How the end of USAID is playing out in this ‘rape capital of the world’

She was 17.

After armed men attacked her village in eastern Congo and raped her, she fled into the night — bloodied and alone. By morning, in late January, she reached a clinic on the outskirts of Goma.

The nurse knew exactly what she needed: a post-exposure prophylaxis (PEP) kit — a small box of medication that can prevent HIV, sexually transmitted infections and pregnancy if given within 72 hours.

“She arrived within the window,” said a local social worker in Goma, who followed the case closely and spoke to me by phone. I’ll call her Grace. “But the kit wasn’t there.”

“We’re sorry,” the nurse told her. “We have nothing.”

Three months later, after a desperate, unsafe attempt to end her pregnancy, Grace died. We shouldn’t consider her direct cause of death the assault, but rather her despair that there was no care for her after her assault.

We can blame Washington, where Elon Musk-appointed disruptors locked out U.S. Agency for International Development staff and began dismantling the 61-year-old agency that once dominated PEP kit supply in the Democratic Republic of the Congo. Dr. Esther Kitambala of Heal Africa — a Goma-based hospital on the front lines of the crisis — told me over the phone that more than 80% of those kits previously came from USAID.

At the beginning of this month, Secretary of State Marco Rubio put the finishing touches on the process Musk began in January when he declared USAID “beyond repair” and “a criminal organization.”

On June 30, NBC News reported on an analysis of USAID cuts published in the medical journal The Lancet that found:

Ending USAID could lead to the deaths of 14 million people over the next five years, the analysis predicts.

The day after that news story, Rubio, in a press release headlined “Make Foreign Aid Great Again,” said, “As of July 1st, USAID will officially cease to implement foreign assistance,” in part because “the countries that benefit the most from our generosity usually fail to reciprocate. For example, in 2023, sub-Saharan African nations voted with the United States only 29 percent of the time on essential resolutions at the UN.”

Humanitarian aid shouldn’t be pay to play.

At Heal Africa, one of Goma’s few hospitals offering full support to rape survivors, the shelves once stocked with PEP kits now sit bare. Women and girls are turned away.

Kitambala, who leads reproductive health at Heal Africa, said the phrase she dreads most is now routine: “I’m sorry. We don’t have a PEP kit.” Her voice trembled over the phone as she described the anguish of turning away survivors in urgent need.

She spoke of a 3-year-old girl who’d been subjected to brutal sexual violence and a young woman, raped and pregnant, who went to her village clinic only to be turned away.

“When we receive rape victims like her, we call everywhere,” Kitambala said. “Every clinic I know. But the answer is always the same: ‘We ran out of PEP kits months ago.’”

I knew exactly what those kits meant. As a journalist, I reported from war zones like Goma. More recently, I led global media and public relations for Corus International, a humanitarian organization active in Goma and across 30 countries with fragile health systems.

A practitioner in Goma who asked to remain anonymous told me, “Survivors come clinging to hope that they’ll at least be protected from HIV. But when we turn them away … we send them back into the dark with nothing.”

“But their stories don’t end there,” that doctor said. “I see the face of that 12-year-old rape victim I had to turn away today. I think about the trauma she’s already endured — and the unimaginable challenges still ahead for her.”

Empowered by U.S. funding, facilities such as Heal Africa provided critical, compassionate care for survivors of sexual violence. The program’s success was striking — United Nations data indicates annual HIV/AIDS deaths in the DRC have fallen from 200,000 to roughly 14,000.

Then came Donald Trump and Elon Musk and Marco Rubio.

In multiple capacities across my professional career, I’ve walked through overcrowded camps filled with people carrying the weight of unspeakable loss. But what’s unfolding in Goma is unlike anything I’ve ever seen.

Over 500,000 people are crammed into makeshift shelters. Children are dying of preventable disease. Health workers are exhausted and being forced to explain that even the most basic supplies, supplies once funded by about 1% of the U.S. budget, are no longer coming.

As USAID collapsed, Rwanda-backed M23 rebels surged into eastern DRC. The fallout was immediate. UNICEF reported a fivefold spike in rape cases in one week alone — children made up 30% of victims.

Back in early July, the United Nations Population Fund shared a document with Reuters revealing that only seven out of 34 health zones in North Kivu currently have even a minimal supply of post-rape kits. Fewer than 1 in 4 survivors are receiving the care they need, and shockingly, just 13% of those seeking help are receiving HIV-prevention medication within the critical 72-hour window.

This is how America’s exit played out in a place long labeled the “rape capital of the world,” where — even in relative calm — up to 80% of women and girls as young as 8 have endured sexual violence, according to front-line clinicians.

It didn’t have to happen this way. A working system existed that meant the difference between life and death. And Congress should either restore USAID or establish a replacement that reflects the generosity of the American people and not the inhumane agenda of one man and his administration.

Rubio says aid from the U.S. will now serve “American interests,” but what American interests are served by withholding a box of pills and letting a 17-year-old girl die alone in a displacement camp?

I’ve seen American power up close — not in tanks or embassies, but in quiet acts of courage:

A winter blanket handed to a shivering child in Ukraine. A solar panel powering a maternity ward in South Sudan. And in Goma, a PEP kit handed to a terrified teenager who still had a chance.

That girl is gone now. As is the system that could have saved her.