JUANA SUMMERS, HOST:
In north Nigeria, Ibrahim Musa makes his living by driving this motorcycle taxi.
(SOUNDBITE OF MOTORCYCLE REVVING)
IBRAHIM MUSA: (Through interpreter) Sometimes I get passengers. Sometimes I don't. But I try my best. This is how I feed my family.
SUMMERS: Still, Musa's income is modest. So when it came to medical needs, he and his family relied on care once subsidized by USAID - until last year when that funding suddenly ran out right when the family desperately needed it. Here's NPR's Ari Daniel.
ARI DANIEL: Until recently, Ibrahim Musa and his wife had four kids, including their son Abdullahi, who used to love to help with small tasks however he could.
MUSA: (Through interpreter) He always goes to clean my motorcycle. His heart is just kind. If someone was sad, he would go and sit with them.
DANIEL: Abdullahi developed asthma when he was 5. Over time, it became increasingly serious.
MUSA: (Through interpreter) Sometimes he will wake up suddenly, gasping for air. I feel very, very scared. We usually rush him to the hospital.
DANIEL: They take the motorcycle, Abdullahi sandwiched between his two parents. Those visits, plus the drugs and inhalers, were usually free. Musa says he was told that USAID was helping to offset the costs.
MUSA: (Through interpreter) Because of that support, people like us, who don't have much, could still get treatment.
DANIEL: Then, last year, he had an especially severe asthma attack.
MUSA: (Through interpreter) He told me, Daddy, I can't breathe well. We rushed to the clinic.
DANIEL: But they learned the drugs were no longer available. Musa speculates that was due to USAID funding drying up in the wake of the Trump administration's decision to shut down the agency. A similar story had been playing out more than 150 miles away to the south in central Nigeria. In early 2025, a once-cheerful 8-year-old named Ibrahim contracted typhoid fever, a dangerous bacterial infection that his father, Yakubu Garba, says he likely picked up from the drinking water.
YAKUBU GARBA: (Through interpreter) It started like a normal sickness. He had fever, weakness and was not eating well.
DANIEL: Ibrahim's condition worsened. The family visited the local clinic and received an antibiotic and rehydration regimen for free. The staff told them USAID was picking up the tab. Soon, Ibrahim was feeling better - so much so that he didn't complete his course of antibiotics.
GARBA: (Through interpreter) Sometimes too much stress at home will make us not remember to give the child the medicines to take.
DANIEL: But Ibrahim's typhoid rebounded and knocked him flat.
GARBA: (Through interpreter) He would just look at me and tell me, Baba, I am tired. That broke me.
DANIEL: When he and his family returned to the clinic, the meds were no longer free. Another possible casualty of the dismantling of USAID. Ibrahim's family couldn't afford the new round of drugs. They took him home, tried an herbal remedy and prayed.
GARBA: (Through interpreter) We delayed, hoping we could find money or that he would get better. But he did not.
DANIEL: When NPR asked the U.S. State Department for comment, they didn't refer to these two specific cases. Rather, they referenced the five-year, $5.1 billion health memorandum of understanding that the Trump administration has signed with Nigeria. It consists of nearly 2.1 billion in health assistance, alongside another 3 billion or so from the Nigerian government.
BROOKE NICHOLS: In theory, setting up these systems is great. This amount of investment will actually generate a lot of good health.
DANIEL: But it's only part of the picture, argues Brooke Nichols, a health economist at Boston University. Her research shows more than half a million children perished due to USAID being shut down, mostly in sub-Saharan Africa. She says the abrupt termination led to a breakdown of trust and supply chains, which are challenging to reinstate.
NICHOLS: It's one thing to turn something off. It is something entirely different to turn something back on again. This funding could have done much more good if there was a transition from the before times into the current MOUs because we wouldn't have had that disruption of services.
DANIEL: While it's difficult to say for sure what would have happened had USAID remained, Nichols says the agency had been in Africa enabling a range of treatments. The MOUs are perhaps of little comfort to the two Nigerian families. Abdullahi died from that final asthma attack. And four days after Ibrahim's family was told they'd have to pay for the typhoid antibiotics, Ibrahim passed away. Ari Daniel, NPR News.
(SOUNDBITE OF EMOTIONAL ORANGES SONG, "TALK ABOUT US (FEAT. ISAIAH FALLS)") Transcript provided by NPR, Copyright NPR.
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