{"id":902,"date":"2026-07-12T12:04:13","date_gmt":"2026-07-12T12:04:13","guid":{"rendered":"https:\/\/cityrelocationnews.com\/?p=902"},"modified":"2026-07-12T12:04:13","modified_gmt":"2026-07-12T12:04:13","slug":"the-human-cost-of-doges-war-on-u-s-a-i-d","status":"publish","type":"post","link":"https:\/\/cityrelocationnews.com\/?p=902","title":{"rendered":"The Human Cost of DOGE\u2019s War on U.S.A.I.D."},"content":{"rendered":"<div>\n<div>\n<div>\n<div>\n<div>\n<p><em>Listen and subscribe:<\/em> Apple | Spotify | Wherever You Listen<\/p>\n<div><\/div>\n<p><em>Sign up for our daily newsletter to get the best of The New Yorker in your inbox.<\/em><\/p>\n<p>Read more <a href=\"https:\/\/cityrelocationnews.com\/?p=900\">The Summer I Surrendered to Wilson Phillips<\/a><\/p>\n<p>In 1988, Richard Rhodes, a historian and a journalist who wrote a definitive study of the creation of the atomic bomb, published an article in the <em>Journal of the American Medical Association<\/em> called \u201cMan-made Death: A Neglected Mortality.\u201d Rhodes argued that demographers and public-health officials ought to take greater care to account for deaths caused by war, neglect, privation, and other effects of policy. His emphasis was on deliberate acts\u2014artificially induced famines, for example, and the willful dismantling of public-health aid and infrastructure.<\/p>\n<p>Atul Gawande, who was a leading administrator at U.S.A.I.D. until the Trump Administration\u2019s <em>DOGE<\/em> initiative, led by Elon Musk, set about defunding and destroying the agency, is a surgeon and a longtime <em>New Yorker<\/em> contributor. In our latest conversation for The New Yorker Radio Hour, Gawande uses Rhodes\u2019s concept to help describe the colossal human cost that Musk and <em>DOGE<\/em> have exacted on the world. Gawande, backed up by recent academic studies, says that the decimation of U.S.A.I.D. around the globe has been responsible for some seven hundred thousand deaths, and that number will likely ascend into the seven figures. The policy is not only immeasurably cruel, Gawande argues; it is also stupid, badly undermining what remains of American soft power and prestige, from Africa to Latin America. Our conversation has been edited for clarity and length.<\/p>\n<p><strong>Atul, Elon Musk claims there\u2019s no evidence at all that <em>DOGE<\/em> cuts to U.S.A.I.D. led to even a single death. He tweeted\u2014and I\u2019m quoting here\u2014that \u201cno validated medical funding was stopped,\u201d and that \u201clegitimate life saving funding continued.\u201d You\u2019ve replied saying that the reduction in life-saving aid has already led to no fewer than seven hundred thousand deaths. How did you come to that number?<\/strong><\/p>\n<p>The seven-hundred-plus thousand that have been estimated to have died at the end of a year since the U.S.A.I.D. closure comes from a couple of different sources. One is a Boston University estimate. A separate one comes from an international study published in <em>The Lancet<\/em>, looking at the impact U.S.A.I.D. had over the past twenty years\u2014saving ninety-two million lives\u2014and projecting, based on the cuts that have occurred, how many deaths have occurred, and they came up with a very similar number. This is what pissed off Elon Musk. Representative Ro Khanna cited the estimate that 4.5 million children, just <em>children<\/em>, could die by the end of 2030. The precision of the numbers is a question, but it\u2019s clear that it\u2019s, at minimum, tens of thousands in 2025, and very likely hundreds of thousands.<\/p>\n<p><strong>This is an enormous number, so I think it would be worth specifying: people where? People dying of what? Maybe if you could put some more specificity on this, then it ceases to be just a gigantic number.<\/strong><\/p>\n<p>Yeah\u2014this is an example of what Richard Rhodes, the historian, called \u201cpublic man-made death.\u201d A big part of what U.S.A.I.D. did was humanitarian response: disaster relief for tens of millions of people who are fleeing war or in conflict zones or were driven out by floods, and those kinds of things. W.H.O. estimates that, where eighty million people were reached by emergency-health services in 2024, that number in 2025 dropped by more than fifty million people. That included, for example, fourteen million people who were victims of severe, acute malnutrition. 2.5 million of them were children.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<div>\n<div>\n<div>\n<p>Like, a peanut bar that gives you your calories for the day, distributed by community health workers, that the U.S. manufactured, but was cut off\u2014that cut the death rate to less than one per cent. That\u2019s just one category. Another one is childbirth. You know, many of these people who are being forced out of their homes are pregnant. They deliver thousands of babies, and die when they have no services. Another example is Ukraine, which was the biggest single beneficiary of aid\u2014and that was energy infrastructure that kept heat going. It was services for three and a half million children and pregnant women displaced from their homes.<\/p>\n<p>I could go into the H.I.V. story. I could go into the tuberculosis story. I could go into the ways that U.S.A.I.D. was insuring that vaccines were going out in the world. We\u2019re not even beginning to see the vaccine-preventable deaths, the H.I.V. deaths, the TB deaths rise. We know these are only going to grow with time.<\/p>\n<p><strong>Atul, there\u2019s a great deal of discussion about the number seven hundred thousand and the mortality data itself. Help me on that.<\/strong><\/p>\n<p>One of the complaints is: these are projections. And therefore the projections are fake. When will we actually know what the child-mortality rates are? It\u2019s going to be a while. The U.S. was the provider of some of the best, highest-quality data in the world\u2014out of U.S.A.I.D., which was dismantled. The inspectors general who would be doing audits and investigations to show what systems were broken\u2014they fired the inspector general at U.S.A.I.D. and have intimidated the I.G.s from doing those kinds of investigations. And so the result is, in the best of circumstances, we will have data over the next two to three years.<\/p>\n<p>This is not like deaths of war, where there are mass graves. You have a jump in child mortality from three per cent to four per cent. That\u2019s a one-third jump. And yet, when you\u2019re in a community that has a ninety-seven-per-cent survival rate versus a ninety-six-per-cent survival rate, you don\u2019t feel it, and you don\u2019t see it just from people walking around. We\u2019ve been compiling a tracker. I say \u201cwe\u201d\u2014I have put together a team, a group of reporters and journalists that have been compiling all of these reports. And, already, they have documented not only the systems that have gone down but twelve hundred different individually identified people who have directly died from the shutdown of foreign aid.<\/p>\n<p><strong>Musk\u2019s defenders have responded saying that the United States shouldn\u2019t be responsible for taking care of people around the world. What do you say to that argument?<\/strong><\/p>\n<p>When J.F.K. argued for U.S.A.I.D., he was arguing that assistance abroad, first and foremost, was also assistance to the United States itself. One of the direct benefits to the United States was eradicating polio in the world, eradicating outbreaks. We were the driver of eradicating smallpox, interestingly, with the Soviet Union as the instigator of the idea. This was rooted in the Marshall Plan: the idea that, instead of pillaging the world around us as other nations were defeated in war or weakened, we would invest\u2014invest in their liberty, invest in their economic capacity, invest in their survival. And the result was thirteen out of the top fifteen trade partners of the United States received assistance from the United States along the way, whether it was Germany, or South Korea, or India, or then places like Mexico and Latin America, and now we see Africa starting to become middle-income along the way.<\/p>\n<p>Total foreign aid from the United States was in the sixty-billion-dollar range, got cut by more than sixty per cent, and then what was left has been sort of turned into \u201cGive me your critical minerals or I won\u2019t give you H.I.V. drugs.\u201d This goes hand in hand with an approach that says, \u201cWe don\u2019t co\u00f6perate in the world, we try to dominate.\u201d U.S.A.I.D. couldn\u2019t be more opposite in its approach.<\/p>\n<p><strong>You mentioned J.F.K. Let me mention R.F.K., Jr. I haven\u2019t heard that much about him in this context. What has he been doing with the C.D.C. and other agencies that fall under Health and Human Services, his agency? What\u2019s he had to say about all this?<\/strong><\/p>\n<p>First of all, he\u2019s reached <em>beyond<\/em> H.H.S. by stepping in to block foreign assistance\u2014with White House backing\u2014for vaccines around the world. But, within the H.H.S., C.D.C. is hollowed out as an organization capable of acting, abroad or at home, in public health. More than a quarter of their staffing has been removed. Their laboratories have been shuttered, significant parts of them. The vaccine-advisory committees that are needed to approve vaccines are not functioning at this point, and it\u2019s going to take a while to recover that. C.D.C. <em>can<\/em> recover it, because they still have an institution. They still have budgets that can be restored. It will take a while to build the expertise and infrastructure. U.S.A.I.D. is a shell and will be hard to bring back. It will take time for countries to trust that every election does not become a change in the goals in the first place.<\/p>\n<p>It takes years to eradicate polio, years to build their surveillance for pandemics, years to reduce malnutrition in the world. And if we\u2019re divided about <em>that<\/em>, and that becomes political fodder, then the institutions can\u2019t function. We won\u2019t be able to make a way forward. So, I\u2019d say, the No. 1 thing to restore capacity is getting back to a place where we believe that these kinds of institutions are what we all want.<\/p>\n<p><strong>Atul, you can\u2019t read anybody\u2019s mind, but what was Elon Musk\u2019s motivation when it came to cutting U.S.A.I.D. so severely?<\/strong><\/p>\n<p>The approach of <em>DOGE<\/em> was like the approach he\u2019s taken with companies like Twitter: take over, slash and burn, and, if anything\u2019s broken, we\u2019ll fix it after. That continues, to this day, to be his argument.<\/p>\n<p><strong>So it\u2019s the vanity of an efficiency expert.<\/strong><\/p>\n<p>Only he\u2019s destroying in the name of efficiency, and left no efficiency behind at all. He came in believing you could cut two trillion dollars out of government, and it hit the shoals of U.S.A.I.D.\u2014this obscure agency accounting for less than ten dollars per American taxpayer per month\u2014and, within weeks, suddenly it became apparent that there would be catastrophic loss of life, and it made the enterprise incredibly unpopular. He thought this was going to be, you know, a weekend and we\u2019ll move on, and it didn\u2019t turn out to be the case at all.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<div>\n<div>\n<div>\n<p><strong>I wonder if you could give a specific example of a program that went down in flames in this effort, and what the effect of its destruction has been, in concrete terms.<\/strong><\/p>\n<p>The TB program, which dealt with a long-term effort to try to reverse what is still the biggest infectious killer in the world\u2014and there are drug-resistant strains that are now evading our current arsenal of TB drugs. That work involved a project that I was part of that brought chest X-rays that were read by an A.I. reader, for countries that didn\u2019t have a radiologist. You would screen, get a molecular test the same day, and be able to be put on treatment and follow-up, so that you stay on your medicines, because you have to stay on your medicines for a year. Those trials, the innovation was stopped. The programs to roll out the innovations that have been created were stopped. In South Africa, in Mozambique, in other places like that, where you had high rates of TB, they have now seen the tuberculosis deaths starting to rise. The cases have grown by multiples\u2014and they have the names of people who\u2019ve died.<\/p>\n<p><strong>A couple of things happened financially in the world in the past month. The first is that we have now conclusively discovered that the President of the United States\u2014who we have to say is the person <em>most<\/em> responsible for this\u2014has enriched himself and his family by, at the very least, a couple of billion dollars in cryptocurrency scams that have taken hold while he\u2019s been President. And Elon Musk has become the first trillionaire in the history of humanity. When you think about this, what possibly motivates these two unbelievably wealthy human beings to exact what seems to me, and certainly seems to you, such ruthless destruction on the health of humanity? What could possibly motivate them? And here I\u2019m enlisting someone who is a surgeon as a possible psychiatrist.<\/strong><\/p>\n<p>Let me put it this way. In the memorandums of understanding that they now make with countries where they are putting some foreign assistance in, you don\u2019t see commitment to goals like \u201cWe\u2019re going to reduce the over-all mortality for children in the world. We\u2019re going to stop neglected tropical diseases.\u201d And the U.S. has led the way in eliminating conditions that ranged from leprosy to river blindness. It\u2019s unimaginable that this is a group of people who would commit to such goals. They see them as woke. They see them as signs of weakness. Their view of the world is\u2014<\/p>\n<p><strong>Wait, wait, wait. How is it \u201cwoke\u201d to save the lives of children? Is it because they\u2019re not white European children, in the main?<\/strong><\/p>\n<p>Read more <a href=\"https:\/\/cityrelocationnews.com\/?p=898\">An O.M.B. Plan to Defund Science\u2014and Anything Trump Doesn\u2019t Like<\/a><\/p>\n<p>The world view, the actions that you see, are that you believe the world is an amoral, ruthless \u201cMad Max\u201d world of the dominators and the dominated, and it is woke to believe that we can come together and solve problems. It is na\u00efvet\u00e9\u2014and, worse, it\u2019s a distraction from the fact that we\u2019re in a battle, and the world is governed by those who are strong, dominating the weak.<\/p>\n<p><strong>I\u2019ve never had the impression that Trump voters wanted this\u2014that Trump voters were voting for Trump the first time, the second time, or the third time because they wanted to see aid to really disadvantaged populations all around the world dry up and disappear, leading to hundreds of thousands of deaths.<\/strong><\/p>\n<p>I couldn\u2019t agree more. That has been extremely unpopular. As the word filtered out of abandoning H.I.V. patients, people in clinical trials, you name it\u00a0.\u00a0.\u00a0. the U.S., across both parties and independents, reacted with horror.<\/p>\n<p><strong>What is your sense of how reversible this is? In other words, how much more damage is going to be done, and how much is it possible to put this terrible genie back in its bottle, if that\u2019s the right metaphor?<\/strong><\/p>\n<p>It\u2019s so unpopular that both Republicans and Democrats in the House and the Senate voted for restoring the budget for foreign aid. They also refused to end and close down U.S.A.I.D. completely, so it exists on paper. And they want the President and his officials to spend the funds on the things they specified\u2014the power of the purse includes instructing the executive branch. It\u2019s already become apparent to the Administration that they need these functions after all. They are now attempting to rehire into the State Department disaster-assistance teams that were dismantled, but they have none of the infrastructure we had, with offices and embassies around the world, depots that had stockpiles ready to go. And it\u2019s not clear they have the intent, but they know that it\u2019s unpopular, so they\u2019re trying to say, \u201cWe\u2019re doing some of this stuff.\u201d<\/p>\n<p><strong>So, let\u2019s assume the best thing happens: the money is restored, the infrastructure is rebuilt. In the end, what will be the damage report for this adventure in <em>DOGE<\/em>?<\/strong><\/p>\n<p>It\u2019s already public man-made death. We\u2019re at hundreds of thousands of dead. We\u2019re seeing the signs of reversal of gains in H.I.V. I just received information from the African Neonatal Network, and they already have spikes in pregnant women with untreated H.I.V delivering babies. So we know these conditions are getting worse.<\/p>\n<p>It\u2019s not just Democrats turning some of these things back on. We have to have a bipartisan commitment about the idea of the role the United States plays in discovering solutions, co\u00f6perating and leading the world together, to get them out into the world, and to set high standards for what the world can accomplish. That\u2019ll take time. But it\u2019s going to be millions of deaths.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div>\n<div>\n<div>\n<div>\n<p><strong><em>Millions<\/em> of deaths?<\/strong><\/p>\n<p>It\u2019s millions of deaths.<\/p>\n<p><strong>Earlier, I asked you to be a psychiatrist. Now I\u2019m asking you to be a political analyst\u2014and both things are asking a lot. Who will be held accountable by either the law or, more likely, history in this episode? And let\u2019s hope it\u2019s a limited episode. How will the amount of destruction and death be accounted? And what effect do you think it\u2019ll have on the lives of those responsible for executing this?<\/strong><\/p>\n<p>I think the reason why Elon Musk, the same month he\u2019s been made a trillionaire, is screaming online and aloud at congressmen and others, and responding to things that <em>I<\/em> put online, is because he believes he\u2019s going to be held accountable by history.<\/p>\n<p>Trump routinely asks publicly\u2014and, reportedly, privately\u2014about whether he\u2019s going to hell or not. And the anger that is directed at those who suggest there has been public man-made death, the anger comes from the cognitive dissonance between what they want to think they are\u2014world dominators, people who will be remembered in history as having done good\u2014they can\u2019t countenance the image that is suggested by this, which is that they are monsters.<\/p>\n<p><strong>Atul, you were in South Sudan not long ago. Tell me, why were you there in the first place, and what were you trying to find out?<\/strong><\/p>\n<p>The United States has been instrumental in supporting its very establishment as a country. It\u2019s the youngest country in the world. It has still unresolved political issues and conflicts that have left people very vulnerable, and providing aid against suffering has been a key thing that the United States did. The subcounties I visited, where these primary-health-care centers were, did not have intact government services otherwise.<\/p>\n<p><strong>Who did you talk to?<\/strong><\/p>\n<p>I met with, first of all, a woman named Angelina David, who is the clinical manager in Panyijiar for the International Rescue Committee clinics. She was overseeing the clinics that were shut down and could tell me exactly what happened. It was a complete shutdown, and a scramble, because there were medicines and other things on the shelves they didn\u2019t want looted, so they had to get out to these places\u2014and they\u2019re very far away. You have to travel, in some cases, seven or eight hours in order to get to the extent of what\u2019s there.<\/p>\n<p>I then went and visited some of those facilities, and I connected, with her help, to the subcounty chiefs\u2014they\u2019re called the payam administrators\u2014who keep their own records of deaths. So one of the things I found was that their own records showed that they are measuring an over-all tenfold increase in child and adult deaths.<\/p>\n<p><strong>Wait. A <em>tenfold<\/em> increase?<\/strong><\/p>\n<p>Yes.<\/p>\n<p><strong>And how much of that increase can be put at the feet of <em>DOGE<\/em> and the cutting of American aid?<\/strong><\/p>\n<p>I can\u2019t exactly parse it out, but a huge amount of it. You know, it went from forty-two deaths in those seven subcounties for children, for example, over two years, 2023 to 2024, and those deaths rose to two hundred and fourteen, that they recorded.<\/p>\n<p>I also met with villagers and learned of dozens of cases of direct effects. I\u2019ll give you an example. One was a woman I met in a community called Machar, and her name was Nyajiek Gai Guol. Her niece was staying with her, a two-year-old girl, who developed the symptoms of pneumonia. The clinic that <em>would have<\/em> been there to take the girl to was no longer there. In order to travel, she had to go three hours, walking and by canoe.<\/p>\n<p>The girl arrived alive. They attempted to do resuscitation. She had already gone into organ failure, and died. Completely avoidable. And I found numerous cases like these.<\/p>\n<p><strong>I have to say, not only must this make <em>you<\/em> beyond furious\u2014the people there, their attitude toward the United States must be transformed, no?<\/strong><\/p>\n<p>It\u2019s heartbreaking and devastating to see the people we\u2019ve abandoned. They, first and foremost, are furious at their own government. These are people with leaders who have been at war with one another on and off for a couple of decades. Part of our role there has been to be a steady force of support against suffering. America is loved there, and that has not faded.<\/p>\n<p><strong>How is that possible?<\/strong><\/p>\n<p>Because we\u2019ve generally been there, and there is belief that we have not yet completely abandoned them, that we may yet come back. They know Trump has done it. When I left, however\u2014this was the first time I\u2019d seen this\u2014there was someone from China Aid. China has rebranded their agency in providing co\u00f6peration and assistance. And there was an official coming to visit to offer <em>their<\/em> capabilities.<\/p>\n<p><strong>Let\u2019s say that, in the best scenario, the system is reconstructed. What will that require? And, if the best scenario comes about, what do you think, ultimately, the death toll will be?<\/strong><\/p>\n<p>You know, my parents came from India, and India was a place of starvation and recurrent droughts, and, with support that lasted a quarter century, emerged after the Green Revolution and food aid as a place that was a food exporter and a breadbasket to the world. And, if we\u2019re not committed to this fundamental proposition, then nothing happens. If we are committed, as we <em>were<\/em>\u2014as the vast majority of Americans were, for six decades\u2014then incredible things happen. If we believed in it today, we could stop this from being in the millions. The only reason I predict that it gets to seven figures is because we\u2019re so deeply divided over everything right now, as a country. We\u2019ll halt worsening the damage, but it\u2019ll take joint effort to actually stop it and regain our momentum.\u00a0\u2666<\/p>\n<p>Read more <a href=\"https:\/\/cityrelocationnews.com\/?p=896\">Ana Mendieta, the Body Artist<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Atul Gawande, the former assistant administrator for global health at U.S.A.I.D., talks with David Remnick about the devastating effects of cuts to international aid by DOGE and Elon Musk.<\/p>\n","protected":false},"author":1,"featured_media":901,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32],"tags":[],"class_list":["post-902","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-new-yorker-interview"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The Human Cost of DOGE\u2019s War on U.S.A.I.D. - 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