This story first appeared at ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive ProPublica’s biggest stories as soon as they’re published.
On the one-month anniversary of President Donald Trump’s inauguration earlier this year, a group of his appointed aides gathered to celebrate.
For four weeks, they had been working overtime to dismantle the U.S. Agency for International Development, freezing thousands of programs, including ones that provided food, water and medicine around the world. They’d culled USAID’s staff and abandoned its former headquarters in the stately Ronald Reagan Building, shunting the remnants of the agency to what was once an overflow space in a glass-walled commercial office above Nordstrom Rack and a bank.
There, the crew of newly minted political figures told the office manager to create a moat of 90 empty desks around them so no one could hear them talk. They ignored questions and advice from career staff with decades of experience in the field.
Despite the steps to insulate themselves, dire warnings poured in from diplomats and government experts around the world. The cuts would cost countless lives, Secretary of State Marco Rubio and the other Trump officials were told repeatedly. The team of aides pressed on, galvanized by two men who did little to hide their disdain for the agency: first Peter Marocco, a blunt-spoken Marine veteran, and then 28-year-old Jeremy Lewin, who, despite having no government or aid experience, often personally decided which programs should be axed.
By the third week in February, they were on track to wipe out 90% of USAID’s work. Created in 1961 to foster global stability and help advance American interests, USAID was the largest humanitarian donor in the world. In just a month’s time, the small band of appointees had set in motion its destruction.
In a corner conference room, it was time to party. They traded congratulatory speeches and cut into a sheet cake.
Days later, on a remote patch of land in South Sudan, a 38-year-old man named Tor Top gathered with his neighbors outside the local health clinic. Surrounded by floodwaters, their hamlet of thatch and mud homes had been battling a massive outbreak of cholera, a deadly disease spread by poor sanitation. Around the country, it had infected 36,000 people in three months, killing more than 600, many of them babies. Top’s family lived in the epicenter.
The clinic, one of 12 in the area run by the Christian, Maryland-based humanitarian organization World Relief and funded by USAID, provided a key weapon in the fight: IV bags to stave off dehydration and death. The bags cost just 62 cents each, and in three months, the clinics had helped save more than 500 people.
Now, Top, who lived with his wife, children and mother in a one-room house less than 50 feet from the clinic, listened as World Relief staff shared grim news: The Trump administration had stopped USAID’s funding to World Relief. Their clinic, their lifeline, was closing.
Top’s usual gentle demeanor broke down. Why would the U.S. just cut off their medical care in the middle of a deadly outbreak?
By now the broad story of USAID’s ruin has been widely told: The decree handed down by Trump; Elon Musk, who led the new Department of Government Efficiency; and Russell Vought, who holds the purse strings for the administration as the head of the Office of Management and Budget, to scuttle the agency and undo decades of humanitarian work in the name of austerity. Publicly, the administration tried to temper international backlash by promising to keep or restore critical lifesaving programs.
But that promise was not kept. Instead, a cast of Trump’s lesser-known political appointees and DOGE operatives cut programs in ways that guaranteed widespread harm and death in some of the world’s most desperate situations, according to an examination by ProPublica based on previously unreported episodes inside the government as well on-the-ground reporting in South Sudan. In some cases, they abandoned vital operations by clicking through a spreadsheet or ignoring requests in their inboxes.
The abrupt moves left aid workers and communities with no time to find other sources of funding, food or medicine. Borrowing from a phrase used to describe the U.S.’ overwhelming military campaign during the Iraq War, political appointee Tim Meisburger told senior USAID staff that the strategy was “shock and awe.” (Meisburger declined to comment.)
Tibor Nagy, a veteran diplomat who was Trump’s acting undersecretary of state for management until April, has long been a critic of the vast networks of nonprofit organizations funded by American taxpayers. But he told ProPublica the administration never cared to differentiate between the “fluff” and vital humanitarian programs. “It was the most harebrained operation I’d seen in my 38 years with the U.S. government,” Nagy said, referring to the methods used this year. “Who knows how much damage was done.”
In public statements and congressional testimony, Rubio has repeatedly insisted that no one died because of cuts to U.S. foreign aid and that his staff had reinstated lifesaving operations. But ProPublica found that those claims were a charade: Lifesaving programs remained on the books, but the flow of money didn’t restart for months, if at all. Lewin blocked funding requests for programs like tuberculosis treatment in Tajikistan and emergency earthquake response in Myanmar, records show.
This meant that dozens of supposedly “active” operations were dormant throughout most of the year. Rubio’s advisers let other critical programs, which typically run on one-year grants, expire without renewing them.
Few places were hit harder than South Sudan, the youngest and poorest country in the world, as well as one of the most dependent on American aid.
After Trump’s inauguration, career USAID and State Department staff spent months warning top officials that the funding cuts would exacerbate a historic cholera epidemic ripping through the country. They needed less than $20 million to fund lifesaving health programs, including cholera response efforts, for three months at the beginning of the year — an eighth of what Trump recently approved to buy private jets for one cabinet secretary and just 3% of USAID’s budget in South Sudan last year. But Rubio, Marocco and Lewin failed to heed their own agencies’ assessments, according to internal records and interviews.
As a result, people in South Sudan died.
By denying and delaying those funds for months, Trump’s appointees incapacitated the fragile nation’s emergency response systems at the very moment when doctors and aid workers were scrambling to contain cholera’s spread. “We had to start rationing lifesaving interventions,” said Lanre Williams-Ayedun, the senior vice president of international programs for World Relief. “To have something like this happen in a place like this, where there aren’t mechanisms for backup, just means people are going to die.”
Villages and towns that had been reining in the outbreak suddenly lost essential services. Cholera came roaring back. “The trend was going down,” said a former U.S. official. “When we stopped the funding, it just surged.”
This summer, ProPublica journalists hiked and boated across Rubkona County, the epicenter of South Sudan’s outbreak and home to the country’s largest refugee camp, to interview families that the U.S. cut off from help. We collected medical files, diaries, meeting notes and photographs documenting cholera’s devastation after essential services stopped.
ProPublica also interviewed more than 100 government and aid officials and reviewed enormous caches of previously unreported memos, correspondence and other documents from inside the Trump administration. Many were granted anonymity due to fears of reprisal.
In response to a detailed list of questions, a senior State Department official said fast, drastic changes to foreign aid were necessary to reform a “calcified system.” The world, especially U.S. interests, will be better for it in the long run, the official said, despite “some disruptions in the short term.”
The official also said that Rubio was the final decision-maker for all aid programs. They also contended that they had a limited budget to work with, “which required some tradeoffs on what programs to continue,” saying OMB has ultimate control over new humanitarian funds.
The official maintained that nobody died as a result of the funding cuts. “That’s a disgusting framing,” the official said. “There are people who are dying in horrible situations all around the world, all of the time.”
“Who is responsible for the suffering of the people of South Sudan?” the official added. “The South Sudanese [government leaders] who take their oil revenues and buy private jets and fancy watches and don’t see to their own people? Or the United States? Are we responsible for every poor person all around the world?”
Officially, the death count in South Sudan is nearly 1,600, making it the worst cholera epidemic in the country’s history. But that toll is a dramatic undercount. ProPublica found newly dug, unmarked graves alongside roads and in backyards. In one town, community leaders showed reporters an informal cemetery with at least three dozen people who they said did not make it to medical facilities in time.
Tor Top’s mother, Nyarietna, was one of the uncounted. In March, the clinic doors had been padlocked for two weeks when she developed vomiting and diarrhea. Top bundled her into a rented canoe and began paddling toward the nearest hospital, eight hours away. Less than halfway into the journey, long after they had stopped reassuring one another that she would be OK, Nyarietna died.
Top turned the canoe around and made his way back home, where he buried his mom in their backyard. Now he alone tends the small garden where she grew corn and okra for their family. “If there was medicine here,” he said later, “maybe her life would have been saved.”
Aid to South Sudan
For years, Sudan’s Arab-led central government waged a campaign of brutal violence against its Christian minority in the south. Their persecution became a cause celebre of the American Evangelical movement, which convinced President George W. Bush’s administration to help broker a peace agreement that led to independence 15 years ago. Since then, the U.S. has given the fledgling nation nearly $10 billion in aid, according to federal data. That money subsidized virtually every corner of the health care system, among other institutions.
Still, South Sudan remains undeveloped. Political instability, corruption and dysfunction are rampant. The transitional government hasn’t paid public employees’ salaries for most of the last two years. U.S. officials had long been on alert to South Sudanese aid workers siphoning resources. Deadly political violence — left over from the civil war and threatening a new one — besets much of the country.
Well before Trump took office this year, the international community had broadly agreed that it was necessary to end the nation’s dependence on foreign aid, and U.S. officials were working on strategies to force its leaders to take responsibility for its citizens.
Some of the most vulnerable among them live in Rubkona County, an oil and cattle hub larger than Rhode Island near Sudan’s border. There, a refugee camp formed in 2014 during the nation’s civil war when thousands of people fled behind a United Nations peacekeeping mission to escape a massacre in the nearby town of Bentiu. As South Sudan’s political turmoil continued to spiral, tens of thousands more fled to the camp. In 2020, Rubkona was hit by a series of catastrophic floods that submerged the majority of the county. Generations of people are now essentially trapped there with nowhere else to go.
Previously, USAID gave the U.N.’s International Organization for Migration $36 million for work in South Sudan, which included keeping the Bentiu camp habitable and making critical repairs to the dikes that surround the camp and hold back the rising floodwaters. The group maintained the drainage system and paid people to pick up garbage and clean the latrines — essentially performing sanitation services for 110,000 people.
Despite those efforts, cholera began spreading late last year as new refugees poured in from neighboring Sudan. Rubkona County quickly became the outbreak’s epicenter. In a matter of days, hundreds of infections turned to thousands and the death toll mounted. U.S.-funded organizations raced to set up treatment units in the camp and surrounding communities.
The situation was dire, and people had few viable options to leave Bentiu, U.S. Ambassador Michael Adler reported back to Washington after USAID staff visited the camp to assess the outbreak in early December. The U.S.-funded cholera clinics and other programs were necessary given the “explosivity” of the illness’ spread, he wrote.
It was the kind of routine crisis response that USAID was renowned for handling. The last cholera outbreak in Rubkona, in 2022, lasted seven months, and government statistics say that just one person died while about 420 were sickened. An aggressive sanitation campaign, largely funded by the U.S., was crucial to containing the disease.
Now faced with a new outbreak, the embassy’s staff rushed to get the aid organizations in Rubkona more money, according to the organizations and former officials. By early January, humanitarians were preparing to expand operations. World Relief planned to expand its mobile clinics, Williams-Ayedun said. USAID told Solidarités International, which repaired water pipes, provided sanitation services and distributed soap, to aggressively spend the money it had to combat cholera, with the understanding that the agency would immediately review a proposal for more funds, according to two former officials. An additional $30 million for the U.N.’s migration office — which planned to use the money to continue maintaining the refugee camps — was already committed.
Then Trump took office, signing an executive order on day one to freeze all foreign aid pending a review of whether it aligned with the administration’s stated values.
“Just Throw Them in the Pot”
Days later, Rubio issued sweeping stop-work orders to aid programs worldwide. Musk declared that his DOGE team had fed USAID “into the woodchipper.” After a swift backlash from aid organizations, foreign governments and U.S. ambassadors overseas, Rubio announced that lifesaving operations would continue during his review. Marocco told lawmakers as much during briefings.
It wasn’t true. Behind the scenes, Marocco and his lieutenants repeatedly obstructed USAID’s Africa, humanitarian aid and global health bureaus from restarting programs critical for responding to disease outbreaks, according to interviews and memos obtained by ProPublica. The money aid organizations in South Sudan were expecting by February didn’t come. Meanwhile, the appointees suspended nearly all of USAID’s staff, and those remaining said their bosses blocked payments even for approved programs.
Marocco was meant to be “the destroyer, and then someone else would come in to rebuild,” one former official said a senior political appointee had told her. “I guess the one thing happened, but not the other.” (Marocco did not respond to multiple requests for comment.)
The cuts were so frenetic that, for a brief time, the U.S. government stopped paying for the fuel that ran the electricity for the American embassy in Juba, including the security compound, just as violence was surging throughout South Sudan, according to former senior officials.
In response to questions about the episode in Juba, the senior State Department official denied it was a mistake or that Rubio’s review wasn’t careful. “Going back and looking at things again doesn’t mean that you’ve made a mistake,” the senior official said.
At one point in February, Marocco tried ordering the immediate return of foreign service officers stationed abroad. Several senior USAID officials protested, citing safety and logistical concerns for staff in war zones. During one meeting that month, Lewin responded, “You don’t want to get to know the lobsters. Just throw them in the pot,” according to an attendee and meeting notes.
Lewin joined the government via Musk’s DOGE and later took over for Marocco. He seldom came to the USAID office or met with his own staff experts, officials said. Publicly, he called the agency an “unaccountable independent institution” where secrets leak so quickly “we have to hand-walk memos around like we’re in the ’40s.”
In the weeks that followed, DOGE and Trump appointees forbade those who remained at USAID from communicating with aid groups and discouraged discussion internally, telling staff abroad not to approach ambassadors to advocate for programs, emails show.
Senior staffers said they were prohibited from meeting with congressional delegations to share basic information, which was critical to Congress’ oversight capabilities. The government’s health experts feared that taking any action to save lives could be a fireable offense.
Still, some spoke out.
“The consequences on lives lost and funding squandered will grow exponentially and irreversibly in many cases,” Nicholas Enrich, then an acting assistant administrator at USAID, warned in a Feb. 8 email to agency leaders, including Joel Borkert, the chief of staff, and Meisburger, who led the humanitarian affairs bureau. They did not respond to his plea, and Enrich was later put on administrative leave.
Crucially, even when USAID’s new bosses did approve organizations to resume lifesaving work, they at times denied requests for the money that would allow them to do so, internal records show. Other proposals to fund existing grants or reverse terminations languished in limbo.
The official responding on behalf of the State Department said Trump’s OMB ultimately has more control over approving new grants and extensions, but that it was never the administration’s intention to keep all of the lifesaving programs forever.
When ProPublica asked about the funding delays and the State Department’s explanation, OMB communications director Rachel Cauley said in an email, “That’s absolutely false. And that’s not even how this process works.” She did not clarify what was false, and the State Department did not address when Lewin sought funds from OMB for South Sudan’s cholera response.
In early February, embassy staff in South Sudan provided Adler, the ambassador, with a list of the most critical operations there, warning that funds had not been released and lifesaving programs would cease when their money ran out.
A career foreign service officer appointed to his post by the Biden administration, Adler had long been critical of the government of South Sudan for ongoing violence and deserting its own people, according to embassy cables and interviews with people familiar with his thinking.
Still, early on he appeared to recognize that without U.S. intervention, the most vulnerable people in the country did not stand a chance against cholera. In a Feb. 14 memo addressed to the leadership of the State Department’s Africa bureau, Adler asked the administration to release money to keep people alive.
“Lifesaving medicine and medical care, as well as emergency water and sanitation services, play a critical role in controlling disease outbreaks,” the embassy wrote, “notably a severe cholera outbreak in South Sudan’s border regions hosting the greatest number of refugees.”
Adler declined to meet with ProPublica in South Sudan and did not respond to a detailed list of questions.
Death by Spreadsheet
As humanitarian groups racked up unpaid bills, they began to file lawsuits challenging the foreign aid freeze. A federal judge ordered the administration to reimburse the organizations. But on Feb. 26, the Supreme Court temporarily paused the lower court’s order.
In a meeting with senior agency staff the next day, Lewin, who at that time was not yet in charge of USAID programs, indicated that he interpreted the recent legal decisions as a potential license to dispense with one of the key review processes for unfreezing operations, according to two attendees and meeting notes. One of those attendees took Lewin’s remarks to mean that “he had no intention to review contracts or implement lifesaving programs.”
In response, the senior State Department official told ProPublica, “No one meant that or said that.”
The next night, a Friday, staff at the Bureau of Humanitarian Assistance, the division of USAID that dealt with emergencies and ran nearly all of the programs in South Sudan, were working late, scrambling to keep emergency programs operational. Suddenly, they noticed Borkert making changes to a key spreadsheet.
To create the spreadsheet, DOGE had sidestepped career staff, pulling information from databases made for project management. It was so rudimentary that it was often impossible to tell what a program did from descriptions as vague as “extension No. 4” or “allocation of funds,” according to people who saw the spreadsheet.
Rubio and his aides had already terminated hundreds of programs in preceding days. Staff were bracing for another round of cuts, but many of the line items remaining in the file were for programs that provided food, clean water or essential medicines.
Veteran USAID officials watched as Borkert scrolled down the spreadsheet, turning rows red, yellow or green every few seconds, never asking a single question. Realizing the red programs were slated to be cut, they frantically started editing descriptions so that Borkert would at least know what those programs did. Within minutes, he’d flagged dozens of them for termination. (Borkert declined to comment.)
A senior staff member in the group raced upstairs and begged Borkert to reinstate them, according to two officials familiar with the episode. He relented on several. But the next day, Marocco and Lewin told the group they’d kept far too many programs, emails show. Lewin ordered 151 additional awards terminated, writing that he would “have strong objections to these awards being turned on.” Marocco followed up by email at 11:30 p.m. saying the reactivations were “far too broad,” indicating several more line numbers and writing “sound like terminations,” next to them, ultimately canceling even more programs.
On March 10, Rubio announced on X that the review was over. In response to lawsuits, Trump officials told the courts that the review was a careful examination of USAID’s operations.
More than 5,000 programs had been canceled, and fewer than 1,000 remained — a figure that many officials told ProPublica was arbitrary but binding. In reality, the administration still wasn’t releasing money and many of the surviving programs had no funds, according to interviews with humanitarian groups and government officials, as well as memos and spreadsheets documenting those decisions.
When asked about the current status of the 1,000, the senior State Department official criticized USAID’s former vetting procedures and said the administration is in the process of creating new programs.
Soon after the review ended, the cholera response in South Sudan came crashing down.
“God Is With Us”
Rebecca Nyariaka and Koang Kai were shrouded in grief throughout the upheaval in Washington. Their only child, 4-year-old son Geer, had been one of the first victims when cholera inundated the Bentiu camp in December.
The couple met in secondary school at a refugee camp in Kenya and got married after they’d both returned to their homeland in 2013. After violence broke out, they fled to Bentiu, finding occasional jobs working with health clinics.
Now, in early March, they prodded one another to stay hopeful: 28-year-old Nyariaka was once again pregnant.
In the refugee camp, the couple could see the signs of the funding cuts everywhere. Uncollected garbage barricaded the drainage ditches that encased their neighborhood. Human waste spilled out of the overflowing communal latrines near Nyariaka’s house and into the fetid water filling the culverts. Toilets crawling with rats, maggots and flies became so noxious that neighbors began defecating on the surrounding dirt roads. The stench was overwhelming. “Those who washed the latrines have gone,” Kai said. “And we are left here all alone.”
The U.N.’s new sanitation contract had been committed before Trump took office, but it hadn’t received any money since last year. On March 12, USAID staff in the region sent Washington field notes about the conditions in the camp, where health services faced “closure or severe cutbacks” because of the funding shortfall. Officials at the organization pleaded behind the scenes as well. They repeatedly called and met with embassy leaders to request help, to no avail. “What we have now is survival of the fittest,” one U.N. official told ProPublica.
WhenNyariaka gave birth to a healthy baby boy, cholera was rampant throughout the camp. Neighbors were dying around them, and Kai was worried for his wife and new baby. “When cholera enters your home, you know the chances of survival are very low. Very few people survive it,” he said later.
Nyariaka named the baby Kuothethin, “God is with us.” In her first days back from the hospital, her body still healing, the new mom used the bathroom frequently, teetering back and forth to the overflowing latrines close to her house. She soon developed violent vomiting and diarrhea, the hallmark symptoms of cholera.
Kai, tall and muscular, picked her up in his arms and raced to the camp hospital, but it was too late. Nyariaka died just after they arrived.
She had been nowhere except her house and the latrines since coming home from the hospital, Kai said. He’s certain the toilets are to blame for her death. Depressed and unable to care for their newborn, he sent the baby across the floodwaters to live with his mother-in-law on another side of the state.
Kai and Nyariaka had been best friends for years before they started dating, their lives intertwined for nearly two decades. “Her whole way of life was good. She loved our children and cared for them,” Kai said. “I am heartbroken.”
As the disease ripped through the camp, more services shut down, including transportation for the dead. Kai’s neighbor, John Gai, lost his father to cholera. Gai had to take him to the cemetery himself in a wheelbarrow, his father’s head bobbing at his knees. “Nobody should have to carry a dead body among the living,” Gai said.
“Gross Neglect”
On March 28, Rubio notified Congress that he was officially shuttering most USAID operations and transferring programs that survived his review, including several in South Sudan, to the State Department.
Staffers spent the next weeks repeatedly appealing to Lewin — who by then had replaced Marocco as Rubio’s top foreign aid official — for authority to perform the mundane tasks needed to keep the programs operating. In late April, the agency’s humanitarian bureau submitted a blanket request to fund grants that Lewin had already approved. Lewin refused, records show, and the humanitarian bureau had to submit country-specific proposals for consideration. That process dragged on for months.
In June, just before USAID was shut down for good, Lewin finally approved some of the funding the staff had advocated for. But by then it was too late. The officials had run out of time to transfer money already appropriated by Congress to remaining programs.
On June 26, R. Clark Pearson, a supervisory contracting officer at USAID, sent a scathing email to USAID offices around the world in response to an email from the top procurement officer for the agency listing the hundreds of programs that were meant to be active. He said there was no one who could manage the awards, which he called “gross neglect on an astonishing level.”
“In a time of unimaginable hubris, gross incompetence and failures of leadership across the Agency, this has to be one of the most delusional emails I have seen to date,” Pearson wrote. “Lives depend on these awards and for the [U.S. government] to simply not manage them because of an arbitrary deadline is inexcusable.”
That same day, a senior humanitarian adviser informed Adler that payment extensions for several programs, with the exception of food aid, weren’t processed because the “approval was received late.”
In September, the Supreme Court issued another emergency ruling that let the administration withhold nearly $4 billion that Congress earmarked for foreign aid.
Later that month, OMB released some new foreign aid funds. That’s when World Relief finally began to receive funding, allowing the clinic in Tor Top’s community to reopen, even though the administration claimed the program had been “active” for almost seven months.
The U.N.’s migration program has not received a new South Sudan grant. The organization will run out of money for dike maintenance in Bentiu by February, after months of some of the most severe flooding in years.
A spokesperson for the U.N.’s migration program said the organization was still in discussion with the State Department and “continues to engage with donors about the critical humanitarian needs in South Sudan.”
The Uncounted
During the first months of the cholera outbreak, a mobile health team run by the International Rescue Committee, a U.S.-based nonprofit that works in crisis zones around the world, visited Nyajime Duop’s remote village on the edges of Rubkona County twice weekly. The team brought soap and transported sick people to IRC’s nearby clinic for care.
At 27, Duop’s youthful face belied a life marked by war and poverty. She had arrived just a few months earlier, fleeing violence in Khartoum, Sudan, with an infant and toddler in tow, when Trump officials terminated IRC’s $5.5 million grant.
The IRC suspended its operations in the village in the spring. When Duop’s 1-year-old baby, Nyagoa, fell ill with cholera in July, on a day IRC would have visited, there was no one to help her. By the morning, Nyagoa was unconscious. She died that day, the Fourth of July.
Cholera has spread to nearly every corner of South Sudan, infected at least 100,000 people and killed 1,600, though cases began abating this fall. The true death toll is impossible to know, in part because clinics that would have cared for people and counted the dead were shuttered. The Trump administration also cut funding to the World Health Organization, which helped the South Sudanese government gather accurate data on the outbreak.
In a pasture a short walk from IRC’s clinic, ProPublica found at least three dozen mounds covered in sticks — the makeshift graves, village leaders said, of those who died of cholera before reaching the clinic. The clinic’s security guard told reporters he saw one man collapse and die just yards from the front gate.
“There are many more cases,” said Kray Ndong, then acting minister of health for the area, “many more deaths.”
The Trump administration recently announced a new era of foreign aid, where the U.S. will prioritize “trade over aid.” South Sudan, with a gross domestic product one-tenth the size of Vermont’s, has little to offer.
“The administration says they are committed to humanitarian needs,” one aid official in South Sudan said. “But we don’t know what that means, only that it will be transactional.”
