On the bumpy road leading out of Mahama refugee camp, eastern Rwanda, women used to travel for as much as two hours to reach the nearest hospital – sometimes giving birth on the way.
“I remember two babies died in that process. The mother had a cord prolapse. That is an extreme emergency; you have to act within ten minutes,” says Dr Yassin Uwimana.
Dr Uwimana is now the head of comprehensive obstetric and neonatal care at the camp run by Save the Children where, as of 2023, refugees have been able to get all the medical care they need to deliver safely. But since Donald Trump came back into office and slashed foreign aid spending via the US Agency for International Development (USAID), the clinic has been living on borrowed time.
The doctors, nurses and midwives who care for women giving birth, including performing life-saving emergency caesareans, are completely funded by the US government. The whole health centre, which also vaccinates children and treats malnutrition, receives 70 per cent of its funding from the US with the other 30 per cent coming from the UN.
In January, when he became president for the second time, Trump put a stop to all foreign aid spending overnight. Shortly afterwards, the Mahama clinic team was told its funding would run out on 15 August. Now, a funding extension is keeping the clinic going until November with little clarity as to what will happen after that.
Without it, women could face long journeys for emergency care once again, and newborn deaths could return to previous levels – almost 30 times higher than once the clinic opened.
While the clinic has had a stay of execution, the effects of the funding squeeze are still being felt.
‘The queues are growing’
Save the Children Rwanda says it is having to run on “minimal staffing levels” as many staff, in the face of this uncertainty, have left for other work. “The number of nurses and midwives have been reduced to bare minimum. This means there are longer queues at the waiting areas. The time taken to access care is longer and staff are sometimes overworked,” a spokesperson says. One psychiatric nurse working with new mothers now has a case load of 300 women.
Care for patients in need of emergency referrals to district hospitals is also being affected, the charity explains. Specialised treatment including for patients on chemotherapy or receiving kidney dialysis requires a lot of resources and has been “scaled down to extremely emergency cases”.
“This could be children with congenital heart problems…Tumours that are benign but would once become malignant without regular checks,” says Dr Uwimana.
Since the cuts, the hospital has stopped providing some mothers with basics like swaddles, nappies, soap and basins – even a supply of milk for mothers struggling to produce enough.
Veronique*, 31, a mother of five from the Democratic Republic of Congo (DRC), has seen the staff dwindling and the queues growing. Meals given in the hospital are not as regular as they were before.
“Sometimes you find a lot of people waiting,” she says. “If you are not able to keep waiting, you go back home. And sometimes they make prescriptions, but you don’t get medicines. So if you have any money in your pocket, you can check outside the camp”.
Nevertheless, she still trusts that the clinic is there and always comes to the team with any concerns. After all, they saved her life.
‘People are running for their lives’
Veronique’s sixth pregnancy, with her fifth living child, felt different from the others – though she couldn’t put her finger on why. After going two weeks overdue, she began a difficult labour.
The obstetric team realised she was losing a lot of blood. For the first time, she thought, “I’m going to die…this is my last day”. She was given an emergency blood transfusion and her recovery is going well. But she knows that without the medical team there in the camp, she might not have made it.
The Mahama refugee camp, the largest of six in Rwanda, hosts more than 60,000 refugees and asylum seekers, and each month on average 140 babies are born in the camp.
People come mostly from DRC, as well as from Eritrea and Sudan, braving perilous conditions in order to flee violence.
“It’s a long, arduous and complicated journey,” says Jo Musonda, Save the Children’s country director for Rwanda and Burundi.
“People are running for their lives literally,” she says. Some drown crossing the river from DRC into Burundi to make it to Rwanda and those who do make it arrive “hungry, scared, exhausted… traumatised from the violence that they’ve seen”.
But the clinic can no longer do everything she wishes it could, with funding terms winnowing down their offer to what is considered “life-saving” – at least as long as the funding still remains.
“What’s really difficult is the unknown,” Musonda says.
Dr Uwimana, who heads up the maternity team, says her contract was initially terminated on 30 April, then extended until 14 August. Now it runs until 14 November the US money is currently scheduled to run out.
“People have already left. One of my anaesthetists resigned because of uncertainty. We are currently having understaffing issues as those [working] in maternity leave and those who resigned are not replaced due to funding cuts, which is the case in laboratory and pharmacy”.
In 2024, more than 2000 women were given pre- and post-natal care in the camp. There were roughly 1000 deliveries and more than 200 caesarians. On top of that, thousands of children were treated for malnutrition and given routine vaccinations.
“Any stoppage to this grant will directly put these services to a halt,” a Save the Children Rwanda spokesperson says. “This also includes emergency C-sections,” which are, “extremely essential and life-saving interventions”.
‘Very, very afraid’
Celestine*, a 20-year-old mother of one, also from the DRC, had an ectopic pregnancy which needed to be operated on in the camp.
She had experienced years of problems with bleeding. A botched caesarean in a different clinic before she arrived at Mahama had left her with wounds and clotted tissue which the Mahama team linked to her ectopic pregnancy.
She was admitted to the hospital in searing pain and had surgery within 24 hours of arriving in the camp. The surgeon told her it likely would have been fatal had they not operated when they did. When she learned she would need surgery, she thought back to her previous, mangled, caesarean and thought to herself, “this time I’m going to die. I will not survive this second attempt,” she says. She was “very, very afraid”.
After recovering from the surgery, she no longer lives in pain like before and is being reassured by the doctors that she should be able to have more children in the future. Though her past pain does still come to her mind from time to time, she feels comforted by the presence of the clinic in case she needs any more help in the future.
Anne, a midwife in the clinic, worries about the psychological impact on mothers if care is withdrawn. “Once the aid stops it will particularly affect our clients, especially teen mothers. We need to help mothers from the moment they become aware of their pregnancy until they give birth and afterwards”. If this stops, she says, they may, “lose hope,” which can lead to severe mental health difficulties and even loss of life.
A study published in The Lancet medical journal in July estimates that US aid cuts could lead to 14 million more deaths by 2030, including 4.5 million children.
“We’re just very concerned about the health of women and their unborn children,” Musonda says. “The implications are vast”.
*Names have been changed to protect identities
This article is part of The Independent’s Rethinking Global Aid project
