In Kenya’s largest and most impoverished county, the frustration of a hospital director battling a looming health crisis is unmistakable. His facility is just weeks away from running out of vital USAID medical supplies, following the withdrawal of American aid.
“From then on, I don’t know,” said Ekiru Kidalio, acting director of Lodwar County Referral Hospital, as he expressed deep concern over how his hospital will treat illnesses such as measles and HIV without USAID-provided medication.
Turkana County — located in Kenya’s remote and arid north — borders Ethiopia, South Sudan, and Uganda. Home to just under one million people according to Kenya’s 2019 census, nearly a third of its population are refugees reliant on international assistance.
But the dramatic reduction of American funding under former US President Donald Trump is already reshaping daily life in this region. The Trump administration announced sweeping cuts to USAID — whose annual budget of nearly $43 billion accounted for more than 40 percent of the world’s humanitarian aid.
Thousands of kilometres away from Washington, the impact of those decisions is being acutely felt in Turkana’s overstretched hospitals.
At Lodwar County Referral Hospital, Kidalio explained that USAID had funded the salaries of 64 staff members — nurses and clinical officers — out of approximately 400 total hospital employees.
“All those workers were laid off,” he said.
“Everything was stopped… and then the commodities (drugs) were not received,” Kidalio added, with particular alarm over a looming shortage of measles vaccines.
He admitted he was “not aware” of any plans by the Kenyan government to fill the widening gap left by the US withdrawal.
The crisis has drawn public appeals from local leaders. Turkana’s governor called for the reinstatement of US-backed health programmes during a recent visit by US charge d’affaires Marc Dillard.
In the dry, dusty streets of Lodwar — where white UN vehicles are a familiar sight and banners advocating for gender equality and aid initiatives dot the landscape — anxiety is growing.
“There is a lot of worry because the US has ended their support,” 32-year-old resident Lydia Muya told AFP.
Muya, a mother of three, said the community — where an estimated 77 percent of the population lives below the poverty line according to 2021 government data — fears for their access to life-saving medicines.
“We see that is now a very big risk to us, because we depend on those medicines, so most of the people will suffer,” said Muya.
“It is difficult.”
Meanwhile, conditions are deteriorating even further in Kakuma refugee camp, which shelters more than 300,000 refugees from countries such as South Sudan, Somalia, Burundi, and Rwanda.
Last month, tensions erupted into protests after it emerged that already-reduced food rations would be slashed again due to the cut in US foreign aid.
“It was tense,” said one humanitarian worker, stationed in Kakuma for nearly five years, who spoke anonymously because he was not authorised to speak to the media.
Asked whether aid supplies were still arriving, his response was stark: “No. With what money? No funding, no stuff.
“It’s operating on hand-to-mouth basis on this point.”
He estimated that about 40 percent of the aid workforce had already lost their jobs due to the US funding cuts.
The situation, he warned, could still deteriorate further.
The World Food Programme (WFP), which provides food and cash support to nearly 200,000 refugees in Kakuma, told AFP that it had reduced rations to 40 percent of their previous levels.
A mother of four, who has lived in the camp for nearly 20 years, expressed her growing anxiety.
“How many days will I eat? The food can end so fast,” she said, asking to remain anonymous for fear of reprisals.
With the rainy season approaching — a time when malaria cases often surge — she worried even more about the lack of medical care.
“If you go now to the hospital there is no medicine, they just check you,” she said.
“Trump has stopped everything, and it’s closed now, there is nothing coming in and nothing coming out.”
Privately, aid workers acknowledge that the crisis cannot be blamed solely on the US cuts. Some pointed to longstanding weaknesses in the aid system itself.
“The camp has been managed as an emergency, so they were not preparing people” to become more self-sufficient, a second Kakuma-based aid worker told AFP by phone.
“If refugees were treated like people not in an emergency set-up anymore… these fund (shortfalls) could not affect them,” he said, suggesting that more emphasis should have been placed on long-term solutions.
The first aid worker echoed this frustration, arguing that too much of the aid budget is consumed by administrative and operational costs — rather than directly assisting those in need.
“The aid, the majority of it goes to the operational bit of it, not the actual work,” he said. “It’s madness.”
Like many in the humanitarian field, he admitted to questioning whether the current system genuinely empowers people or simply fosters dependency.
“As a person who has worked in multiple areas, sometimes you wonder if you are really helping or if you are enabling,” he said.
