For 42 days, Nicholas Enrich tried to save the life-saving work of the US government’s global health agency from the Trump administration as they set about dismantling it.
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they → try → it
Having worked at the United States Agency for International Development (USAID) since 2013, Enrich was appointed head of the Global Health Bureau shortly after President Donald Trump was inaugurated in January 2025.
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Trump → work → January
He had been tasked with restarting vital international health programmes after Secretary of State Marco Rubio announced a waiver to an aid funding freeze.
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Rubio → task → freeze
A week before, and hours after taking office, Trump had ordered a 90-day freeze on foreign assistance from the US, the world’s largest aid donor.
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Trump → take → US
Enrich spent the next few weeks “banging my head against a wall trying to get that done and being thwarted at every turn by DOGE, the political appointees and by the restrictions and disruption put in place by the administration,” he told The Independent.
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he → spend → Independent
DOGE, the Department of Government Efficiency, was an initiative led by billionaire Elon Musk – CEO of Tesla and Space X – that spearheaded efforts to slash federal spending, including by cutting USAID’s workforce.
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that → lead → workforce
“By late February, it was clear that I was not going to be able to implement that waiver and restart programmes, and that it was actually kind of a farce,” he says from his home in the US.
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he → go → US
“Meanwhile, Elon Musk, the secretary of state [Marco Rubio], and others were publicly saying that our programme had restarted,” he adds.
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he → say → state
Enrich began documenting the obstacles in internal memos, detailing how the administration’s shifting guidance, blocked payment systems and mass contract cancellations had made it impossible to restart life-saving programmes.
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it → document → programmes
In a memo dated February 28 and circulated to colleagues on March 2, he warned that the failure to deliver aid would lead to preventable deaths.
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failure → date → deaths
About 20 minutes after sending it, he informed staff that he had been placed on administrative leave.
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he → send → leave
His contract was later terminated when, in July, USAID officially closed, with the State Department taking over its remaining programmes.
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Department → terminate → programmes
The agency, set up by President John F Kennedy during the Cold War, had been the backbone of US development assistance for more than six decades.
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agency → set → decades
Enrich believes its closure saw the country “walk away from our role as a leader in global health”.
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country → believe → health
From the fastest and widest-spreading Ebola outbreak ever, first reported in the Democratic Republic of Congo in May, to tuberculosis, malaria and malnutrition, “the kinds of support USAID used to provide is now the exact areas where we are seeing a breakdown,” he says.
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he → spread → breakdown
“During the first year after the dismantling of USAID, we saw destruction, suffering, and death on a massive scale.
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we → see → scale
And for what?” said Enrich.
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Enrich → say → what
Estimates have suggested that USAID cuts could have caused between 500,000 and 700,000 global deaths in the first year.
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cuts → suggest → year
Rubio and the State Department have disputed that the aid cuts have directly killed anyone.
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cuts → dispute → anyone
Now, a little short of two years after the initial halt to USAID operations, the devastating global consequences are becoming ever clearer, including widespread severe hunger, increasing maternal complications, shortages of lifesaving medicine and spikes in child marriage.
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consequences → become → marriage
The speed and lack of transition left those on the ground with little time to find alternative funding – the agency had spent billions of dollars a year on disease prevention programmes, food aid, clean water, education, agriculture and emergency relief.
Despite the insistence of Musk and the US government that no one has died as a result of the agency’s dissolution, our reporting has shown otherwise.
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reporting → leave → dissolution
The Independent has documented newborn deaths in sub-Saharan Africa, deaths of pregnant women who could no longer access hospitals in Afghanistan, and heavily underresourced humanitarian responses.
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who → document → Afghanistan
Funding for HIV responses in low- and middle-income countries fell by $2.1 billion (£1.6bn) last year, putting decades of progress to combat HIV at risk.
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Funding → fall → risk
The reductions are likely to lead to a resurgence of the AIDS epidemic, United Nations agencies have warned.
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agencies → lead → epidemic
In Uganda and Zimbabwe people are dying of HIV because of a lack of access medication, Chief International Correspondent Bel Trew reported for Independent TV.
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Trew → die → TV
In the Central African Republic, and beyond, hard-won successes in efforts to stop women and babies dying in childbirth have faced a serious setback due to cuts to aid.
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women → win → aid
The Ebola epidemic, the second deadliest ever, in the DR Congo, Uganda, Kenya and Nigeria has killed almost 5,000 people so far.
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epidemic → kill → people
Health workers have warned repeatedly that the response effort had been hampered by aid cuts.
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effort → warn → cuts
The true measurable impact is hard to calculate as the eventual dissolution of USAID was compounded by cuts to international aid by the UK and elsewhere.
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dissolution → calculate → UK
Experts say the repercussions will also take time to manifest, with thousands of front line workers laid off – some of whom collected mortality data.
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some → say → data
Enrich has documented his experience at the agency in his book, Into the Wood Chipper: A Whistleblower's Account of How the Trump Administration Shredded USAID.
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Administration → document → USAID
He believes that the dissolution of the agency was not about saving money – “there was no money saved” – or because the agency was wasteful or inefficient.
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agency → believe → money
“It was not even about realigning priorities of foreign aid, or [Trump’s] ‘America First’ agenda,” he says.
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he → realign → aid
“It was just destroyed because there were a bunch of people whose job it was to stroke the ego of Elon Musk, who got upset when he wasn't able to do whatever he wanted inside of a federal agency …
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he → destroy → agency
Then they spread a bunch of lies about what was actually happening there,” he adds.
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he → spread → lies
The Independent has contacted the State Department for further comment.
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Independent → contact → comment
However, Enrich believes that If USAID had built more sustainable systems over the last 65 years, vulnerable countries would have been made more resilient and we would not have seen the “destruction” that he says he have thanks to aid cuts.
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he → believe → cuts
“The idea of transitioning to a place where countries don't need to rely on American aid should, frankly, be the goal of foreign assistance,” Enrich says.
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Enrich → transition → assistance
He hopes that the US can now use the opportunity created “from the wreckage that we're seeing now” to build a system in the future that does not come at the cost of dependency.
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that → hop → dependency
He also has faith in the American people, who are “embarrassed about the way we have broken promises on the global stage and moved away from demonstrating American generosity on kind of a mass scale”.
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we → have → scale
…and 2 more, not listed.
The Aporia
