BBC South Asia Correspondent
BBCWhen Kajol contracted tuberculosis in January, USAID kept her alive. Now she and her family are in danger again after the Trump administration ordered most US aid spending to end.
Tuberculosis can be fatal if left untreated. The very contagious fungal disease, which typically infects the breathing, is not common in rich countries, because treatment is relatively inexpensive. But in Bangladesh, it is a plague.
That’s especially so in towns such as Mohammadpur, a tenement in the investment Dhaka where Kajol, 17, life.
” We are weak people”, she says. She is the single father for herself, her mother and little nephew. Her job in a garment shop keeps them all upright.
But when she fell poor in January, it could have been fatal.
Otherwise, support arrived through Dipa Halder. For the last three decades, she has been canvassing the inhabitants of Mohammadpur about TB and getting people the care they so desperately need, free of cost.
The program is run by a native help company, Nari Maitree. It was funded by the US Agency for International Aid ( USAID ) until February, when it received a letter from the US government saying the funds had been terminated.
That brought Kajol’s care, only half completed, to an abrupt conclusion.
” Then I have to go get the healthcare myself”, she says. ” I am struggling a bunch”.
Cutting off treatments mid-treatment makes the chances of TB becoming drug-resistant substantially greater. It makes the illness significantly more difficult to combat and puts people at greater risk of severe illness and death.
” The people here are quite vulnerable”, says Dipa, 21. ” I can tell them to go to a certain physician, which may help them save some money.
” Or I try to provide them with some economic aid from our company so that they can continue their care.”
According to a US government efficiency record seen by the BBC, support by USAID in 2023 resulted directly in the identifying and reporting of more than a third of a million new cases of TB in Bangladesh. In the same year, there were 296, 487 novel or illness cases of TB which were cured or successfully completed as a result of USAID.
The organization was seen as essential to the government’s fight against tuberculosis.
” You ask people on the street, they may say yeah, it’s the US, they are the ones that are keeping it]tuberculosis ] in manage,” said a director of a USAID initiative in Bangladesh, who is not authorised to speak publicly and did not want to be named.
” Bangladesh was USAID’s largest project in Asia,” says Asif Saleh, senior director of the non-profit BRAC company”. In terms of its impact, especially in the medical field, it has been enormous.
” Mainly around vaccination, reducing infant mortality and maternal deaths, USAID has played a large role in this region”.
In 2024, Bangladesh received$ 500m in foreign aid. This time, that number has cratered to$ 71m. To put that number into context, in the three-year period from 2021-2023, USAID committed an average of$ 83m annually in Bangladesh for health initiatives alone, including combating TB.
Cuts to USAID have meant Nari Maitree can no longer sell its Stop TB Program, but it also means Dipa is out of job. She supports her old kids and her younger sister.
” I am totally shattered then that I lost my job. I am carrying the burden of the community. Being unemployed is a destructive condition”, she told the BBC.
In a report seen by the BBC, 113 programs that were funded immediately by the USAID company in Bangladesh have stopped. The listing does not include the various programs that are funded straight by US companies in Washington.
” The NGO sector] In Bangladesh ] employs 500, 000 people at least”, says Mr Saleh. ” It’s great. Thousands and thousands of work are going to be eliminated”.
It’s not just the United States that is moving away from international support. The UK has announced breaks to its international aid programs, while has Switzerland. It is likely that other states may follow match.
It’s a disturbing truth for Bangladesh. The government’s government was overthrown last year and the market is weak, with inflation near 10 % and a work problems, particularly among young people.
Interim chief Muhammad Yunus says Bangladesh will come up with a fresh strategy on how to live following the help cuts – but doesn’t suggest how.
When pressed in a BBC interview on how the country will cover the shortfall from USAID, Yunus said:” It was a small part, not a big deal. It doesn’t mean Bangladesh does disappear from the map”.
Asif Saleh says the way the breaks have been implemented has been dramatic and disorganized. The effects on a state like Bangladesh is enormous.
Nowhere is that more evident than in Cox’s Bazar, a seaside town in south-eastern Bangladesh, house to the nation’s largest refugee station. More than one million Rohingya, a persecuted Muslim minority group that the United Nations calls subjects of ethnic cleansing, fled violent massacres in their home state, neighbouring Myanmar.
Unable to go back home and unable to operate outside the refugee camp, the Rohingya depend on foreign help for their success.
The United States contributed about third of all help to Rohingya immigrants.
” We have run out of soap”, says Rana Flowers, state representative for the UN family’s company Unicef. ” We are now having to truck water into the tents. It’s an totally crucial moment. There is an epidemic of typhoid with over 580 situations, along with a scabies outbreak”.
Water hygiene jobs in the tents used to be funded by USAID.
Since the order to stop labor went into effect at the end of January, institutions such as the International Red Cross hospital in Cox’s Bazar are reduced to providing emergency aid only. Any trust the funds would be reinstated was crushed this year, when the Trump administration cancelled more than 80 % of all the programs at USAID.
People like Hamida Begum, who was getting standard treatment for hypotension, are left with some alternatives.
” I’m older and I don’t have anyone to assist me”, she says. Her father died last month, leaving her to care for her four kids alone, including her 12-year-old child who cannot move.
” I cannot go to another doctor far from home because of my girl”.
At a local UN food supply center, Rehana Begum is standing beside two huge sacks.
Outside, she says, are six gallons of cooking oil and 13kg of corn, along with principles such as garlic, onion and dried peppers. These rations, given to her by the World Food Programme ( WFP), need to last her and her family a month.
I ask how she will handle now that her meals will become cut in half beginning next month.
She looked shocked. Finally she started to cry.
” How may we probably survive with for a small amount”? asks Rehana, 47, who shares one room with her father and five kids. ” Yet today, it is difficult to control”.
The WFP says it was forced to make the major minimize because of” a crucial funding gap for its crisis response businesses”.
The meals then being allotted to the Rohingya group will merely meet their basic regular dietary needs, igniting doubts they will be left with just enough to survive and not much more.
” This is an utter devastation in the making”, says Rana Flowers of Unicef. ” Hungry frustrated people within the tents may lead to safety concerns. If that escalates to the level it was, we won’t be able to go into the tents to support”.