Koert Lindijer has been a correspondent in Africa for the Dutch newspaper NRC since 1983. He is the author of four books on African affairs.
Many African countries are facing a crisis due to the withdrawal of American aid, especially but not only in the health sector. Even if courts in the US would stop the dismantling of USAID, so much of the organization’s structure has already been destroyed that picking up the pieces will be impossible. The increased dependence on foreign donors is painfully visible. The withdrawal is felt in many economic sectors. This story I wrote twee weeks ago in Western Kenya.
The smell of fish rises from the hot gusts of cooking oil on the shores of Lake Victoria in western Kenya. “When I heard about Trump’s executive order to close USAID, I knew what was coming,” says fisherwoman Yunis as she takes the skin of a tilapia and throws it into the oil. “My business is in tatters. People are eating less fish and hotels are canceling orders.”
Every crisis is immediately felt at the Kisumu fish market on the shores of Africa’s largest lake. Fisherman Nicolas Didi carries a bucket of tilapia ashore between papyrus plants in the rippling water. “I’m only selling half of what I used to sell since USAID was closed. This is a disaster, just like HIV was and then Covid.”
In western Kenya, the halt of US development aid and the suspension of the USAID staff are having a serious impact. This region traditionally is suffering greatly from the effects of HIV, corona, malaria and tuberculosis. In Kisumu state, 35 percent of the health budget came from USAID, says Frederic Oyango, Kisumu’s director of public health. “We are in danger of being thrown back to the 1990s, when we did not have laboratories and medical staff for AIDS and tuberculosis.”
Free Condoms
Until recently, the USAID logo could be found in the farthest corners of Kenya. It adorned food aid bags and cans of cooking oil in remote nomadic areas. It was seen in youth centers, shelters for street children, school buildings, urban family planning clinics, on condom packets in queer bars, on tampon packets for schoolgirls. The first email from USAID headquarters about the suspension of aid, on Friday, January 24, hit like a bombshell here and brought the aid machine to an abrupt halt. It does not only directly concern patients, the triple down affect is enormous.
Kenyan Health Minister Deborah Barasa stated that 37,000 aid workers who provide essential services have unexpectedly lost their jobs in the whole country. She faces a $200 million budget shortfall and estimates that there will be 23,000 more deaths from tuberculosis and 60,000 new HIV cases in the next few years.
Fishermen in Kisumu are seeing poor girls turn to sex work because they can no longer pay their school fees now that subsidies have been cut. “Everyone wants to protect themselves, but we can’t give out free condoms anymore,” says Vera Oyango, head nurse at a clinic by the lake. Testing of pregnant HIV-positive women, which is used to provide medicine, has also come to a standstill. Oyango’s health workers who used to visit poor families to promote family planning and conduct health checks are sitting at home without pay.
In the expensive Milimani district, a jumble of aid agency signs adorns almost every street corner. On orders from the Washington headquarters, USAID’s signs have been removed in recent weeks and the metal gates of foreign NGO workers’ homes have been tightly sealed. “The email of January 24 contained a ban on talking to the media,” says a worker at a USAID-funded organization. “Everyone in the aid industry is terrified. We don’t even dare to communicate via WhatsApp anymore, for fear of being tapped.”
Cholera outbreak
In the laboratory of the Safe Water and Aids Project (SWAP), everyone is busy testing because of a suspected cholera outbreak in the region. “We feel the effect all around us after the stop work order,” says Alie Eleveld, the Dutch founder of SWAP. On the wall of her office hangs a photo of her being honored by former US President Bill Clinton. She worked for 40 years in health care in several African countries. “During those 40 years, I was constantly funded by American organizations,” she says.
Marian Otieno resides at the far end of a labyrinth of alleys in the poorer Nyalenda in Kisumu. In her small mud house, she learned about Trump’s decision from the radio. She is living with HIV; her husband passed away two years ago due to not taking his medication regularly. “Now I am going to die too,” she laments. “I sell some vegetables. The proceeds are just enough for one meal a day, not for my medication. Since USAID stopped paying for my medication, I beg from the teachers every day, but they sent my daughter away because I can no longer afford the school fees.” Many poor residents of Nyalenda who had jobs as security guards or suppliers for the aid workers lost their income. “Everyone in our neighborhood is angry,” says Otieno. “And crime is increasing, our neighborhood has become more unsafe.”
Middle class
The effects of the American decision are noticeable in the upscale Mega City shopping center in Kisumu. Many aid organizations have ended their leases there. Nirmal Darbar, a well-known businessman in Kisumu, describes the Kenyan aid workers, who earn decent salaries, as part of the middle class that frequents his restaurant and nightclub. “The aid organizations no longer hold workshops in my hotel, which means that I have lost more than half of my clientele. Supermarkets, hotels, bars and restaurants, all businesses are losing customers.”
Darbar estimates that 60 percent of the economy in Kisumu is dependent on the aid industry. “We have become dependent on USAID and now have to tighten our belts.”
The manager of a large bank explains how the aid freeze is also affecting the financial sector. “We are now refusing loans to NGO workers from all organizations that are financed by USAID,” she says. “The trust in the relationship with these customers has been damaged. We will not resume lending anytime soon, even if American aid returns.”
With the loss of salaries for thousands of NGO workers and the loss of more than 600 million euros for 230 USAID aid projects, the Kenyan economy is in trouble. “The economy could take a nosedive, and the Kenyan shilling is threatened with devaluation,” according to the bank manager.
Short of cash
How will Kenya continue without USAID? Alfred Adongo works on a water hygiene project in a slum. “A problem in our society has been exposed,” he says, standing by a toilet paid for by USAID. “This is a wake-up call. We have become far too dependent on foreign donors. Toilets and distribution of condoms are basic services that the government should provide.”
No one has answered who will take over the role left by USAID. Traditional donor countries like Great Britain and the Netherlands are reducing their aid as well. The Kenyan government is facing a cash shortage. The country has a foreign debt of 43 billion euros and is using seven out of every ten shillings it collects to pay it off. “Poverty is increasing because of the discontinuation of USAID. Anger among the poor is growing,” sighs Alfred Adongo. “That unrest could explode at any moment.”
This article was first published in NRC on 1-3-2025
