May I just say this is "the cruelest, most senseless thing Trump has done."

Last week I read an interview of Atul Gawande by Jonathan Cohn in the Bulwark Newsletter . It was far-and-away the most incisive piece I’ve read, seen or heard on the reality of dismantling USAID. You may know Gawande as a brilliant writer, surgeon, former Biden administrator. His conclusion is that the Trump Administration’s dismantling of USAID “may be the cruelest, most senseless thing Trump has done.”

I’ve severely edited the interview for length, but if you’d like to read it in its entirety I can refer you to this link.

Here’s some of Jonathan’s conversation with Gawande.

SECRETARY OF STATE MARCO RUBIO was indignant in May when, at a hearing before Congress, lawmakers asserted that the Trump administration’s cuts to international aid were killing people.

“No one has died,” Rubio insisted. It was not an especially believable claim, even then….

Among those most alarmed was Atul Gawande, the surgeon and award-winning writer who had overseen USAID’s global health programs during the Biden administration. He spent much of the winter and spring imploring Trump allies in Congress to save the agency, citing its long history of bipartisan support, including from then-Senator Rubio. As hopes for a reprieve faded, Gawande turned to spotlighting the consequences—partly to build a case for rescuing what could be rescued and rebuilding what couldn’t, and partly just to bear witness.

“They’re trying to make the loss of life invisible,” Gawande told me this week, “they’re trying to deny the reality, and the first task is making the invisible visible....

[Infectious disease modeler] Brooke Nichols has led a team that has estimated 600,000 people have died already so far, 400,000 of them children. But it is hard to see. You can see the deaths that are related to childbirth. You may not see the deaths for a while where HIV is going out of control. It can take months or years sometimes for a death to occur from TB…. So the consequences were that the World Food Program dropped to only 40 percent of the minimum calories required for children being available.

COHN: Food rations down to 40 percent or more—what does that look like?

GAWANDE: We’re talking about the family having no more than one meal per day. That meal, they aren’t assured that they could get protein. When you don’t have adequate protein, you see some really terrible things happen—loss of skin integrity, swelling.

COHN: Why is that dangerous?

GAWANDE: Without protein and basic vitamins, you can’t create skin. You start losing the ability to form collagen. So skin wounds don’t repair.

You reach the point where the skin simply starts sloughing off and you become unable to maintain your body temperature, where you also get skin infection because there isn’t a barrier between you and infection in the outside world.

They had not seen cases like that for two decades.

At the same time, more than half of children are not yet getting access to what the modern regimen is, which is actually a lower-cost regimen as well. But rather than close that gap, the [funding was] ripped away. They were simply removed with no conscience, no willingness to wrestle with the harms being done.

None of that. Instead, a complete denial of what has been done.

COHN: There was a way to do this gradually, right? There was just this sort of blast wave of damage.

GAWANDE I think the thing to understand is that there is an assault on the idea of cooperation to solve big problems in the world, and instead a belief that domination, predatory transactions are how the U.S. wins.

And the thing is, it doesn’t even work on its own terms. This approach doesn’t make us more prosperous. It doesn’t win us more respect. It ends up costing lives. You end up funding the most expensive parts of aid, which is disaster relief. Or you end up abandoning people, being an unreliable partner, and having nobody trust you in the world.

COHN: When this was all playing out initially, there was this argument that ‘This is too expensive.’ ‘There’s tons of waste in the system.’ ‘The USAID is funding ideological agendas.’ ‘The Europeans could step up more, so why are we bearing this burden?’

I know you heard that from people. What was your answer?

GAWANDE: ...This is $24 per American taxpayer, where American taxpayers are already paying $15,000 in taxes to the US government. It’s a tiny fraction of our spending. The total amount for USAID is less than half of the budget of my hospital in Boston.

And it’s reaching hundreds of millions of people and saving lives by the millions. It is the highest-impact agency in the U.S. government. So is there more efficiency that you can get? Compare it to our own American health system, and what we are achieving out of our own health system….

COHN: This is a very disheartening story…. Someone wanting to do something — what should they do?

GAWANDE: So a couple of things.

Number one, [the Trump administration is] trying to make the loss of life invisible, they’re trying to deny the reality, and the first task is making the invisible visible.

Richard Rhodes, the historian, uses the term “public man-made death.” He was referring to war, but also Mao Zedong’s Great Leap Forward, which would be found to kill at least 25 million people through famine.

We are in the face of a public man-made death now at large scale. And it is our opportunity to hold people accountable for that.

President Trump never offered a single definitive explanation for the elimination of USAID, and the explanations put forward varied wildly. In addition to the complaints about supposed wokeness and waste, a common claim among right-wing allies of the president was that USAID funds supported terrorism or anti-Americanism.

Meanwhile, critics of the administration speculated that Elon Musk prioritized eliminating USAID as revenge for the agency’s role in the undoing of the apartheid system of his native South Africa.

Specifically, UNICEF estimated that in 2023 timely access to community-based programs likely prevented the deaths of 1.2 million children between the ages of six months and 5 years….”