In testimony before the House Foreign Affairs Committee on May 21, Secretary of State Marco Rubio declared: "No one has died because of USAID [cuts]" – the cutoff of billions of dollars of U.S. support for global health programs.
At a subsequent congressional hearing, he said, "No children are dying on my watch."
Mariam Mohammed begs to differ.
The widowed mother of two says her younger son — 7-year-old Babagana Bukar Mohammed — died as a result of the disruptions to U.S. foreign aid.
Mohammed had lived with her two sons in a single room made of cinderblocks without running water. She says Babagana was a cheerful boy who loved to ride his bike around the neighborhood and at school. Their home sits in the town of Bama in the northeastern corner of Nigeria that has, in the past, been terrorized by Boko Haram, the militant Islamist group.
Babagana has sickle cell disease and, in the middle of the night on February 2, Mohammed noticed her son had a fever. As soon as morning came, she rushed him in a keke — a tricycle taxi common in Nigeria — to the local clinic a little over a mile away where Babagana had received care in the past.
When she got there, the security guard told her the clinic was closed.
The clinic was funded by USAID or the U.S. Agency for International Development and was the busiest medical facility in the area, seeing up to 400 patients a day. But, just over a week before Babagana arrived, the Trump Administration sent the clinic a stop-work order — part of a massive pause in foreign assistance as U.S. officials reviewed contracts and programs to determine whether they should continue.
but Babagana's clinic was allowed to resume operations on April 14, after the review was complete and the funding restarted.
But that was more than two months after Mohammed's visit on that February morning. She remembers standing outside the closed clinic with Babagana. "I was shocked and became angry," she told NPR by phone on May 23. She spoke in Kanuri, a local language in Nigeria. "Immediately, I prayed for God to intervene."
That night, Babagana died.
Mohammed says Babagana's care at the U.S.-funded clinic had been free and she didn't have money to take him to the local government clinic, which charges for medical care.
Babagana's doctor at the clinic — Edifre Jacob — says he'll never know exactly what happened to the youngster because he did not get medical help before dying, but Jacob feels confident his team could have prevented his death.
"We are sure we would have done something to save the patient," says Jacob. "We have the facility to manage these patients, and we have results — positive results — from patients we manage with sickle cell [disease]."
Sickle cell disease is a condition where a person's red blood cells are deformed, causing them to break down more quickly than normal and potentially clog blood vessels. The condition is associated with a long list of dangerous complications but prompt medical care can make a big difference.
Even in places with far more medical resources, quick medical care for sickle cell patients is critical. "We recommend that if a child has a fever, that they be seen as soon as possible, and often within the hour," says Dr. , director of the sickle cell disease program at Boston Children's Hospital.
She says there are several serious conditions Babagana could have had. One is sepsis — a life-threatening infection that can cause a fever. People with sickle cell disease are vulnerable because their spleens often don't clean blood as well as in a healthy person. With quick access to antibiotics sepsis can be curable, Archer says.
NPR asked the State Department to comment on Babagana's death and Rubio's congressional testimony. They did not respond in time to meet our deadline for publication. We will update this article with their comment if they do respond.
What is the death toll?
At the hearings where Rubio spoke, lawmakers highlighted other individual stories of deaths that they attributed to aid cuts. Rep. Brad Sherman (D-Calif.) said that in Myanmar was unable to get oxygen at a local hospital after the aid cuts and that , a 5-year-old in South Sudan, could not get HIV medications previously funded by USAID.
Sen. Jeff Merkley (D-Ore.) went a step further, citing work from a team at Boston University that aims to estimate the total human cost of cuts to aid through modeling. Such estimates represent a crucial tool in understanding the possible implications of policy actions.
"Monitoring mortality in low- and middle-income countries is difficult, the systems are not as robust as we have in the United States," says , an infectious disease modeler who led the team. Many of the health systems that might have collected such data were funded by the same programs that got cut, she says.
Nichols and her team started working within days of the Trump administration's freeze of USAID to project the potential impact on human lives. They started with the assumption that all USAID programs were cut, based on publicly available data at the time. Then they factored in what researchers know about what happens when people and children with HIV, tuberculosis, malaria and other diseases stop getting treatment.
All told, the researchers estimate that have already died because of cuts, which began on January 24.
"It's really important they're doing this," says Dr. , director of the Duke Global Health Institute. "Generally speaking, their assumptions are quite reasonable."
Still, Nichols is the first to acknowledge that these are very rough estimates.
"The error bars are huge, because we don't know what gaps are being filled and by whom," says Nichols. National governments could be stepping in to make up for the abrupt withdrawal of U.S. aid, or non-governmental organizations on-the-ground could be finding other sources of funding. Or some clinics could still be operating with volunteers or with funding from other sources.
Their estimates are not accounting for some deaths, such as Babagana's, who likely died from causes they didn't include in their analyses. Even with all that uncertainty, Nichols stands by her estimates. "We can argue about the specifics and the size of the error bars, but we're not talking about dozens of people [dying]," she says. "We're talking about tens of thousands of people."
Rubio is dismissive of their modeling. "That's false, that's fake," the Secretary of State said of the numbers cited by Merkley at the hearing. He pointed to the fact that these estimates are based on a total cessation of funding, whereas he said 85% of people who rely on PEPFAR — the U.S. President's Emergency Plan for AIDS that funds HIV clinics — were still receiving care.
Rubio did not provide further information on the source of the 85% number. The State Department did not respond to multiple requests for clarification.
It "seems impossible to me" that 85% of recipients are still getting care, says , vice president of Avenir Health, a global health consulting firm. "USAID was dismantled, and most of that [PEPFAR] money was flowing through USAID, so there's no mechanism for that money to reach the programs that need it," he said, and far fewer people to implement those programs.
Nichols said she would happily update the model of estimated deaths with more information about what programs are still operational. "If there are programs that are running, provide a list, then we can update it."
A mother's wish
Mariam Mohammed says she now lives in fear of losing her older son — 9-year-old Umar — who also has sickle cell disease. She says she's relieved that the clinic hospital has reopened but the previous stop work order underscores for her the frability of the system.
She says her one wish is that USAID programs are allowed to continue.
Umar says simply that he misses playing with his little brother.
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