In August, I traveled to Kakuma, Kenya, to try to understand what happened when the United States cut off food to the world’s third largest refugee camp.
Shortly after President Donald Trump froze foreign aid on his first day in office, my colleague Brett Murphy and I began hearing from government experts. Despite Secretary of State Marco Rubio vowing that food and other life-saving care would continue during his administration’s foreign aid review, the program was shut down and millions of lives were found to be at risk. I have covered health in the United States and abroad for 15 years, and Brett has covered both the State Department and U.S. public health. Brett and I teamed up to interview dozens of government officials and aid workers and pour over tons of internal government documents. We then traveled to Kakuma (and South Sudan) to see for ourselves how these policies are affecting the people.
In our research report published last week, we wrote about how food rations have been cut across the camp, which is home to more than 308,000 people. We learned firsthand how the Trump administration’s decision to withhold funding from the World Food Program’s Kenya operations left children going hungry and forced thousands of families to make impossible decisions. One of the groups hardest hit by the cuts was pregnant women.
We arrived on a hot, dry August day with Kenyan photographer Brian Otieno and went straight to the camp’s only hospital, run by the International Rescue Committee. Dr. Kefa Otieno (no relation to the photographer), the only doctor working in the hospital’s ward at the time, showed us around.
Dr. Kefa Otieno (right) was the only doctor working at Kakuma’s hospital through most of August. Otieno is caring for an infant in the maternity ward. Dr. Kefa Otieno (right) was the only doctor working at Kakuma’s hospital through most of August. Otieno is caring for an infant in the maternity ward.
When we entered the maternity ward, a large yellow room with about 45 beds, most of them occupied, the doctor explained that aid cuts were causing an epidemic of life-threatening pregnancy complications. Starving women were giving birth to premature babies. Even those who were able to carry their babies to term were often dangerously underweight. Hospitals were understaffed and people in the camp were anemic and did not receive enough donated blood. Otieno donated twice during surgery to save a pregnant woman’s life.
Two women hug each other in front of the obstetrics and gynecology department. Two women hug each other in front of the obstetrics and gynecology department. Otieno performs a caesarean section.
On one side of the maternity ward was a small, bleak room with benches and two-wheeled metal beds along the walls. Otieno called it the Kangaroo Room. Inside was a mother and her premature baby, who was too small to return home safely. Because the hospital didn’t have a functioning incubator, medical staff believed in a method called kangaroo mother care, in which mothers hold their babies close to their skin to keep them warm and help them grow.
Otieno speaks to the patient. Otieno speaks to the patient.
There we met Monica and baby Mary, Binti and her son Nur. Both women had difficult births, which medical staff attributed to malnutrition. Both babies were born prematurely with low birth weight. And when we visited, both of them had been locked in their rooms for weeks, desperately trying to help their baby gain weight.
Monica feeds Mary. Monica feeds Mary. Monica and her husband Razani. They met at church when she was singing in the choir. Monica and her husband Razani. They met at church when she was singing in the choir.
Monica, 21, is funny and has a dry, sharp wit. She met her husband Ramazani in church when he was singing in the choir. The two dated for several years before finding out they were pregnant in December last year. We were both anxious and excited about becoming parents, but the timing of the pregnancy was unfortunate. As Monica’s belly grew, the amount of food she received decreased.
Monica began suffering from anemia and high blood pressure. Otieno said the cause of these complications is malnutrition.
Monica doesn’t remember her contractions starting. Ramazani found her lying on the floor when he returned from the camp’s community shower. She had a seizure and it took several hours to get her to the hospital. Medical staff rushed her to the hospital for an emergency caesarean section. Her condition was so dire that staff thought they would lose both Monica and the baby. When we met three weeks later, Monica was still struggling to speak and her tongue was distorted and swollen from biting it for so long during the attack.
Still, she was able to tell me about her pregnancy, including the time she was about five months pregnant and hadn’t eaten for two days. She begs a nearby peddler to lend her some samosas and promises to return them the same day. She then hid at home for several days, pretending no one was home when he came to collect the few cents she owed him. (Lamazzani eventually paid him back.)
Nur, 28, was Binti’s third child. I had no complications in my previous pregnancies, but I gained very little weight when I was null. Binti came to Kakuma in 2016 after fleeing violence in the Democratic Republic of Congo. When she first arrived at camp, there was always food there.
Binti and her son Nuru. The third child gained almost no weight. Binti and her son Nuru. The third child gained almost no weight.
“I’ve had other kinds of stress, but never with food,” she said one afternoon, sitting on the floor sewing curtains in her sparse hospital room.
But during this pregnancy, she said, all she thought about was food. She was so anemic and hungry that she resorted to eating clay, digging up the top layer of soil to get clean soil underneath, and eating charcoal. According to her chart, she gained less than 10 pounds during her pregnancy. Her baby Null was born at 33 weeks and weighed approximately 3.5 pounds.
Otieno wanted the baby to weigh 4 pounds so it would have a good chance of fighting off infection by the time she went home. Hospital staff put the baby on the scale every two days, and Binti felt excited before each weighing. “I feel like today is the day I’m going home,” Binti said one afternoon. Monica tried not to think about what the scale said. Both she and Mary had lost weight in the previous weeks. After losing so much, she didn’t want to get her hopes up.
Monica feeds Mary. anna maria barry jester
But while Binti and Monica are desperate to get out of the hospital and home with their families, Binti with her other children and Monica with her two younger brothers, leaving the hospital comes at a price. If they left, they would be deprived of food again.
At the hospital, staff brought in about three simple meals each day, usually lentil and rice or sorghum porridge. There will be almost nothing outside the hospital.
Faced with dwindling supplies, WFP, which provides food to the camp, made the dramatic decision in August to provide food to only about half of the camp’s residents. Families were divided into groups based on rough estimates of need. Monica and Binti were confined to the hospital precisely because they didn’t have enough to eat, but Binti and Ramazani were both in the inedible category. Monica and her younger brothers were each set to consume only 420 calories per day.
Women receive porridge for breakfast in the maternity ward. Women receive porridge for breakfast in the maternity ward. Refugees line up at a World Food Program distribution point in Kakuma in August.
During that time, Binti and Monica developed a bond. We told stories and held each other’s babies while we showered and went to the bathroom. They took turns sleeping on the bench so the babies could use one of the beds. Spending almost every night in the hospital, Monica and Razani made sure to keep a small Bible next to little Mary’s head.
Monica places the Bible next to Mary. Monica places the Bible next to Mary.
One Saturday morning, Otieno came in to weigh the baby. Binti bounced back and forth on his feet like a boxer preparing for a fight. Null weighed just under 4 pounds. Binti raises his arms in triumph and says he can go home.
After Otieno weighs her, Binti holds Nuru. After Otieno weighs her, Binti holds Nuru.
Then it was baby Mary’s turn. “This baby is refusing to gain weight,” Otieno murmured as she tried to move her shaky legs to get accurate measurements. Mary’s weight has increased by 10 grams, which is the equivalent of two-thirds of a tablespoon of water. After days of losing weight, it was probably a small victory, but not one that Monica would be happy about. She picked Mary up, held her close to her chest, and sat back down on the bench.
I asked Monica about her hopes for the future. All she wanted, she said, was to resettle her brother and Mary in the United States so they could all go to school and have enough to eat. “Write it in your notebook,” she said. “That’s all I want.”
Monica and Otieno weigh Mary. Monica and Otieno weigh Mary.
At the end of September, the administration awarded WFP’s Kenya operations $66 million, 40% less than what the United States would give in 2024 and nine months later. WFP says the funding is enough to feed the camps through March, but the rations are far below what humanitarians consider a minimum daily calorie count.
In response to a series of questions, a senior State Department official said the U.S. still contributes hundreds of millions of dollars a year to WFP, and the administration is moving toward investments that have better long-term benefits for both the U.S. and key allies such as Kenya.
The official also said the Office of Management and Budget, not the State Department, has the ultimate authority to approve new foreign aid money. When we asked OMB about the delay, Communications Director Rachel Corey said, “That’s completely false. And that’s not even how this process works.” She did not reveal what was false.
