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.
TB can be fatal if left untreated. The highly contagious bacterial disease, which usually infects the lungs, is not prevalent in rich countries, because treatment is relatively cheap. But in Bangladesh, it is a scourge.
That’s especially so in neighbourhoods such as Mohammadpur, a slum in the capital Dhaka where Kajol,17, lives.
“We are poor people,” she says. She is the sole breadwinner for herself, her mother and little brother. Her job in a garment factory keeps them all afloat.
So when she fell ill in January, it could have been catastrophic.
Instead, help arrived through Dipa Halder. For the last three years, she has been canvassing the residents of Mohammadpur about TB and getting people the treatment they so desperately need, free of cost.
The initiative is run by a local aid organisation, 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 treatment, only partially completed, to an abrupt end.
“Now I have to go get the medicine myself,” she says. “I am struggling a lot.”
Cutting off medicines mid-treatment makes the chances of TB becoming drug-resistant much greater. It makes the disease much more difficult to combat and puts patients 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 particular doctor, which would help them save some money.
“Or I try to provide them with some financial assistance from our organisation so that they can continue their treatment.”
According to a US government performance report seen by the BBC, support by USAID in 2023 resulted directly in the identification and reporting of more than a quarter of a million new cases of TB in Bangladesh. In the same year, there were 296,487 new or relapse cases of TB which were cured or successfully completed as a result of USAID.
The agency was seen as integral to the country’s fight against tuberculosis.
“You ask people on the street, they will say yeah, it’s the US, they are the ones that are keeping it [tuberculosis] in control,” said a director of a USAID project in Bangladesh, who is not authorised to speak publicly and did not want to be named.
“Bangladesh was USAID’s largest programme in Asia,” says Asif Saleh, executive director of the non-profit BRAC organisation. “In terms of its impact, particularly in the healthcare sector, it has been massive.
“Particularly around vaccination, reducing child mortality and maternal mortality, USAID has played a massive role in this country.”
In 2024, Bangladesh received $500m in foreign assistance. This year, that amount 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 offer its Stop TB Program, but it also means Dipa is out of work. She supports her elderly parents and her younger sister.
“I am completely shattered now that I lost my job. I am carrying the burden of the family. Being unemployed is a devastating situation,” she told the BBC.
In a document seen by the BBC, 113 programmes that were funded directly by the USAID office in Bangladesh have stopped. The list does not include the myriad programmes that are funded directly by US agencies in Washington.
“The NGO sector [In Bangladesh] employs 500,000 people at least,” says Mr Saleh. “It’s huge. Thousands and thousands of jobs are going to be eliminated.”
It’s not just the United States that is moving away from foreign aid. The UK has announced cuts to its foreign assistance programmes, as has Switzerland. It is likely that other countries may follow suit.
It’s a sobering reality for Bangladesh. The country’s government was overthrown last year and the economy is shaky, with inflation near 10% and a jobs crisis, particularly among young people.
Interim leader Muhammad Yunus says Bangladesh will come up with a new strategy on how to survive following the aid cuts – but doesn’t say 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 will disappear from the map.”
Asif Saleh says the way the cuts have been implemented has been abrupt and chaotic. The impact on a country like Bangladesh is immeasurable.
Nowhere is that more clear than in Cox’s Bazar, a coastal city in south-eastern Bangladesh, home to the world’s largest refugee camp. More than one million Rohingya, a persecuted Muslim minority community that the United Nations calls victims of ethnic cleansing, fled violent purges in their home country, neighbouring Myanmar.
Unable to go back home and unable to work outside the refugee camp, the Rohingya depend on international aid for their survival.
The United States contributed almost half of all aid to Rohingya refugees.
“We have run out of soap,” says Rana Flowers, country representative for the UN children’s agency Unicef. “We are now having to truck water into the camps. It’s an absolutely critical time. There is an outbreak of cholera with over 580 cases, along with a scabies outbreak.”
Water sanitation projects in the camps used to be funded by USAID.
Since the order to stop work went into effect at the end of January, hospitals such as the International Red Cross hospital in Cox’s Bazar are reduced to providing emergency assistance only. Any hope the money would be reinstated was crushed this week, when the Trump administration cancelled more than 80% of all the programmes at USAID.
Patients like Hamida Begum, who was getting regular treatment for hypertension, are left with few options.
“I’m old and I don’t have anyone to help me,” she says. Her husband died last year, leaving her to care for her four children alone, including her 12-year-old daughter who cannot walk.
“I cannot go to another hospital far from home because of my daughter.”
At a nearby UN food distribution centre, Rehana Begum is standing beside two large sacks.
Inside, she says, are six litres of cooking oil and 13kg of rice, along with basics such as onions, garlic and dried chillies. 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 manage now that her rations will be cut in half beginning next month.
She looked shocked. Then she started to cry.
“How can we possibly survive with such a small amount?” asks Rehana, 47, who shares one room with her husband and five children. “Even now, it is difficult to manage.”
The WFP says it was forced to make the drastic cut because of “a critical funding shortfall for its emergency response operations”.
The rations now being allotted to the Rohingya community will only meet their basic daily dietary needs, igniting fears they will be left with just enough to live and not much more.
“This is an absolute disaster in the making,” says Rana Flowers of Unicef. “Desperate frustrated people within the camps will lead to security concerns. If that escalates to the degree it could, we won’t be able to go into the camps to help.”