A loving father and his daughter (who is HIV+) wait to visit/visit a doctor at the Bukoba Regional Hospital, Tanzania.
USAID: The End of a Lifeline in Africa
In 2014, I documented HIV, tuberculosis, and malaria treatment programs, as well as nurse and doctor training initiatives across Africa, focusing on how investments in health had significantly improved well-being across the continent. What I witnessed was remarkable—unlike anything I had seen in my many years working there. Investments in equipment and infrastructure had transformed entire hospitals, equipping them with modern technology and hygienic facilities. My work reflected not just a continent in need but one progressing toward prosperity, even as challenges remained.
These photos capture that progress—many of those pictured were living with HIV yet leading healthy, fulfilling lives, a testament to the impact of sustained investment in public health. The majority, if not all of these locations received funding from USAID and no longer do.
A decade earlier, at the height of the HIV pandemic, I had seen entire villages devastated and was deeply critical of my own nation’s inaction. Yet, under a president with whom I profoundly disagreed, a transformation in global public health took shape. Through the President’s Emergency Plan for AIDS Relief (PEPFAR), launched by George W. Bush, along with USAID, I saw firsthand the immense return on investment—lives saved, medical infrastructure built, and goodwill toward the United States heightened. Beyond being sound public policy, these efforts were also a strategic move at a time when multiple global actors sought to diminish the U.S.
Rural Health Motivators visited homes in remote areas, engaging women in conversations about health. When the COVID-19 pandemic struck, these same healthcare workers walked those familiar roads, playing a crucial role in slowing the spread of the virus.A young man is tested for HIV. (Rapid test result: negative.) Rural outreach teams goto great lengths to test people for HIV in their homes and council them on how to live healthy lives surrounding the Lake Victoria region.A blood sample for tuberculosis. Modern, refrigerated facilities have made tests much more accurate and even feasible, as equipment before USAID investments was lacking.The Nicoadala District Mobile Clinic with decals of participating organizations from the United States and globally.The laboratory room with GeneXpert machine (rapid test TB) and lab technician in the TB clinic at TEBA headquarters in Maseru.The x-ray room in Mwanyamala Hospital, Dar es Salaam, Tanzania.Student training at Mwanyamala Hospital, Dar es Salaam, Tanzania.
Bishoftu Hospital, Ethiopia.
Bishoftu Hospital, Ethiopia
A pregnant woman receives a checkup from a male midwife at Bishoftu Hospital, Ethiopia.A community-based ARV distribution program in Nicoadala District, Mozambique, operated through a network of women who gathered weekly to collect antiretrovirals and distribute them to surrounding villages. This system later proved essential during the COVID-19 pandemic, as the established networks helped curb the spread of the virus and deliver aid to those who fell ill.A rural patient is given ARV refills at a clinic in Berea District, Leshoto.A woman and her daughter is visited by a TEBA Care supporter in her house. Households are visited of those miners that are diagnosed with TB. HCW’s also visit family members who might be infected because they share the house with the infected miner. TEBA Supporters also sign up people with a cell phone so that they can easily be reached to check their status and see if they are taking their medications.A woman pumps water at the CMS Gbagbam-Faith based clinic, Ivory coast. USAID has contributed significantly to improving access to drinking water in Côte d’Ivoire, particularly through its programs targeting both urban and rural areas.Mother and mentors coffee ceremony at Bishoftu Hospital, Ethiopia.Mother and mentors coffee ceremony at Bishoftu Hospital, Ethiopia.Mothers wait on benches at the clinic where their sons went to be circumcised in a rural village near the Kagera Sugar Company, Bukoba, Tanzania.This is young women is of the many who benefitted from USAID. Walking down a rural road in Leshoto, she was making her way to a clinic. She wanted to make sure that she was healthy and safe for those she chose to be with and was going to get tested for HIV.HIV+ Women dance as a act of supporting supporting each other in Berea in Hospital, Swaziland.HIV+ children play in the waiting area of the pediatric clinic of the Bukoba Regional Hospital, Tanzania. HIV is no longer the life ending disease it used to be. Great strides have been made to treat children such as these to that they can lead healthy and happy lives..HIV+ teens attend informational sessions at the Baylor Teen Clinic where they also play football and dance. The clinic happens every Saturday and is essential of these boys and girls lives. It is the one of the few places where they can get to gather and not have to worry about the stigma of being HIV+. They support each other and bring each other in in a welcoming and free manner.
Port au Prince, April 6 2010 The Petionville golf course, once a retreat for wealthy Haitians and foreigners, became an IDP camp after the 2010 earthquake, where USAID played a substantial role in tent distribution and food aid—USAID’s role in Haiti was deeply flawed, including a $140 million food program that ultimately harmed Haitian farmers by undermining local agricultural production.
USAID: Imperfect Aid, Essential Relief
In post-disaster scenarios, I often found myself deeply critical when I saw the USAID logo emblazoned on tents and cans of food. Given the immense wealth of the United States, these contributions felt insufficient compared to the dire conditions in which refugees and internally displaced people were forced to live—and yet without it millions would have been dead. Over 20 years, I documented this flawed and essential in aid in Kosovo, Albania and Pakistan, amongst other nations. No country illustrates both how essential and flawed it was than Haiti, following the 2010 earthquake. USAID allocated approximately $2.3 billion for reconstruction and development. However, only about 2 percent of these funds—just over $48 million—were awarded directly to Haitian organizations, with the majority going to firms in Washington, D.C., Maryland, or Virginia. Over my
At the same time, despite my government’s contradictory policies in many of these regions which exasperated the need and deepened poverty, USAID’s help (however much of a bandaid, and a small one at that)remained absolutely essential. Those who have since dismantled the agency were well aware of its flaws. However, their mandate should have been to address these shortcomings and implement meaningful reforms, not to erase the institution entirely.
Muzaffarabad, Pakistan, November 25, 2005 Under president George W. Bush, The U.S. responded Pakistan’s October 8, 2005, earthquake, pledging $50 million for initial relief and reconstruction. Assistance included emergency shelter, food, water, medical supplies, and military support, with ongoing coordination to address evolving needs.Mapou, Haiti, May 30, 2004 Wheat distributed by US Central command to displaced Haitians following the 2005 flooding which killed over 1,000 people in this rural village.Bara Kau, Pakistan, November, 2, 2005
USAID/OFDA in Washington committed $1 million to be provided through the American Red Cross in response to a Preliminary Emergency Appeal issued by the International Federation of Red Cross and Red Crescent Societies. This was in addition to the $100,000 announced yesterday by the U.S. Embassy in Islamabad.Port au Prince, Haiti, Petionville IDP Camp, April 8. 2010 Despite its significant shortcomings, USAID played a crucial role in distributing food and tents in this camp after the 2010 earthquake.Mapou, Haiti May 30, 2004 Children look at marine Chinooks as US Central Command distributed food.Mapou, Haiti, May 30 2024 A boy holds a handful of rice as U.S. Central Command distributes food aid.Port Au Prince, May 31, 2004 Following the February 2004 ousting of President Jean-Bertrand Aristide, Haiti was plunged into political turmoil. Concerned about potential mass migration to the U.S., President Clinton deployed the U.S. military under the pretext of maintaining order. In this image, U.S. Marines search young men for contraband—an act that, in practice, often amounted to routine harassment rather than genuine security enforcement.Port Au Prince, May 31, 2004 Rations from USAID and the World Food Program were sold on the street, although they were intended solely for humanitarian assistance.Mapou, Haiti, May 30 2024 Humanitarian assistance that was delivered by US Central Command was distributed by the Red Cross.Port Au Prince, May 31, 2004 U.S. Marines and Canadian forces await a Chinook helicopter delivering humanitarian aid to flood-stricken Mapou. Given the region’s extreme poverty and urgent need, the militarized response was excessive. In Haiti, a country with a long and fraught history of foreign military interventions, the heavily armed presence of U.S. and Canadian forces during the Mapou flood relief effort was both appreciated and felt more imposing than reassuring to many.Kukes, Albania, March 1999 While food distribution from donor states is essential, it does not come without arrogance from the agencies that deliver it; pictured here, an unknown aid worker tosses aid to the desperate. Arrogance aside, the U.S. Department of Defense shipped 500,000 Humanitarian Daily Rations (HDRs) to Albania, while USAID/OFDA contributed an additional 300,000 HDRs to support food distribution efforts.Kukes, Albania, March 1999 USAID coordinated closely with the UN World Food Program (WFP) and other NGOs to ensure food supplies reached refugees in camps and host communities.Kukes, Albania March 1999 14,000 tons of food per month were supplied by the U.S. government (including USAID) for distribution to refugees in camps and those staying with host families in Albania. Family food packs, airlifted from Utah, were distributed to 3,000 refugee families. These packs included essential items like rice, wheat, and cooking oil.Central Haiti, Early June, 2004. After Hurricane Alex hit Haiti thousands where left homeless and hunderds where killed when their village, Mapou, was flooded. With food supplies already dangerously low (the countryside has been been destroyed and therefor people cannot grow their own food) thousands risked starvation. Aid was distributed by the United States and The Red Cross.Central Haiti, November 2010 Already reeling from the January 12 earthquake and an influx of foreign aid that undercut local farmers, Haiti was further devastated by heavy storms, which caused severe flooding, particularly in the western regions. Pictured: A flooded field as a man carries a bag cooking charcoal.Muzaffarabad, Pakistan, November 25, 2005 A mother and her daughter boil water for cooking. While the 2010 earthquake claimed over 230,000 lives, a harsh winter loomed, threatening even more casualties. A concerted global effort—led in part by the U.S.—became critical. Without winterized tents, deaths from exposure were expected to surpass those from the quake, making rapid intervention essential. Thanks to contributions from USAID and other international partners, that crisis was largely averted.Panjgran, Pakistan, November 15, 2005. Panjgran, a remote village in Punjab Provience, was among the most vulnerable, accessible only by helicopter and lacking tents before aid arrived. Here, residents receive blankets and supplies from Médecins Sans Frontières (which does not accept government funding) to prepare for the winter. However, the United States’ contribution cannot be overlooked or discounted: USAID provided $41.8 million in aid, including airlifts of 45,000 blankets, 1,570 winterized tents, water purification units, and other essential supplies.Kukes, Albania, March 1999. After crossing the border from Kosovo to Albania a woman departs to a destination unknown. USAID provided critical aid to Kosovar refugees, including emergency shelter, food, medical assistance, and clean water, helping thousands survive displacement and harsh conditions. Muzaffarabad, Pakistan, November 25, 2005 A girl blows on the last ember of a fire along the Jehlum river. Without the support from USAID she very likely would not have survived through the winer.
