The Trump administration’s decision to withdraw foreign aid and dismantle the U.S. Agency for International Development is likely to cause enormous human suffering, according to estimates by the agency itself. Among them:
up to 18 million additional cases of malaria per year, and as many as 166,000 additional deaths;
200,000 children paralyzed with polio annually, and hundreds of millions of infections;
one million children not treated for severe acute malnutrition, which is often fatal, each year;
more than 28,000 new cases of such infectious diseases as Ebola and Marburg every year.
Those stark projections were laid out in a series of memos by Nicholas Enrich, acting assistant administrator for global health at U.S.A.I.D., which were obtained by The New York Times. Mr. Enrich was placed on administrative leave on Sunday.
In one memo, he placed the blame for these potential health crises on “political leadership at U.S.A.I.D., the Department of State, and D.O.G.E., who have created and continue to create intentional and/or unintentional obstacles that have wholly prevented implementation” of aid programs.
Those leaders have blocked payment systems, created new and ineffective processes for payments, and constantly shifted guidance regarding which activities qualify as “lifesaving,” Mr. Enrich wrote.
Another memo describes the slashing of the agency’s global health work force from 783 on Jan. 20 to fewer than 70 on Sunday.
In an interview, Mr. Enrich said he released the memos on Sunday afternoon, after an email arrived placing him on leave, to set the record straight on the gutting of U.S.A.I.D. staff and the termination of thousands of lifesaving grants.
By detailing the series of events behind the scenes, he hoped “it’ll be clear that we were never actually given the opportunity to implement lifesaving humanitarian assistance.”
Officials at the State Department did not immediately respond to a request for comment.
In January, the Trump administration froze funds intended for foreign aid. On Jan. 28, Secretary of State Marco Rubio issued a temporary waiver for lifesaving humanitarian assistance.
But very little money has actually been delivered, essentially shuttering aid programs worldwide and forcing hundreds of organizations to furlough or fire workers.
Still, employees in U.S.A.I.D.’s Bureau for Global Health tried to remain optimistic and “to do everything we can” to implement the waivers, Mr. Enrich said.
But on Wednesday the Trump administration abruptly terminated some 5,800 projects financed by U.S.A.I.D., including many that had received waivers.
“It was finally clear that we were not going to be implementing under that waiver,” Mr. Enrich said.
“I needed for myself and all the staff who had been pouring their hearts into doing this — we needed records to show what had happened,” he said.
Mr. Enrich said he had hoped to compile one more memo, showing the ways in which he and others had conveyed the risks of disrupting crucial programs to Mark Lloyd and Tim Meisburger, political appointees at the agency. But they repeatedly asked for more details to justify the programs, he said.
“It is clear the Trump administration is well aware that it is violating court orders and not delivering lifesaving aid it claimed to be funding under a waiver,” said Matthew Kavanagh, director of the Georgetown University Center for Global Health Policy and Politics.
“Unless reversed, this will cost millions of lives, by the government’s own accounting,” Dr. Kavanagh added.
According to Mr. Enrich’s memo, other devastating impacts could include uncontrolled outbreaks of mpox and bird flu, including as many 105 million cases in the United States alone, rising maternal and children’s mortality in 48 countries, and a 30 percent increase in drug-resistant tuberculosis.
Disruption to TB programs overseas will result in more patients arriving in the United States, Mr. Enrich’s memo warned. Treating one patient with multidrug-resistant TB costs more than $154,000 in the United States.
(The Trump administration is said to be readying plans to turn back migrants on the grounds that they might bring TB into the country.)
The memos also note the disruption to the effort to contain Ebola in Uganda.
A single Ebola patient in New York in 2014 cost the city’s Health Department $4.3 million in response measures. The outbreak in Uganda appeared to be ebbing, but a 4-year-old boy died earlier in the week, indicating that the virus was still circulating.
The consequences may extend beyond human health, affecting U.S. businesses — including agriculture — and families by increasing health care costs, disrupting international trade and straining domestic resources.
Programs for maternal and child health and for nutrition can stabilize the economy and political climate in other countries, the memo notes.
“Article 1 of the Constitution gives Congress the power to create or remove agencies and authorize spending, not the president,” Dr. Kavanagh said.
By dismantling U.S.A.I.D. and terminating its programs, the Trump administration is not only “risking death for millions of the most marginalized around the world, but they are also triggering a constitutional crisis in the service of cruelty,” Dr. Kavanagh added.