When a billionaire told his staff to feed an agency "into the wood chipper," he was not speaking metaphorically. Hundreds of thousands of people are dead as a result.

"Now we're seeing conservative estimates show that 750,000 people have already died, most of those are children, and that's within the first year. And unfortunately, what we're learning is that really this is just the tip of the iceberg."

— Nicholas Enrich, former Director of Policy for Global Health at USAID

The phrase came from a tweet, the way so much of this administration's worst damage has. Elon Musk wrote, with visible glee, that he had spent the weekend feeding USAID "into the wood chipper." He was referencing the United States Agency for International Development, the federal agency that had spent six decades distributing foreign aid to over 100 countries and, according to its own records, saved more than 92 million lives in the last two decades alone.

Musk had never mentioned USAID in his entire public career until a conspiracy theorist named Mike Benz appeared on the Joe Rogan podcast and claimed the agency was a front for the CIA. Musk, who knows nothing about international development, repeated the lie. Then he was given the authority to act on it.

The former USAID official who bore witness to the destruction from the inside was Nicholas Enrich, who served as the Director of Policy, Programs, and Planning for Global Health. He wrote about what happened in his book, Into the Wood Chipper: A Whistleblower's Account of How the Trump Administration Shredded USAID.

His account describes a pattern that repeated itself across every bureau: political appointees who knew nothing about the agency's work, who had formed their opinions from right-wing conspiracy theories, were handed authority over programs they could not understand. When Enrich tried to explain malaria prevention to a senior political appointee, he was told to make "Barney-style slides" so non-health people could understand. When he pushed to restart Ebola response activities during an outbreak in Uganda, another appointee told him Ebola was a scam.

Translation: the people who held the power to save or kill millions of people did not think infectious diseases were real, and they had no intention of spending the time to learn otherwise.

Enrich was elevated to lead Global Health with a simple directive: focus his entire team on restarting lifesaving activities under a narrow waiver the State Department had issued. In practice, the administration made this impossible. They scaled back what qualified as lifesaving, slashed staff, broke the payment system that moved funds to the field, and then terminated the contracts required to deliver services. All while publicly claiming they had preserved essential humanitarian work.

The human cost shows up in places the American media barely covers. In Sudan, families walked all day to USAID-branded clinics expecting food and medical supplies, only to find the doors locked. Pregnant women perished when the ambulance services that served them were cut off. In countries with high HIV infection rates, testing fell by 22 percent and condom funding was slashed by more than 90 percent in some places, according to data released in June by the UN agency that fights HIV.

But the story that crystallizes what has been lost is one The Associated Press reported from Nepal, where the destruction of USAID funding did not just cut off services. It destroyed livelihoods, and then it destroyed the people who depended on them.

Rubi Lama spent nine years as an HIV outreach worker with an NGO called Friends Hetauda, helping Nepal's most marginalized communities, including the LGBTQ+ sex workers who service travelers along the country's highways. She earned roughly 30,000 Nepalese rupees per month, about $200, enough for a one-room apartment. In February 2025, she walked into her office and learned her funding was gone. The USAID freeze had wiped out her employer's budget overnight.

Nepal has virtually no legal employment for openly transgender people. Lama applied for local government jobs she was initially promised, only to be rejected in person once her employers learned of her gender identity. A hotel manager offered her a cleaning position, then groped her during training and made sexual demands. She refused and was fired.

She started skipping meals. Her landlord threatened eviction. She could no longer afford medicine or rent.

She began walking the same stretch of highway where she once tested sex workers for HIV. Now she was standing where they stood, waiting for clients, trying to earn $3 per customer. Her rent was $80 for the month.

Lama is not an outlier. According to Arjun Bhattarai, president of the NGO Federation of Nepal, roughly 35,000 aid workers lost their jobs in Nepal after the USAID cuts. Across the world, the total was more than 280,000, with only 23,000 of those jobs held by Americans.

The Blue Diamond Society, Nepal's largest LGBTQ+ advocacy organization, received 85 percent of its funding from USAID and employed 350 staffers, most of them gender and sexual minorities themselves. They ran 20 clinics across Nepal, dispensing antiretroviral medication and PrEP to prevent HIV infection. When the funding disappeared, all 262 of their field workers were let go. More than 1,200 clients lost access to PrEP.

Manisha Dhakal, the society's executive director, estimated that between 35 percent and 45 percent of those former aid workers turned to sex work. It was the only viable employment available to transgender people in Nepal.

Aashika Tamang, who spent 16 years in HIV prevention, said she now encounters the sex workers she once counseled, but only at night. "I used to meet them during the day," she said. "Now I meet them during the night."

The violence these women endure is routine. Lama had a knife held to her throat. Barsha Magar was held at gunpoint and raped by two soldiers in the jungle. Sujata Chaudhary was taken against her will to a hostel where she was gang-raped by at least eight men. Bharati Thapa was gang-raped on her very first night on the street.

They use the skills they learned as health counselors to survive. Lama talked a man down by warning him about HIV risk. Chaudhary explains the dangers of unprotected sex to clients who try to force it. Sometimes the men back down. Sometimes they do not.

The State Department issued a statement to the AP defending the cuts, saying the Trump administration had "reinvigorated its assistance programs to focus on efficiency, effectiveness, and partnership," and that "the rest of the world needs to contribute more and share the burden."

The problem with that statement is that USAID was already widely considered one of the most efficiently run agencies in the federal government. It operated on less than 1 percent of the federal budget. Every payment, no matter how small, was audited and verified before funds were released. The anti-fraud systems were the most rigorous in government. DOGE did not improve those systems. It broke them.

Musk's response to criticism about the human cost has been characteristically unhinged. When Democratic Rep. Ro Khanna said Musk needed to be held accountable for the deaths caused by his actions at DOGE, Musk responded by threatening to sue. He did not offer data, explanations, or evidence of efficiency gains. He offered a lawsuit.

Enrich's estimate of 750,000 deaths comes from conservative tracking of what happens when preventable diseases are left untreated. Children who do not receive immunizations. Pregnant women who cannot access antiretroviral drugs to prevent mother-to-child HIV transmission. People with drug-resistant tuberculosis who are cut off from clinical trials, creating new untreatable strains of an airborne disease. The Ebola outbreak in Uganda where passengers were not screened at airports because there was no funding for the screening program.

Enrich said the full effects will not be visible for another four years. The babies who are being born right now without vaccines, the children who will contract HIV in clinics where the rates were near zero a year ago, the pandemic early warning systems that were dismantled and never rebuilt.

The question is not whether this was intentional. Musk was gleeful about it. The question is whether anyone in Washington was willing to tell him that feeding an agency into a wood chipper was not a metaphor, and whether they cared that the chips were human beings.

Lama stands on the side of the highway in Nepal, in the same spot where she once tested clients for HIV, trying to earn enough to survive one more month. She knows the road she is on. She knows it will likely kill her. But without a new source of funding for the work she once did, there is no other road.

She was trying to save other people's lives. Now she needs someone to save hers, and no one is left who can.

usaid, trump, global health, musk