As the rainy season sets in across West Africa — a time when malaria cases typically surge — Musa Adamu Ibrahim, a Nigerian nurse, finds himself at home, unemployed. In conflict-ridden Borno state, where he used to treat hundreds of patients each week, the clinic he worked at has shut its doors following abrupt aid cuts from the United States.
“There are no more free drugs or mosquito nets,” said Ibrahim, whose dismissal came after American foreign aid was withdrawn under President Donald Trump’s administration.
The dismantling of USAID — the United States’ primary overseas development agency — is causing widespread damage to health care systems across Africa. Built through a complex network of national health ministries, non-profits, private partners and international donors, these systems are now under immense strain.
The consequences are far-reaching and, in many cases, deadly. Malaria infections, expected to peak by the end of the rainy season, are already increasing. Looming American cuts to global vaccination funding are anticipated to further destabilise healthcare access later this year.
Across the continent, the knock-on effects continue to grow: clinics treating malnutrition have closed in Nigeria, while in Mali, medicine stockpiles risk remaining undelivered due to disrupted supply coordination. In South Sudan, children are dying en route to cholera treatment centres, and Kenya’s refugee camps are grappling with medicine shortages.
“People with means will still get treatment,” said Lawrence Barat, formerly of the US President’s Malaria Initiative. “But the poorest, especially in remote areas, will be cut off — and their children will die.”
Before the shutdown, Ibrahim’s clinic saw around 300 patients a week during the peak malaria season. Fatima Kunduli, another aid worker laid off in Borno, said her clinic treated 60 children a day for malaria and malnutrition before it, too, was forced to close.
Now, with the rainy season advancing across the region — Nigeria’s rains already underway and Senegal’s expected soon — countries that had made considerable strides against malaria are left without one of their biggest financial backers.
Saschveen Singh, an infectious disease expert with Doctors Without Borders, said national malaria response plans have been severely disrupted. “Forecasting systems relied on stable funding, and USAID was a critical part of that,” she said.
Each country had its own funding structure, but US programmes played an essential role. In Mali, for example, while anti-malaria drugs can still enter the country, the funding needed to coordinate their distribution has dried up. In the Democratic Republic of Congo, USAID-supported efforts provided most of the malaria drugs and testing kits for nine provinces. Now, health centres are facing sudden and severe shortages.
“Our teams are scrambling to map out where the gaps are,” said Singh.
In South Sudan, the impact is already being felt. Amid a cholera outbreak, USAID-funded clinics have shut, forcing children to travel hours to access care. At least five have reportedly died during the journey, according to Save the Children.
In Kenya’s Kakuma refugee camp, home to over 300,000 people, the healthcare situation is deteriorating rapidly. Medicine supplies are dwindling, leading to growing unrest. “We only have paracetamol. Nothing else,” said a camp elder.
Further west, at Kinkole General Hospital in Kinshasa, Democratic Republic of Congo, American funding supports treatment for patients suffering from mpox. The facility recently housed 23 patients in tents. Yet staff now fear the funding could end abruptly, despite an outbreak that has already killed 1,600 and infected 16,000.
“We’re bracing for disaster,” said Yvonne Walo, an epidemiologist at the hospital.
Further jeopardy looms as Washington considers reducing its contributions to Gavi, the global vaccine alliance. Gavi’s CEO, Sania Nishtar, warned that the funding shortfall would be devastating: “This is too big a hole to be filled,” she said.
If the cuts are confirmed, John Johnson, a vaccination specialist with Doctors Without Borders, believes vaccine programmes will begin to buckle later this year.
For those on the ground, the situation was already dire — even with American support. “The workload was overwhelming,” said Kunduli, recalling the demand in Borno. “Now, I can only imagine what it will be like.”
