A $45 treatment can save a starving child

The women walked miles through the dusty streets of Maiduguri, in the northeastern corner of Nigeria, carrying their emaciated children. At 7 am, they began lining up to wait, for hours, to be handed a small red packet containing a special paste that could bring their children back from the brink of starvation. The children were eerily listless; they did not run, shout or even swat the flies off their faces. Their tiny, frail frames made many appear years younger than they were. Near the head of the line, Kaltum Mohammad clutched her 2-year-old daughter, Fatima, who weighed just 16 pounds.

Women and children like these waited for treatments in the half-dozen camps and clinics visited by The New York Times last November. Now, six months into the US’ withdrawal of foreign aid, many of the sites are closed, some permanently. At others that remain open, rooms once filled with boxes of the lifesaving packets are close to empty. Starvation in the Gaza Strip has brought intense international attention to the horrors of famine, but less attention has been paid to a wider issue: The dismantling of the US Agency for International Development has worsened the problem of severe hunger and malnutrition throughout the world. Saving children with severe acute malnutrition is simple and inexpensive. Each packet costs less than 30 cents but contains a high-calorie mix of peanuts, sugar, milk powder and oil — flavours appealing to children — and a blend of vitamins and minerals. A complete six-week treatment for a severely malnourished child runs less than $45.

USAID funded roughly half the world’s supply of ready-to-use therapeutic food, or RUTF, purchasing some directly from US manufacturers and funding the United Nations Children Fund, or Unicef, to manage its distribution. All those grants were abruptly halted when the Trump administration froze foreign aid earlier this year.

Funds for 2025 have yet to be released to manufacturers; the World Food Programme, which distributes a similar product for moderate acute malnutrition; those who transport the products; or the many organisations, like the International Rescue Committee or Helen Keller International, that run the malnutrition programmes.

In response to questions from the Times, the State Department emailed a statement asserting that lifesaving malnutrition programmes “remain a priority.” “Malnutrition treatment is among the first new obligations of foreign assistance funding,” the statement said. But it also said that “other actors — including national governments and international humanitarian organisations — must step up.”

President Donald Trump has made the same argument for many aid programmes, saying the United States should not have to carry the bulk of the burden of caring for the world. Although other countries do already contribute, and some organisations are scrambling to fill the gap, it is unlikely that they can do so quickly enough to help the children who are now in need.

Now boxes containing millions of dollars’ worth of the lifesaving packets are stuck at every link in the supply chain: in manufacturers’ warehouses, at shipping companies, in cities that received the shipments and in treatment centres that have shut down all over the world. In nearly a dozen countries, the supply chain for the packets has become so unstable that thousands of children are at high risk of dying, according to organisations that help distribute the treatments. Tens of thousands more could be in danger in the coming weeks and months if funds for this year do not move quickly.

Increasingly, some governments such as Nigeria, Kenya and Burkina Faso have been contributing by hosting factories that manufacture the packets. The Child Nutrition Fund, started by Unicef, the British government and others, encourages governments to finance supply by offering a 1:1 match for every dollar. Before the sudden withdrawal of aid, “things were absolutely moving in the right direction,” said James Sussman, a spokesperson for the International Rescue Committee.