After Elon Musk made a public show of remedying an apparent error in DOGE’s massive cuts to foreign aid, the Trump administration has quietly doubled down on its decision to stop sending emergency food to millions of children who are starving in Bangladesh, Somalia, and other countries. Without urgent intervention, many of these children are likely to die within months, experts told me.
As DOGE was gutting USAID in February, it alarmed the global-health community by issuing stop-work orders to the two American companies that make a lifesaving peanut paste widely recognized as the best treatment for malnutrition. The companies—Edesia and Mana Nutrition—subsequently received USAID’s go-ahead to continue their work. But soon after that, their contracts were officially canceled. When news of the cancellation was made public, Elon Musk vowed to investigate the issue and “fix it.” Hours later, Musk announced that one contract had been restored days earlier; that night, the second company received notice that its contract had been reinstated.
According to Mana and Edesia, however, that was only the start of the story. The contracts reinstated in February applied to old orders for emergency therapeutic food that Mana and Edesia were already in the middle of fulfilling. But two weeks ago, without any fanfare, the Trump administration then canceled all of its upcoming orders—that is, everything beyond those old orders that were previously reinstated—according to emails obtained by The Atlantic. The move reneged on an agreement to provide about 3 million children with emergency paste over approximately the next year. What’s more, according to the two companies, the administration has also not awarded separate contracts to shipping companies, leaving much of the food assured by the original reinstated contracts stuck in the United States.
Globally, nearly half of all deaths among children under 5 are attributed to malnutrition. When children reach the most severe stage, those old enough to have teeth lose can them. Black hair turns orange as cells stop synthesizing pigment. Their bodies shrivel, and some lose the capacity to feel hunger at all. Before the 21st century, starving children could only be treated in a hospital, and among the sliver of them who were admitted, a third would die, Mark Manary, a pediatrics professor at Washington University in St. Louis, told me. The invention of a new type of emergency food allowed parents to treat their own kids at home; more than 90 percent recover within weeks of treatment, according to the International Rescue Committee.
The original brand-name version, Plumpy’Nut, was first used to treat children in the early 2000s, and the U.S. started supplying it to foreign countries in 2011, Manary told me. It’s a pouch—basically an oversize ketchup packet—of peanut butter fortified with powdered milk, sugar, vitamins, minerals, and oil, a mixture that’s easier for shrunken stomachs to digest than a full meal. The packets keep without a refrigerator, making them useful in hunger-prone settings like refugee camps and war zones. They come ready to eat, so parents don’t need to worry about dissolving the contents in clean water. A six-week supply costs $40, and three packets a day fulfills all the basic nutritional needs of children ages six months to 5 years. This regimen regularly saves the lives of even those who are mere days from death. Lawrence Gostin, the director of Georgetown’s Institute for National and Global Health Law, told me that ready-to-use therapeutic foods like Plumpy’Nut are “the singular public-health achievement of the last several decades”—more consequential, experts reiterated to me, than even antibiotics or vaccines.
Typically, the U.S. supplies starving children with emergency therapeutic food through a multistep process. UNICEF and the World Food Programme forecast months in advance how much paste they’ll need to send to various countries, and ask USAID to buy some of it. Previously, USAID hired Edesia (which is based in Rhode Island) and Mana (based in Georgia) to make the paste, then paid to ship the boxes overseas. The United Nations handles delivery once the food reaches port, and organizations such as Save the Children and Doctors Without Borders typically carry shipments to the children who ultimately consume them.
The Trump administration has broken every step of that system. According to Mana CEO Mark Moore and Edesia CEO Navyn Salem, USAID agreed back in October to buy more than 1 million boxes of therapeutic food. The World Food Programme and UNICEF planned to distribute the contents of this order as early as March, according to an email obtained by The Atlantic. But on April 4, both Edesia and Mana received an email from a staffer at the State Department that said the plans for 10 countries to receive the emergency paste would not move forward. (Those countries: Bangladesh, Burundi, Cameroon, the Central African Republic, Chad, the Democratic Republic of the Congo, Djibouti, Nigeria, Somalia, and Yemen, to which the U.S. has separately canceled all humanitarian aid.)
When I spoke with Moore, he panned his phone across the production floor to show me boxes upon boxes of peanut paste piled against the walls. Moore told me he is terrified for the children who will die without the paste. Without it, he said, “they’re trapped. Just trapped.” He is also worried for the Americans who rely on his business for their own livelihoods. “All we’re doing is cutting farmers and hurting kids. That just seems like a terrible plan to me,” he said. Meanwhile, Edesia, which had stopped its production for the first time in more than a decade after the first cancellation notice, is now making just 2,000 Plumpy’Nut packets a day instead of the usual 10,000, Salem said.
Moore and Salem both told me that even if USAID had not canceled the order itself, they have no idea how they would have shipped it. As far as they know, the U.S. government has failed to award many expected contracts to the shipping companies that Moore and Salem have long used to send their emergency food products overseas. This month, Salem said, Edesia was able to ship 42,000 boxes of emergency food for moderately malnourished kids to Somalia, but was unable to secure transport for another approved shipment of 123,888 boxes for acutely malnourished children to Sudan. Salem says she has no clue why. Hundreds of thousands of boxes of food from both companies’ old, reinstated orders still have not left the U.S. “We need product to leave the factories at no later than four months” after it is manufactured, Salem told me, to ensure at least a year of shelf life when it arrives in Africa or Asia. She does not know who to call, at USAID or the State Department, to make that happen, she told me.
On April 10, Moore received an email from a State Department staffer who said that her team is seeking approval to ship the paste that has already been manufactured—if not to the original intended recipients, then somewhere. “We are not sure of the timeline for this approval,” the staffer wrote. “But please know that we are trying to ensure that no commodities go to waste.”
Even if the paste makes it overseas before it expires, it might not make it into children’s hands. Save the Children, one of UNICEF’s major last-mile distributors, typically gives out emergency therapeutic food at clinics where mothers can also give birth and take their infants for health screenings. But the organization has been forced to stop its work in nearly 1,000 clinics since Trump’s inauguration in January because of U.S. funding that his administration eliminated or failed to renew, Emily Byers, a managing director at the organization, told me.
In a statement, UNICEF told me that the Trump administration still has not informed the organization of the canceled orders. UNICEF projects that 7 million children will require treatment for extreme malnutrition in 2025. Even before the USAID cuts, it had the budget to treat only 4.2 million of them. Mana and Edesia typically provide 10 to 20 percent of UNICEF’s annual emergency therapeutic food, and USAID supplies half of its overall funding for nutrition treatment and hunger-prevention services. “Today, we have no visibility on future funding from the US Government,” the statement read. Typically, producers have half a year to fill an order as big as the one the U.S. canceled, according to Odile Caron, a food-procurement specialist at Doctors Without Borders. UNICEF needs that food in much less time. If malnourished kids don’t get access to emergency therapeutic food because of the U.S. government’s decisions, “in three months, half of them will be dead, and the rest will have terrible disabilities, mostly neurocognitive,” Manary, who also ran the first clinical trials on Plumpy’Nut, told me.
Since the dissolution of USAID began in January—most of the agency has been gutted, the rest absorbed by the State Department—the Trump administration has insisted that lifesaving foreign aid will be allowed to continue. Just yesterday, a State Department spokesperson told reporters, “We know that we are a country with incredible resources. We know that. And we have incredible responsibilities, and we do not shy away from them.” The White House did not answer my questions about the discrepancy between that sentiment and the orders that the administration cancelled, nor did the State Department. USAID, DOGE, and Musk did not respond to requests for comment. According to NPR, a program in Syria that feeds expecting mothers and young children was recently told that its contract was spared from the government’s ongoing cuts. But a separate contract funding the program’s staff was terminated, leaving no one to do the work. Meanwhile, all that paste is still piled up in Moore’s warehouse.
During Trump’s first Cabinet meeting, in February, Musk acknowledged that DOGE’s teardown of foreign assistance had been hasty, then pledged that “when we make mistakes, we will fix it very quickly.” But the White House seems to have done nothing yet to fix this problem. Instead, it is keeping in purgatory two American companies that make a product that dying children need to survive. As Moore reminded me throughout our conversation, he has hundreds of thousands of boxes of paste packed and ready for distribution. That means one of two things happens next: “It will get shipped or it will get destroyed.”
