A USAID shipment of antimalarial medication, containing enough medicine to treat tens of thousands of children, arrived in the Democratic Republic of Congo in December.

But 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-yearold Suza Kenyaba contracted malaria, the medicine was not available.

She died Feb. 19.

In the first half of the year, hundreds of USAID shipments of antimalarial and HIV medical supplies arrived late at regional warehouses in dozens of countries.

Many did not arrive at all.

Help never came

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 U.S.-taxpayerfunded program, was tantalizingly close — a little more than 7 miles away. But it hadn’t reached the clinic where Suza was being treated because President Donald Trump’s suspension of foreign aid had thrown supply chains into chaos.

The injections Suza needed had traveled thousands of miles 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 Program that ship antimalarial 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 $190 million were scheduled to arrive at distribution warehouses by the end of June. Instead, the analysis found, shipments worth nearly $76 million 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 $63 million 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 U.S. 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 $900 million, this part of the pipeline is the logistics backbone that handles shipments of medical supplies under two key programs: the U.S. 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 program.

In an April 21 cable reviewed by the Post, Lucy Tamlyn, the U.S. ambassador to Congo, warned officials in Washington and elsewhere that the “abrupt elimination” of PEPFAR-supported programs 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.”

Deliveries slow

More than 1,600 orders were scheduled to be delivered by the end of June. One order, for example, contained almost $1.5 million of HIV antiretroviral medication; another, $199,000 of antimalarial 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.

On Sept. 23, Secretary of State Marco Rubio defended the administration’s aid policies during an interview with ABC’s George Stephanopoulos, saying programs are being restructured to be more efficient and blaming other countries for not doing more.

“No one has died because the United States has cut aid,” Rubio said.

Pipeline thrown into chaos

In their first days back in power, Trump administration officials said many U.S. foreign aid programs were at odds with American interests and values.

Elon Musk, who championed contentious federal spending cuts through the U.S. DOGE Service, called USAID a “criminal organization” in a post on X, adding it was “Time for it to die.” Rubio, who was appointed to oversee USAID, told reporters that its programs “run counter to what we’re trying to do in our national strategy.”

The impact of the freeze, implemented through stopwork 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 age 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 Jan. 28. Chemonics, the D.C.- based contractor that operates the Global Health Supply Chain Program, received waivers in the first week of February to resume the distribution of some medical supplies for HIV treatments and malaria. Smaller programs that also used the pipeline remained frozen, including those focused on family planning and maternal and child health — efforts deemed contrary to U.S. values.

Rubio said in a Feb. 10 interview that “hiccups” regarding the restarted programs would be resolved quickly. “We’re not walking away from foreign aid,” said Rubio . “ 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.

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 U.S. 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 because they, like several others quoted in this article, were not authorized to speak publicly.

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 3,500 USAID employees on administrative leave and eliminated more than 1,600 positions at the agency, USAID told Congress, as Rubio looked to reorganize and then shutter the agency. Staffers with the U.S. DOGE Service slashed staff, programs 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 Feb. 28 memo from Nicholas Enrich, then the bureau’s acting assistant administrator.

Other logistics programs 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 program that would have been involved in delivering the medication Suza needed.

Missing medicine

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 nonexistent. Clinics were overwhelmed. About 60,000 people were dying from the disease each year, according to estimates from the U.N. program UNAIDS.

PEPFAR for the first time made testing and treatment widely available. Regular shipments of free antiretroviral 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 U.S. offi cials in the April 21 cable that also warned about drugresistant HIV strains. More than 2,000 babies born to HIV-positive mothers spent their first year disease-free with PEPFAR’s support, Tamlyn noted.

But that support was interrupted in the first half of this year: Only two of six large shipments of pediatric antiretroviral medication destined for Congo had been delivered to regional warehouses by the end of June, according to the Post’s data analysis.

In Lualaba, one of two mineral-rich provinces in the south where USAID has long provided free antiretrovirals, 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 neighborhood squeezed between towering mounds of mining waste in Kolwezi, the provincial capital.

Gilbert’s mother, Lauraine Kapalanga, 33, said 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 Feb. 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.

Gilbert started to get sick, Kapalanga said. He had bouts of belly pain, then a fever. 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, where he tested positive for malaria. He was treated with quinine — the only antimalarial medication the clinic had in stock, according to the head nurse — and sent home.

A week later, Gilbert began vomiting, and Kapalanga r eturned to the clinic, where Gilbert was admitted w ith severe malaria and a 103-degree fever. Kapalanga h ad 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 realized he had grown weak over some time as a result of not taking [pediatric HIV medicine],” Mukungwa said. “The deep breathing, the fast death, that was the malaria, but the big problem was HIV.”

Less than 4 miles from the hospital where Gilbert had gone for his prescription, a regional warehouse used by USAID’s Global Health Supply Chain Program 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 $50 million in U.S. health commodities stuck in warehouses.

No decision had been made as far as the embassy was aware, according to the cable.

A surge in malaria deaths

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. His clinic r equested 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 .
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 Feb. 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 yards 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 $10 a dose — put it out of reach for many poor families.

Kolongosola said 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 104, 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.

Less than 10 miles 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 . Quarterly shipments to local distribution points had not yet left the warehouse when the freeze was imposed in January, records show.

The delivery of USAID antimalarial medication was underway again in May, according to two people with knowledge of the situation. Government figures show more than 600 deaths from malaria in the first half of 2025 in Haut-Katanga alone, more than i n all of 2024.

Uncertain future

On July 1, oversight of the Global Health Supply Chain Program transitioned from USAID to State Department staff.

The number of employees dedicated to the program appears to have shrunk dramatically.

Almost two months after the transition, fewer than 10 people at State focus solely on the program, 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 programs that provided clinical care for HIV remained canceled, a USAID document reviewed by The Post showed.

Among them were programs that Tamlyn, the ambassador, warned in April could jeopardize the lives of 28,000 adults and 2,500 children in PEPFARsupported provinces if not restored.

One of those programs 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-monthold 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 prioritize?”