Atul Gawande, head of the U.S. Agency for International Development (USAID) global-health efforts during the Biden administration, condemned the shutdown of his former agency as an example of Donald Trump’s “cruelty and lethality.”

Gawande cites statistics implicating Trump in the deaths of over 600,000 adults and children, following the president’s executive order suspending all U.S. foreign aid in January.

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“We are now witnessing what the historian Richard Rhodes termed ‘public man-made death,'” Gawande says in an essay in The New Yorker.

Deaths caused by “funding discontinuation” include 198,878 adult deaths and 413,613 child deaths, according to the “Impact Metrics Dashboard” cited by Gawande. The dashboard is maintained by Brooke Nichols, a Boston University epidemiologist and mathematical modeler.

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To date, an estimated 127,073 adult and 13,527 infant deaths have been caused by the effects of HIV/AIDS due to cuts in funding for the President’s Emergency Plan for AIDS Relief (PEPFAR); 124,434 deaths have occurred due to child malnutrition; 101,048 due to child diarrhea; over 57,000 child and adult deaths due to malaria; and 49,686 deaths from tuberculosis.

Gawande calls the model’s current numbers and projections “conservative.”

“A fuller accounting of the fallout from USAID’s shutdown will probably have to await analysis of the United Nations’ 2025 mortality statistics, which likely won’t appear until 2027,” Gawande writes. “But there are other ways to glimpse the scale of the harm.”

The former USAID administrator recently headed to Kenya to film a documentary about the effects of the agency’s closure at the notorious Kakuma refugee camp near the border of South Sudan. The facility holds over 300,000 refugees fleeing war, famine, and political persecution across East Africa.

Gawande spent time with parents and children at Clinic Seven, where the sickest children at the camp come. Because U.S. support has been terminated, World Food Program supplies were slashed to 40% of minimum needs, and cases of acute malnutrition among kids had surged. Two-thirds of the clinic’s community health workers were laid off, Gawande shares, hobbling an early-detection system that once saved most children before they needed acute care. 

Nine months later, a child is dying from malnutrition somewhere in the world every three and a half minutes that didn’t have to.

There are examples, Gawande writes, of USAID bending to American military and political aims, in Vietnam, Iraq, Afghanistan, and elsewhere, but no other U.S. entity has saved more lives per dollar, he says.

“It helped move billions of people out of poverty. And it showed how to deliver results for all of humanity, including Americans, through cooperation, rather than coercion,” he wrote.

Trump, Gawande implied, has destroyed that promise and taken hundreds of thousands of lives with it.

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