This week, Democratic Congressman Ro Khanna said that Elon Musk should be held accountable for “4.5 million children around the world who he possibly sentenced to death by dismantling USAID.” Back in February 2025, Musk bragged about putting the U.S. Agency for International Development (USAID) “through the wood chipper” in just one weekend with his Department of Governmental Efficiency (DOGE) team, gleefully destroying the decades-old institution because of allegations of corruption. The effects of the cuts were immediate and profound, with thousands of programs serving millions of people disrupted overnight. While some of these programs eventually had their funding restored, others did not.
Where did the 4.5 million number come from? One study from The Lancet estimated that if USAID cuts became permanent, 4.5 million children under five could die over the period from 2025 to 2030. Another frequently cited estimate comes from Boston University’s Impact Counter, which estimated the number of deaths in the hundreds of thousands. Musk has rejected these estimates, claiming that “nobody died” and that he would even be willing to call the bereaved parents of children who died due to USAID cuts.
So what is the truth here? Are Musk and his team responsible for hundreds of thousands and possibly millions of deaths to come? Or was USAID so corrupt that disemboweling it overnight caused no deaths? As is often the case, the truth is somewhere in the middle.
USAID was a remarkably efficient organization, spending about 1% of the federal budget to prevent millions of deaths over several decades. While there were clear instances of corruption (several of which were prosecuted under the Biden administration) and some questionable choices, particularly around arts funding, the vast majority of its work focused on providing healthcare, education, and food aid to people who needed it around the world.
Musk has claimed that “[a]ll DOGE did was require contact with the aid recipients to confirm that funds were being used legitimately.” This is not true. There has never been any evidence that DOGE attempted to contact any aid recipient anywhere in the world. Some of those recipients live in such remote places that it would take roughly the entire weekend to travel there; others don’t have phones or email addresses. There were voluminous records summarizing how USAID funds had been spent, and DOGE could have gone anywhere to verify this in person if they wished.
Rather, the narratives of DOGE’s work suggest a brazen and cruel disregard for the human lives it condemned to death. Musk himself bragged about destroying the agency until people pointed out that it was funding food aid, HIV care, and Ebola monitoring programs that were weaker for having been abruptly cut off, even if funding was eventually restored. Such flippancy with human life — and a denial that one’s actions had the effects that they truly had — is damnable for a man with such power.
People died over the past year as a result of USAID cuts. There are more deaths yet to come. If someone, for example, was on HIV medication and stopped taking it because the clinic closed, it will probably be a few more months before they start showing up at hospitals around the world. If Musk is serious about his concern for the bereaved parents, he should go to a refugee camp and meet some people who lost loved ones to cholera.
However, it is not fair to count the death toll in the millions, and people who are throwing around these estimates are foolish for their hyperbole. The estimates are worst-case scenarios; funding for many critical programs has already been restored, and other organizations have stepped up to help fill in the gaps. These estimates also don’t include realities like the fact that some aid recipients may sacrifice other needs like school fees in order to pay for medical treatment, and some people will still survive diseases like cholera without treatment (though they will surely suffer more for lack of treatment).
Why do accurate figures matter? If Musk only has to rebut the claim that he has the blood of millions on his hands, he can easily and truthfully deny this. If the claim instead is that he recklessly cut off lifesaving humanitarian aid based on a misunderstanding of what USAID did in a manner that left no time for careful sifting of the good programs from the bad, with immediate consequences for a few people and long-term consequences for many more, then he has no ground to stand on.
It is true that millions of people would have died had the USAID cuts remained permanent and nothing else compensated for those cuts. It is more truthful to say that hundreds died in the past year and a half, while others will slowly suffer and even die — the downstream consequences of one weekend spent dismantling an institution dedicated to helping people around the world. Elon Musk should be held accountable for his disregard for human life. He has a much better chance of being held accountable if we are truthful about his crimes.
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Matthew Loftus grew up in a family of 15 children and completed his medical training in Baltimore, Maryland. Since 2015, he and his family have lived in East Africa, where he currently teaches and practices family medicine at a mission hospital. His first book, Resisting Therapy Culture, will be published by InterVarsity Press on August 18, 2026. You can learn more about his work and writing at www.matthewandmaggie.org
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