What I Saw at a Maternity Ward in Kenya After the U.S. Cut Off Food and Foreign Aid

In August, I traveled to Kakuma, Kenya, to try to understand what happened when the U.S. cut off food to the world’s third-largest refugee camp.

Soon after President Donald Trump froze foreign aid on his first day in office, my colleague Brett Murphy and I began hearing from government experts. We learned that despite explicit promises from Secretary of State Marco Rubio that food and other life-saving care would continue during the administration’s review of foreign aid, programs were shutting down, putting millions of lives at risk. I’ve covered health in the U.S. and abroad for 15 years, and Brett has covered both the State Department and public health in the U.S. Brett and I teamed up, interviewing dozens of government officials and aid workers, and pouring over reams of internal government documents. Then, we traveled to Kakuma (and South Sudan) to see for ourselves how these policies were affecting people.

In an investigation we published last week, we wrote about how food rations were slashed throughout the camp of more than 308,000 people. We learned first-hand how the Trump administration’s decision to withhold funding for the World Food Program’s operations in Kenya led children to starve and forced thousands of families to make impossible decisions. One of the groups hit hardest by the cuts was pregnant women.

We arrived on a hot, dry day in August with Kenyan photographer Brian Otieno and went straight to the camp’s only hospital, which is run by the International Rescue Committee. The only physician working the hospital’s wards at the time, Dr. Kefa Otieno (no relation to the photographer), gave us a tour.

As we entered the maternity unit, a large yellow room with around 45 beds, the majority of them occupied, the doctor explained that the aid cuts were causing an epidemic of life-threatening pregnancy complications. Starving women were giving birth to premature babies. Even those who made it to term were often dangerously underweight. The hospital was understaffed, and people in the camp were so anemic that they couldn’t get enough blood donations. Otieno had twice donated himself while he was midsurgery in order to save a pregnant woman’s life.

Off one side of the maternity ward was a small, stark room with a bench along one wall and two wheeled, metal beds. Otieno called it the kangaroo room. Inside were moms and premature babies too small to safely return home. The hospital had no functional incubators, so medical staff ascribe to a method called kangaroo mother care, where moms hold their babies against their skin to keep them warm and help them grow.

There, we met Monica and her baby Mary, and Binti and her son Nuru. Both women had difficult pregnancies that the medical staff ascribed to malnourishment. Both had given birth prematurely to underweight babies. And when we visited, both had been trapped in the room for weeks, desperately trying to help their babies gain weight.

Monica, 21, is funny, with a dry, sharp wit. She met her husband Ramazani at church, when she was singing in the choir. They’d dated for a couple of years before she found out she was pregnant in December last year. They were both scared and excited to be parents, but the timing of the pregnancy was unlucky: As Monica’s belly grew, food rations shrank.

Monica began struggling with anemia and high blood pressure. Otieno told me the roots of these complications were undernourishment. 

Monica doesn’t remember going into labor. Ramazani found her collapsed on the floor when he returned from one of the camp’s community showers. She was having seizures, and it took a few hours before they got her to the hospital. Medical staff rushed her in for an emergency cesarean section; she was in such dire shape that staff thought they were going to lose both Monica and her baby. When we met three weeks later, Monica still struggled to speak, her tongue contorted and swollen from biting on it for so long during the seizures.

Still, she was able to tell me about her pregnancy, including a time when she was about five months along and hadn’t eaten for two days. She went to a nearby vendor to beg for a samosa on loan, promising to pay him back later in the day. She then hid in her house for several days, pretending no one was home when he came by to collect the few cents she owed. (Ramazani eventually paid him back.)

At age 28, Nuru was Binti’s third child. She’d had no complications with her previous pregnancies, but with Nuru, she barely gained weight. Binti had come to Kakuma in 2016 after fleeing violence in the Democratic Republic of Congo. When she first arrived at the camp, there was always food.

“I had other kinds of stress, but never with food,” she said one afternoon while sitting on the floor sewing curtains for the sparse hospital room.

But during this pregnancy, she said, food was all she thought about. She was so anemic and hungry that she resorted to eating clay, digging out the top layer of earth to get to the cleaner soil below, and charcoal. Her chart showed she gained fewer than 10 pounds during her entire pregnancy. Her baby, Nuru, was born at 33 weeks, weighing about 3.5 pounds.

Otieno wanted the babies to weigh 4 pounds before they went home, enough that they’d have a fighting chance against infection. Hospital staff put the babies on a scale every two days, and before each weigh in, Binti would get herself hyped up: “I can feel it, today is the day we are going home,” she said one afternoon. Monica tried not to think about what the scale would say. Both she and Mary had dropped weight in the preceding weeks. After so much loss, she didn’t want to get her hopes up.

But, while Binti and Monica were desperate to get out of the hospital and home to their families — Binti to her other children and Monica to her two younger siblings — leaving would come at a cost. If and when they went, they’d be cut off from food again. 

At the hospital, staff brought around three simple meals every day, typically lentils and rice or sorghum porridge. Outside the hospital, they’d have almost nothing.

Facing dwindling supplies, WFP, which provides food for the camp, made the dramatic decision to only give rations to about half the camp’s residents in August. Families were placed into groups based on rough estimates of need. Even though Monica and Binti were stuck in the hospital precisely because they didn’t have enough to eat, Binti and Ramazani had both been placed in categories that meant they would get no food. Monica and her younger siblings were set to receive just 420 calories a day each.

In the meantime, Binti and Monica bonded: They told stories and held one another’s babies while they showered or went to the bathroom. They took turns sleeping on the bench so the babies could have one of the beds. Monica and Ramazani, who spent almost every night at the hospital, made sure that a tiny copy of the Bible was always placed next to baby Mary’s head.

One Saturday morning, Otieno came in to weigh the babies. Binti bounced back and forth on her feet like a boxer preparing for a bout. Nuru weighed in at just under 4 pounds. Binti raised her arms in victory: They could go home.

Then it was baby Mary’s turn. “This baby is refusing to gain weight,” Otieno mumbled, trying to still her wiggly legs to get an accurate measurement. Mary had gained 10 grams, equivalent to two-thirds of a tablespoon of water. After days of losing weight, it was perhaps a small victory, but not one that Monica would celebrate. She picked up Mary, held her against her chest, and sat back down on the bench.

I asked Monica about her hopes for the future. She said all she wanted was to be resettled in the U.S. with her siblings and Mary, so they could all go to school and have enough to eat. “Fill your notebook with that,” she said. “It’s the only thing I want.”

At the end of September, the administration gave WFP’s Kenya operations $66 million, 40% less than the U.S. gave in 2024 and nine months into the year. WFP has said the funds will be enough to provide food to the camp through March, though rations are still far below what humanitarians consider the daily minimum of calories. 

In response to a series of questions, a senior State Department official told us that the U.S. still gives WFP hundreds of millions a year and the administration is shifting to investments that will better serve both the U.S. and key allies like Kenya over time. 

The official also said that the Office of Management and Budget, not the State Department, has ultimate authority to approve new foreign aid money. When we asked OMB about the delays, communications director Rachel Cauley told us: “That’s absolutely false. And that’s not even how this process works.” She did not clarify what was false.