions in closing USAID."

Status: The case, J. Doe 4 v. Musk, is now a class action by USAID workers and has no final judgment. In sworn answers filed in September 2026, the State Department said the website change was "a group decision" by USAID's leaders and that a General Services Administration official ended the headquarters lease. An appeals court ruled in March 2026 that Musk cannot be questioned under oath for now. Both sides have asked the judge to lift the paused 2025 order, and the workers say they will seek a final judgment.