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Human Rights Watch Calls Out 'Troubling Conditions' in Trump Health Aid Agreements With Africa
“After the sudden and devastating pullback from US assistance in 2025, governments are now being pressured to accept agreements with contingencies that jeopardize human rights."
Jun 08, 2026
The Trump administration is requiring African nations to agree to a series of "troubling conditions" to restore lifesaving health aid, according to a Human Rights Watch report on Monday.
The administration's abrupt shuttering of the US Agency for International Development (USAID) last year shut off billions of dollars and caused havoc across Africa's healthcare system, resulting in what public health models project could be hundreds of thousands of preventable deaths.
But under what has been dubbed the “America First” Global Health Strategy, the administration has negotiated secretive agreements with dozens of these countries to restore some of the funding. Most of them have been kept under lock and key by the US.
Those that have been made public have come with terms that Human Rights Watch said "raise concerns that health aid is being inappropriately leveraged to extract terms beneficial to the US in negotiations around natural resources and access to sensitive health data from recipient countries."
In March, a draft memorandum of understanding with the government of Zambia was revealed to have conditioned $1 billion for HIV, tuberculosis, malaria, and other disease prevention for millions of people, on the country's acceptance of a separate bilateral treaty that would have given US companies greater access to the country's minerals.
A leaked State Department memo, prepared for Secretary Marco Rubio, put the exploitative terms plainly: “We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.”
After the details of that agreement were met with backlash, the text of agreements with several other countries—Ethiopia, Kenya, Mozambique, Nigeria, and Uganda—were suddenly removed from the State Department’s Freedom of Information Act Library.
A Human Rights Watch assessment of the agreements with those five countries—as well as agreements with Rwanda and Liberia that were leaked—revealed that in order to restore a portion of the more than $800 million collectively stripped from them by the US, they'd have to agree to several coercive measures that jeopardize the reproductive and privacy rights of their citizens.
“The agreements show the US intends to condition vital health assistance for millions of people on acquiescence to troubling conditions,” said Julia Bleckner, senior health researcher at Human Rights Watch. “After the sudden and devastating pullback from US assistance in 2025, governments are now being pressured to accept agreements with contingencies that jeopardize human rights.”
All seven of the agreements require the governments to provide the US with "broad access to data and information" to monitor compliance with the Helms Amendment, which forbids the use of US foreign assistance to pay for abortion care.
The agreements with Mozambique, Rwanda, and Liberia require them to provide “any data” requested by the US to ensure compliance with the amendment, while Uganda's permits the US to conduct unannounced spot checks of health facilities and clinics.
"By making a broad package of health aid contingent on broad and potentially invasive surveillance of Helms compliance, the agreement could encourage a more restrictive regulation of abortion than national law mandates and give rise to further violations of the right to healthcare,” says the report.
The agreements also give the US permission to directly audit clinics, laboratories, and health programs to ensure compliance with the conditions. Six of them require clinics to provide access to "any data" requested by the US at a sample of facilities it chooses.
Agreements with five countries also mandate that they share biological specimens taken from patients and associated information related to novel infectious diseases, which HRW described as part of an effort to undermine a global pathogen access and sharing system being created by the World Health Organization, from which Trump has removed the US.
HRW said in a news release:
The agreements raise serious concerns about use of people’s private health data, without clear limits, uniform safeguards, or meaningful protections for patient confidentiality, including in several countries with weak or absent domestic data protection laws. The agreements contain no prohibition on this data being shared with US pharmaceutical companies without patient consent.
“Governments negotiating health assistance agreements with the United States face difficult choices,” Bleckner said. “They should be wary of terms asking them to sign away their populations’ rights and push for the inclusion of civil society representatives and multilateral global health organizations like the Global Fund in deliberations.”
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Trump and Musk Rob the Poorest Children to Pay for War Crimes
These are the human costs of the American people electing politicians whose military death cult keeps getting more Pentagon funding from Congress, displacing programs sustaining life.
May 23, 2026
A skeptical friend reading The New York Times asked me why columnist Nicholas Kristof keeps writing columns about recurring poverty in less developed countries. My answer is simple. Because he keeps going to these remote areas populated by brutalized human beings living in dire impoverishment and sickness.
At no small risk to himself (Kristof caught malaria in the Congo), he goes to where the most deprived people on Earth live for his stories. He does what few columnists are willing or able to do by exposing how children, the elderly, and entire families are dying under the most unimaginable cruelty.
I suspect that what keeps Kristof going is that he sees how inexpensively many of these mortalities and morbidities can and have been prevented. For example, a $4 vaccine can prevent cervical cancer, which kills over 900 women worldwide every day!
Knowing all this has led to his sharp denunciation of Tyrant Donald Trump and DOGE Director Felon Elon Musk’s immediate and illegal closure of the Agency for International Development (USAID). Soon after the failed gambling czar re-disgraced the White House on January 20, 2025, the world heard Musk’s sadistic boast, “We spent the weekend feeding USAID into the woodchipper.”
Nicholas Kristof, it is time to break the unspoken reluctance of The New York Times editorial page—replete with specific editorial and op-ed denunciations of bully Trump’s many crimes—and raise the cry of IMPEACHMENT.
Why on Earth would these callous corporatists criminally destroy an agency with an average budget of $23 billion a year (about 10 days of the Trump-bloated Pentagon war budget) to save the lives of millions of babies, children, women, and men? Especially when much of this spending goes right back to US contractors who ship the food, medicines, drinking water, wheelchairs, medical devices, and other materials to poverty-stricken nations.
The Trump-Musk cabal sadistically exuded glee, declaring they were saving taxpayer money. The money spent by USAID is a small price to pay for preventing the atrocities they visited on those most in need of humanitarian assistance on the planet. Given the reputation of the US’ invasive military empire all over Asia, Africa, and South America, war criminal Trump failed to understand the benefit that such aid—often called “soft power”—does to improve Uncle Sam’s tarnished reputation.
In his latest column, dated May 10, 2026, and titled “The Children America Abandoned,” Kristof makes the following points:
“A year after some of the world’s richest men cut aid for the world’s poorest children, …” Trump and Musk retained “some lifesaving programs, particularly for HIV/AIDS…” However, Trump’s “71% cut in humanitarian aid from 2024 to 2025…” led to the loss of “750,000 lives worldwide” in Trump’s first year, citing a study by a Boston University researcher. The prestigious British medical journal The Lancet projected that at present official development assistance (ODA) defunding rates, 9.4 million lives will be lost worldwide, including 2.5 million among children 5 years and younger, by 2030.
While these enormous preventable death numbers may shock most Americans, it is because USAID over decades has not been encouraged by its cautious superiors in the White House to toot its own horn for fear of enraging right-wing ideologues in Congress who have long wanted foreign aid abolished.
“A few doses of a $3 malaria vaccine can now save a Congolese child’s life,” Kristof writes. Tuberculosis is a major contagious killer in Africa, mostly among children and pregnant women. A series of regular TB drugs, consistently administered by clinics, can sharply reduce this epidemic. Again, very cost-effective.
What these clenched-jawed Trumpty Muskites ignore is that catching precursors of pandemics in African or Asian countries can prevent deadly viruses and bacteria from migrating to the United States. Without funds and diligent monitoring, the current Ebola emergency in the Congo is spreading.
These are the human costs of the American people electing politicians whose military death cult keeps getting more Pentagon funding from Congress, displacing programs sustaining life. Trump’s war crimes are used to seek an increase of a staggering 50% budget increase or $500 billion for the Pentagon. Trump wants to use deficit financing to further bloat the Pentagon budget so he can keep cutting taxes for the super rich, himself, and giant corporations for the next fiscal year.
In one of his previous columns, Kristof shows how the swollen, corrupt military spending on contractors can be better used in our domestic economy, repairing public services and building infrastructure. The last president to make this comparison was former five-star general President Dwight Eisenhower in 1953 in an address before the American Society of Newspaper Editors (See the address.) Two recent books: Prophets of War: Lockheed Martin and the Making of the Military-Industrial Complex by William D. Hartung and The Spoils of War: Power, Profit, and the American War Machine by Andrew Cockburn unmask the devastating impact of wasteful military spending on human needs.
The Democratic Party refuses to make the runaway military budget, now overconsuming half of the entire federal operating budget, a political campaign issue. Worse, they eagerly join the congressional Republicans in the yearly hoopla for ever more megadollars for the Pentagon. Serious appropriations hearings in the House and Senate are a long-ago memory for this untouchable depravity of blank checks, stealing from the many unmet necessities of the American people and their children here at home, which also cost many American lives.
So, Kristof, who has written devastating critiques of Trump, ends his column with “The truth is ugly: The world’s richest men are crushing the world’s poorest children.”
Nicholas Kristof, it is time to break the unspoken reluctance of The New York Times editorial page—replete with specific editorial and op-ed denunciations of bully Trump’s many crimes—and raise the cry of IMPEACHMENT or, in the vernacular that Tyrant Trump very often uses, say “YOU’RE FIRED!” (See, the Impeachment Symposium of April 8, 2026).
As I have said many times, with Trump, IT IS ONLY GOING TO GET WORSE, MUCH WORSE. In addition to manipulating districts, he is openly intending worse takeovers of the November elections, having said in January, “We shouldn’t even have an election” in November. What are our politicians and the mainstream media waiting for? It is time for them to summon the courage of their declared convictions!
P.S. Kristof’s most recent feature exposes the sexual violence by Israeli soldiers against kidnapped Palestinian men, women, and children, including training dogs to rape shackled prisoners (See The New York Times, May 17, 2026, “The Silence That Meets The Rape of Palestinians”).
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Greed and Shortsightedness Are Shrinking the Space Where Humans Can Live
Climate change and war are making life in Somalia almost impossible, and now that the US has shut down the US Agency for International Development, the “almost” is disappearing.
May 21, 2026
One way to think about the climate crisis is that we are systematically reducing the margin on which we live on this planet. There were always places where humans couldn’t live: the Antarctic, the centers of the great deserts, the high mountains. But now we’re systematically adding to that list, as places become dangerously combustible, or overrun by rising seas, or just plain too hot. We’re shrinking the board on which we play the sublime game of being human.
I was thinking of this on Monday because I read a truly remarkable piece in The New York Times, the kind of reporting that justifies a subscription despite all the endless disappointments. It was written by Peter Goodman, with powerful photographs from Finbarr O’Reilly.
The two of them traveled widely in recent weeks across Somalia, and what they found—well, you need to read the whole thing. But climate change and war are making life there almost impossible, and now that the US has shut down the US Agency for International Development, the “almost” is disappearing:
For nine days, they trudged across the parched soil of southern Somalia, taking turns carrying their 3-year-old daughter on their shoulders. Abdullahi Abdi Abdirahman, his wife, and their seven children sought escape from a landscape drained of life.
Another drought had killed their goats and sheep, turning their life savings to dust. So they pressed on for 140 miles toward Dollow, a dusty outpost on the Ethiopian border. They were drawn by the same things that had already attracted more than 100,000 other people: International relief organizations were clustered there, offering food, water, and healthcare.
Yet when they arrived in late January at a camp on the fringes of town, they were horrified to learn that aid groups had abandoned the area. President Trump had dismantled the US Agency for International Development, or USAID, eliminating Somalia’s primary source of assistance. From London to Berlin, governments had reduced funding for humanitarian aid. Relief organizations had been forced to choose where to focus their remaining money.
Let me get my anger out of the way first. Elon Musk, in particular, shut down USAID—boasted about “feeding it to the woodchipper” in the first weekend of his DOGE assault on the federal government. That is to say, the richest man in the world did this, under the auspices of our government. His cruelty and his self-regard—and his abject racism—know no bounds.
And then the most piggish and self-involved man in the world, Donald Trump, started a war in Iran, and now the price of fertilizer is through the roof, making life much harder for the people who grow food in Africa (and those who eat it). And an El Niño is now bearing down on the planet, riding on the highest temperatures in human history, which were caused mostly by us in the Western world. All of it taken together is too much
Drought ravaged the most recent harvest. Some 6.5 million people—roughly one-third of the population—were suffering hunger at levels deemed an emergency, the UN Food and Agriculture Organization warned in February. That included more than 1.8 million children under 5 facing acute malnutrition.
Those numbers have almost certainly increased given the war. Yet the World Food Program, the largest source of aid in Somalia, has only enough funding to support 300,000 people a month through July, a fraction of the nearly 2 million people a month it was reaching in early 2025.
Humanitarian relief organizations now contemplate a surreal hierarchy of suffering.
“There are different categories of starvation,” said Hameed Nuru, the World Food Program’s Somalia director. “We are only able to reach those who are really on the verge of, if you don’t give them something now, they will not be there tomorrow.”
In some areas, children are still getting food, but not pregnant mothers. “Literally, it’s who dies first,” he said, “and who dies next.”
Somalia is, of course, a particularly apt place to do this reporting. Trump has referred to its citizens as “garbage people,” and he and Stephen Miller dispatched Immigration and Customs Enforcement to Minneapolis to hunt Somalis. As it happens, it’s on the fairly short list of places I’ve never been, but one of my closest colleagues is Somali, and she is as fine a human being as I know, so I thought of her as I read and reread this piece. But as Goodman points out in his reporting, Somalia is by no means unique.
Indeed, the news this week of a new Ebola outbreak elsewhere in Africa reminds us of another way we keep shrinking the world: There are places it’s too dangerous to go because we’ve unleashed diabolical illnesses. As Kat Lay reports:
The Global Preparedness Monitoring Board (GPMB) said in a report published on Monday that “as infectious disease outbreaks become more frequent they are also becoming more damaging”, warning that pandemic risk is outpacing investments in preparedness and “the world is not yet meaningfully safer”.
Disease outbreaks are becoming more likely due to the climate crisis and armed conflict, while collective action is being undermined by geopolitical fragmentation and commercial self-interest, the report said.
In fact, it’s more or less Musk again—he made a joke at a presidential cabinet meeting about “accidentally” cutting Ebola funding, but insisted it had been restored, something that—and this will shock you—seems not to be entirely true:
In Geneva, Prof Matthew Kavanagh, director of the Georgetown University Center for Global Health Policy & Politics, said aid cuts may have played a role in leaving the world “playing catch-up against a very dangerous pathogen”.
He said: “Because early tests looked for the wrong strain of Ebola, we got false negatives and lost weeks of response time. By the time the alarm was raised, the virus had already moved along major transport routes and crossed borders.
“This crisis didn’t happen in a vacuum. When you pull billions out of the WHO and dismantle frontline USAID programmes, you gut the exact surveillance system meant to catch these viruses early. We are seeing the direct, deadly consequences of treating global health security as an optional expense.”
That margin is thinner all the time. Consider this report from Laura Paddison about the heatwave that shook India last week: There was a day when all the 50 hottest cities on our planet were in that country:
On April 27, average peak temperatures across all 50 Indian cities on the list hit 112.5°F.
Top of AQI’s list was the city of Banda in the northern Indian state of Uttar Pradesh, which has a harsh, sub-tropical climate which often delivers brutal summers.
Even before what are typically hottest summer months, the heat has ratcheted up. On April 27, temperatures in Banda reached 115.16°F, according to AQI, the highest temperature recorded anywhere on the planet that day. The coolest Banda got, in the early hours of that morning, was 94.5°F…
Experts have warned heat in India is becoming so extreme, it may “cross the survivability limit” for healthy humans by 2050.
Across the border in Pakistan, as Asad Mumtaz Rid reports, it’s at least as bad:
In southern Pakistan throughout April and May, temperatures have risen far above seasonal norms. In Sindh, daytime temperatures have frequently crossed 44°C to 46°C, forcing residents indoors during peak afternoon hours and severely affecting outdoor labourers, transport workers, and farming communities.
The impact has been particularly severe in Karachi’s coastal settlements, where prolonged electricity outages and water shortages have compounded the effects of extreme heat. In Ibrahim Hyderi, one of the city’s largest fishing communities, residents say survival is becoming increasingly difficult.
Abdul Sattar, a fisherman with more than three decades of experience, recalled how one of his colleagues collapsed from heat exhaustion during the recent heatwave. “We gave him lemon water and rushed him to a doctor,” he said. “He regained consciousness after receiving intravenous fluids.”
There are things we can and must do to make a short-term difference. One is to provide cooling—air-conditioning—to much of the planet. As a study last week from the Rocky Mountain Institute described:
Between now and 2030, the increase in electricity demand for air conditioning systems alone will exceed that for data centers, one of the fastest-growing energy uses globally. By 2050, cooling electricity demand is expected to match the combined annual electricity consumption of the United States, China, India, Germany, and Japan today.
That’s not optional—at this point, it’s medicine. In those kinds of heatwaves cool air is as important to the human body as water, or food. But, obviously it will drive up demand for energy, which is why, as the RMI experts point out, we need to
Reduce energy use and emissions through super-efficient technologies, improved system design, and better refrigerant management, while scaling next-gen, innovative solutions that lower life-cycle costs and emissions.
All of this is possible—new heat pumps are far far more efficient at cooling air than old AC units, and we can paint roofs, plant trees, and do lots more.
But at the most basic level we have no more important task than converting absolutely everything we can, right away, to sun and wind and batteries, so that we stop pouring carbon into the air and making the problem ever worse. And the horrible part is that we can do this, which makes the fact that we’re not doing it as fast as we can deeply and profoundly immoral. Hell, no one is even asking Americans to do with less, because that is clearly impossible. We’re just asking them to do with slightly different, and save money in the process. Here, for instance, is the latest update from former President Joe Biden’s key energy deployment expert, Jigar Shah, talking about a new method for coaxing more juice through existing transmission lines, which experts call
reconductoring with advanced conductors. Reconductoring replaces the wire on an existing line with advanced conductor technology that carries 50 -110% more current through the same towers, on the same right-of-way, in 18 to 36 months. No new permitting. No land acquisition. Montana-Dakota Utilities reconductored a 15-mile 230 kV line, increased ampacity by 77%, finished a full year ahead of schedule, and came in 40% under cost estimate. The Berkeley and GridLab 2035 study found a national reconductoring program could quadruple the rate of transmission capacity expansion at only 20% higher total system cost—saving $85 billion by 2035 and $180 billion by 2050.
But we have to do it. We have to force our leaders, state by state at the moment since DC is such a disaster area, to actually make these relatively small changes.
A way to look at the work we’re doing together is that we’re trying to build some margin back in. Every gas car that becomes an EV buys us back an inch or two, every furnace that becomes a heat pump, every solar panel and wind turbine that sprouts takes the tiniest bit of pressure off the system.
We were born onto a world with lots of margin, especially those of us who are older. The size of the game board was expanding back then, as we learned new ways to grow and store food and the like. But through shortsightedness and greed we began to shrink that buffer, and now greed and short-sightedness have become the cornerstones of government policy, along with pure and undiluted racism. It’s not like anyone is fooled. Goodman again:
As he sat beneath the shade of a mango tree, its branches sloping toward the river dividing Somalia from Ethiopia, Adan Bare Ali, deputy mayor of Dollow, said his community was suffering from troubles that had been concocted far away. The drought was worsened by climate change—primarily the result of industrial polluters in larger, more powerful nations. The war was the handiwork of foreign actors.
“The situation has become unbearable,” he said. “The American regime is led by a person who really doesn’t care about anything happening outside his gates. The Americans are not honoring their commitment to the world.”
He is right, and we are very very wrong.
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