The Geneva health centre where Suza could not be treated following the cut in USAid funds is seen in Lubumbashi, Democratic Republic of Congo, on August 3. Photo / Arlette Bashizi, for The Washington Post
A USAid shipment of anti-malarial medication, containing enough medicine to treat tens of thousands of children, arrived in the Democratic Republic of Congo in December.
Upheaval from the Trump Administration’s foreign aid freeze delayed its delivery from a regional warehouse to local health clinics.
As a result, when 5-year-old Suza Kenyaba contracted malaria, the medicine was not available.
She died on February 19.
In the first half of the year, hundreds of USAid shipments of anti-malarial and HIV medical supplies arrived late at regional warehouses in dozens of countries.
Many did not arrive at all.
Fever ravaged the body of 5-year-old Suza Kenyaba as she sweated and shivered on a thin mattress in a two-room clinic in the Democratic Republic of Congo.
The pigtailed girl who liked pretty dresses was battling malaria and desperately needed medication that could save her life.
That medication, already purchased by a US-taxpayer-funded programme, was tantalisingly close - a little more than 11km away.
It hadn’t reached the clinic where Suza was being treated because US President Donald Trump’s suspension of foreign aid had thrown supply chains into chaos.
The injections Suza needed had travelled thousands of kilometres to the Central African nation, USAid and other records show, only to be stranded in a regional distribution warehouse in the same city where she was gasping for air.
Less than a week after her symptoms began, Suza was dead. Congolese government data shows that in Suza’s province, deaths caused by malaria nearly tripled in the first half of this year.
Parts of USAid’s Global Health Supply Chain Programme that ship anti-malarial and HIV supplies officially resumed within days of Trump’s order, but the suspension had lingering effects that left aid deliveries severely disrupted for months, according to a Washington Post investigation.
The delays impeded the delivery of medications, rapid screening tests and other lifesaving supplies to more than 40 countries, including Congo, records show.
A Post analysis of internal data from the first half of the year shows that supplies valued at more than US$190 million ($328m) were scheduled to arrive at distribution warehouses by the end of June.
Instead, the analysis found, shipments worth nearly US$76m were not delivered, including the majority of medication needed to combat severe malaria.
Some medicines never left the places where they were manufactured, and others were stranded in ports or customs facilities near the cities and villages where they were needed.
Additional supplies valued at US$63m were delivered to the warehouses but delayed at least seven days, the threshold at which they are considered late under USAid guidelines.
Those shipments were delayed on average by 41 days - long enough to leave shelves empty in clinics and hospitals that rely almost entirely on US taxpayers for these critical goods.
The disruptions meant even some health supplies at the regional distribution warehouses did not reach the clinics and hospitals that were their ultimate destinations. Among that material was the medication Suza needed.
The scale and duration of disruption in the portion of the pipeline that was supposed to be reactivated has not been previously reported.
With an annual budget of more than US$900m, this part of the pipeline is the logistics backbone that handles shipments of medical supplies under two key programmes.
They are the US President’s Emergency Plan for Aids Relief (Pepfar), a cornerstone of the global effort to fight the Aids epidemic, and the President’s Malaria Initiative (PMI), the Government’s flagship malaria programme.
In an April 21 cable reviewed by the Post, Lucy Tamlyn, the US ambassador to Congo, warned officials in Washington and elsewhere that the “abrupt elimination” of Pepfar-supported programmes would lead to a resurgence of HIV in Congo and “could also lead to the development of new, drug-resistant strains of the virus that pose a direct threat to our homeland”.
More than 1600 orders were scheduled to be delivered by the end of June.
One order, for example, contained almost US$1.5m of HIV antiretroviral medication; another, US$199,000 of anti-malarial medications.
About 12% were late in January, slightly less than what is typical, when the Trump Administration ordered the supply chain to suspend work.
By the end of April, nearly three months after lifesaving aid officially resumed, more than 700 orders - about 42% - had not moved at all.
By late June, almost half were not delivered to regional warehouses. Most of the others had been delivered late.
The State Department did not directly answer detailed questions for this report. The agency said in a statement it attributed to a spokesman that the “most critical elements of our global health response continue to operate and contribute to saving lives”.
The statement said the department is building “future-ready” supply chains with drone technology that will improve speed and efficiency in some parts of Africa.
Without offering specifics, the statement said opposition to its efforts to improve the pipeline has come from “beltway bandits” who have profited from the distribution system.
“Under an America First approach to foreign assistance, we are engaging more directly with recipient governments,” it said.
“We anticipate soon sharing updates on our strategies to cultivate a more durable and lasting supply chain and health infrastructure globally.”
On September 23, US Secretary of State Marco Rubio defended the Administration’s aid policies during an interview with ABC’s George Stephanopoulos, saying programmes are being restructured to be more efficient and blaming other countries for not doing more.
“No one has died because the US has cut aid,” Rubio said.
In their first days back in power, Trump Administration officials said many US foreign aid programmes were at odds with American interests and values.
Elon Musk, who championed contentious federal spending cuts through the US Doge Service, called USAid a “criminal organisation” in a post on X, adding that it was “Time for it to die”.
Rubio, who was appointed to oversee USAid, told reporters that its programmes “run counter to what we’re trying to do in our national strategy”.
The impact of the freeze, implemented through stop-work orders issued by USAid officials, began to ripple around the world.
Food destined for starving people in Sudan, Bangladesh, Gaza, Syria, and Myanmar rotted in warehouses.
Clinics rationed HIV treatment to control and prevent transmission to newborns in Kenya.
Medicine never made it to conflict-ridden Sudan, leaving sick people to die of preventable diseases.
A study published in the Lancet estimated that, if not reversed, the cuts could lead to the unnecessary deaths of more than 14 million people, including 4.5 million children under the age of 5, by 2030.
Even before some of those effects were felt, Rubio backtracked under public pressure, issuing a blanket waiver for “lifesaving humanitarian assistance” on January 28.
Chemonics, the Washington DC-based contractor that operates the Global Health Supply Chain Programme, received waivers in the first week of February to resume the distribution of some medical supplies for HIV treatments and malaria.
Smaller programmes that also used the pipeline remained frozen, including those focused on family planning and maternal and child health - efforts deemed contrary to US values.
Rubio said in a February 10 interview that “hiccups” regarding the restarted programmes would be resolved quickly.
“We’re not walking away from foreign aid,” said Rubio, who called himself a “big supporter” of Pepfar. “We are walking away from foreign aid that’s dumb, that’s stupid, that wastes American taxpayer money.”
But the aid pipeline - a complex network of data collection, freight transportation, warehousing, and staff across multiple continents - struggled to restart, the Post found.
To understand the causes and consequences of these events, Post reporters interviewed more than 20 current and former government employees and contractors and travelled to Congo, where reporters examined medical records and interviewed health officials, pharmacists, doctors, and family members of Suza and another child who died during the period in question.
In the first days of the freeze, Chemonics lost access to the government payment system it used to manage the large costs associated with the pipeline - part of a broader payment problem that the contractor told USAid “directly inhibits our ability to order suppliers to resume work”.
The company sued, saying the Government owed it millions of dollars, and in a March 7 court filing said it still did not have access.
The contractor had to furlough 750 US workers, nearly two-thirds of its total American workforce, it said in the lawsuit.
Local staff who worked on the supply chain were also let go because of the contract cancellations, according to people familiar with the changes who spoke on the condition of anonymity. Some staff members were later reinstated.
Chemonics declined to comment for this story, referring questions to the State Department.
The Trump Administration, meanwhile, put more than 3500 USAid employees on administrative leave and eliminated more than 1600 positions at the agency, USAid told Congress, as Rubio looked to reorganise and then close the agency.
Staffers with the US Doge Service slashed staff, programmes and payments. The number of positions at the agency’s Bureau of Global Health, which administers the pipeline, shrunk to 72 people from nearly 800, according to a February 28 memo from Nicholas Enrich, then the bureau’s acting assistant administrator.
Other logistics programmes that brought lifesaving supplies from in-country distribution warehouses to clinics - known as “last-mile” delivery - did not receive waivers in the first half of the year, according to USAid documents.
Among them was the Chemonics-run programme that would have been involved in delivering the medication Suza needed.
Stranded health supplies collectively accrued hundreds of thousands of dollars in storage fees at ports and temporary holding facilities, an internal delivery tracker shows, as expiration dates inched closer.
Enrich wrote in a separate February 28 memo that political leadership at USAid, the State Department and Doge had created obstacles to restarting lifesaving programmes.
He cited the refusal to pay for goods and services, the restriction of access to USAid’s payment systems, and the creation of “new and ineffective” payment processes as well as cuts to critical projects the supply chain depended upon to function.
“This will no doubt result in preventable death, destabilisation, and threats to national security on a massive scale,” wrote Enrich, who later said he was pushed out of USAid for being a whistleblower.
Before the arrival of the anti-HIV initiative Pepfar in 2003, Congo was buckling under the weight of the Aids epidemic. Affordable medications were virtually non-existent. Clinics were overwhelmed.
About 60,000 people were dying from the disease each year, according to estimates from the United Nations programme UNAids.
Pepfar for the first time made testing and treatment widely available.
Regular shipments of free anti-retroviral medications allowed people with HIV to live long lives and greatly reduced the chances that women with HIV would pass the virus on to their newborn babies. By 2023, estimated deaths from the virus had fallen by three-quarters.
The overall effort, including work by the Congolese Government, brought the country “to the cusp of achieving HIV epidemic control”, Tamlyn, the ambassador in Kinshasa, told US officials in the April 21 cable that also warned about drug-resistant HIV strains. More than 2000 babies born to HIV-positive mothers spent their first year disease-free with Pepfar’s support, Tamlyn noted.
That support was interrupted in the first half of this year: Only two of six large shipments of paediatric anti-retroviral medication destined for Congo had been delivered to regional warehouses by the end of June, according to the Post’s data analysis.
One of those shipments was 231 days late - having been delayed under both the Trump and Biden administrations.
In Lualaba, one of two mineral-rich provinces in the south where USAid has long provided free anti-retrovirals, the medication was scarce in February when 7-year-old Gilbert Kayombo was scheduled for a refill, according to his medical records.
Gilbert was diagnosed with HIV five years ago, along with his parents and brother. His father died the following year. The family lived in a neighbourhood squeezed between towering mounds of mining waste in Kolwezi, the provincial capital.
Gilbert’s mother, Lauraine Kapalanga, 33, told the Post she was diligent about taking her HIV medication and ensuring her boys did the same. Gilbert, an energetic boy who loved cars, usually took two kinds of pills: Dolutegravir and Abacavir/Lamivudine, according to his records and his doctor. The medicine kept him healthy, Kapalanga said.
Gilbert received a partial supply of each medication on February 20 from Mwangeji General Hospital, which obtained the medicines from USAid, said his doctor, Frederick Naya. The hospital was running low on the medications, pharmacy records indicate.
Kapalanga couldn’t remember exactly when Gilbert took the last of his medication, but she said the supply did not last long. She went back to the hospital to check for more several times, she and the doctor said, but none had arrived.
Gilbert started to get sick, Kapalanga said. He had bouts of belly pain, then a fever. He would recover after a few days - only to get sick again.
Without medication, Gilbert developed Isospora and Candida infections, said Naya, the head of the HIV care department at the hospital.
“One month of missing the medicine is a lot to cause damage to the body of a child,” he said, especially when that child does not have access to proper nutrition.
On March 15, Gilbert went to the Dimercia clinic in Kolwezi. His medical records show that he was anaemic and tested positive for malaria. He was treated with quinine - the only anti-malarial medication the clinic had in stock, according to the head nurse - and sent home.
A week later, Gilbert began vomiting. Kapalanga said she tied him to her back with a cloth and walked to the clinic.
Medical records show Gilbert was admitted to the clinic with severe malaria and a fever. Kapalanga said his hand would slip out of hers, dropping as if there was no strength left in it. She had already lost three children, in addition to her husband.
Early on March 24, she said, his breathing quickened. She called the doctors and started screaming, “My child is dying! He is dying!”
They ushered her out of the room. When she was allowed back, Gilbert was gone.
Joseph Lenge Mukungwa, the head nurse at the Dimercia clinic, said Gilbert probably would have been able to fight off the malaria if he had been in good health.
“When Gilbert came, we realised he had grown weak over some time as a result of not taking [paediatric HIV medicine],” Mukungwa said.
“The deep breathing, the fast death, that was the malaria, but the big problem was HIV.”
Less than 6.5km from the hospital where Gilbert had gone for his prescription, a regional warehouse used by USAid’s Global Health Supply Chain Programme typically housed medication including Abacavir/Lamivudine, according to a person with knowledge of the matter.
The medicine had been stranded in warehouses across the country because of the cancellation of the last-mile contract, the internal delivery tracker shows.
A day after Gilbert died, Tamlyn, the ambassador, cabled Washington to say she had asked Congolese health officials on March 13 to help distribute US$50m in US health commodities stuck in warehouses.
No decision had been made as far as the embassy was aware, according to the cable. The cable referenced an order to restore last-mile delivery of HIV aid, also on March 13, but said “the other commodities are still stranded”.
In the Lualaba province, at least 219 HIV-positive people died between January and June of this year, according to preliminary data collected by Congolese health officials. Last year, 164 HIV-positive people died in the same period.
The increase in fatalities probably resulted not only from the lack of HIV medication but from the cascade of disruptions the aid freeze brought to supplies, health services and medicines more generally, said Marcel Yotebieng, a professor at New York’s Albert Einstein College of Medicine and HIV researcher who has extensive experience working on HIV in Congo as a clinician and researcher.
Yotebieng said Congo’s size and weak infrastructure leave its healthcare logistics reliant on international support and vulnerable to instability.
A five-hour drive east of Kolwezi, in the next province over, Nathan Binene Kayeye administered his last dose of injectable Artesunate - a USAid-provided medication used to treat severe malaria - to a patient in mid-January.
The clinic he runs requested more medication that month and again in February, records show. Nothing arrived.
Only three of the nine shipments of medication for severe malaria due in Congo in the first half of this year were delivered, and all three were months late, the Post’s analysis found. Most of the others sat in customs for months.
Malaria is a top killer in Congo. In the Haut-Katanga province, the danger is greatest from October to April, the rainy season, which is when Suza Kenyaba fell sick and ended up in Kayeye’s clinic in Lubumbashi, the provincial capital.
Suza had developed a cough by the time she went to school on February 14, a Friday, according to her mother, Bertha Kolongosola. By the next Monday, Suza was wheezing and her mother was worried.
Early the next day, the two walked the few metres from their house to Kayeye’s clinic, the Centre de Santé et Maternité Geneva.
She saw a doctor, went home and then returned a few hours later.
This time, Suza’s usually bright eyes were inflamed, Kayeye said in an interview. She tested positive for malaria and was diagnosed with a severe case, according to her medical records.
She needed the Artesunate injectable to survive, said Kayeye, a nurse. Delays of even a few hours in treating severe malaria can be fatal, experts say.
The doctor told Suza’s father to try to buy the medication and other supplies from a private pharmacy.
The free USAid-provided medication was already hard to find, Kayeye said. Its cost at a pharmacy - though less than US$10 a dose - put it out of reach for many poor families.
Kolongosola told the Post that the family did not have money to buy everything needed. Suza’s father, Henry Elota Kabange, said he could not remember exactly what he bought.
They returned to the clinic later that day with some supplies, but not the Artesunate, according to Kayeye and medical records.
Suza’s fever soon reached 40C, records show.
Desperate, Kabange set out with his ailing daughter that night to find help elsewhere.
They tried one hospital and then another. She died at the second hospital, the day after she was diagnosed.
The family moved away from the clinic. They did not want to be near anything that reminded them of Suza, but still, everything did: children playing, fetching water, doing each other’s hair. “My Suza would be among them if she had stayed longer,” her mother told the Post.
Less than 16km away, the Haut-Katanga regional warehouse was flush with the injectable medication from USAid.
After delivery of a year’s supply at the end of last year, the warehouse had about 249,000 USAid-provided vials of the drug, according to internal records reviewed by the Post. Quarterly shipments to local distribution points had not yet left the warehouse when the freeze was imposed in January, records show.
By April, anti-malarial health supplies were still stranded there and had missed two quarterly distributions, Janvier Kubuya, the head of the Haut-Katanga provincial health division, said in a letter.
“Some supplies run the risk of expiring,” Kubuya wrote on April 24, as he pressed Chemonics and regional warehouse officials to deliver the supplies. “It goes without saying that needs are increasingly growing, shortages have been observed.”
The last-mile delivery of USAid anti-malarial medication in Congo - from regional warehouses to hospitals and clinics - was under way again in May, according to two people with knowledge of the situation.
Government figures show more than 600 deaths from malaria in the first six months of 2025 in Haut-Katanga alone, more than the number who died of the disease there in all of 2024.
On July 1, oversight of the Global Health Supply Chain Program transitioned from USAid to State Department staff.
A State Department spokesperson told the Post that the switch had “streamlined and ensured co-ordination with our diplomatic operations, which includes humanitarian assistance”.
The statement said the previous approach “used a parallel healthcare infrastructure and partnerships with unvetted and unreliable NGO collaborators” that “proved inadequate in establishing a sustainable or resilient health supply chain”.
The number of employees dedicated to the programme appears to have shrunk dramatically. Almost two months after the transition, fewer than 10 people at State focus solely on the programme, according to people with knowledge of the office. Before the cuts, they said, more than 80 people worked in these roles.
The process for obtaining commodities continues to be slower than before the freeze, according to people with knowledge of the process. Most payments still require personal approval from one senior health official in the State Department, they said.
As recently as mid-June, some programmes that provided clinical care for HIV remained cancelled, a USAid document reviewed by the Post showed.
Among them were programmes that Tamlyn, the ambassador, warned in April could jeopardise the lives of 28,000 adults and 2500 children in Pepfar-supported provinces if not restored.
One of those programmes funded community health workers in Kolwezi, where Gilbert lived. Many of them are no longer being paid.
One of those workers helped establish a support group whose members donate to a communal fund they can use in medical emergencies. But in early August, the money could not buy what they needed most: HIV medications.
Ngoie Mutombo Michel, a doctor in a clinic there, could barely finish a sentence when a Post reporter visited his office late this summer.
His phone buzzed constantly with pleas for help: a parent calling to ask if he had HIV medication yet for their 1-month-old baby; a 20-year-old man messaging, “My body is weak”.
Michel said he has received some HIV medicine from USAid since March, though not in the quantities he received before the freeze.
“When [the supply] comes and they bring less medicine,” Michel said, “which patient will you prioritise?”
- Elisha Iragi, Jon Swaine, Adam Taylor and Annie Gowen contributed to this report.
Sign up to Herald Premium Editor’s Picks, delivered straight to your inbox every Friday. Editor-in-Chief Murray Kirkness picks the week’s best features, interviews and investigations. Sign up for Herald Premium here.