The Verdict of History

 In 1988, the historian Richard Rhodes — who had given us the definitive account of the making of the atomic bomb — published a quiet and terrible essay in the Journal of the American Medical Association. He called it Man-made Death: A Neglected Mortality, and his argument was that our demographers and public-health officials systematically fail to count a certain kind of dying: the deaths caused not by microbe or misfortune but by policy — by war, by neglect, by privation deliberately imposed. Artificially induced famine. The willful dismantling of the infrastructure that keeps the poor alive. Rhodes gave the thing a name. He called it public man-made death.

I had not known that phrase until earlier this week, when The New Yorker published a conversation with Dr. Atul Gawande — surgeon, longtime contributor to the magazine, and, until DOGE reduced it to a shell, one of the most senior officials at USAID. Gawande reaches for Rhodes’s category because he needs it. The ordinary vocabulary of the budget debate — cuts, reforms, efficiencies — cannot hold what he has to report. The interview is titled, without mercy, The Human Cost of DOGE’s War on USAID, and Gawande does two things in it that I would ask every American Catholic as well as all people of faith to carry to prayer.

First, he counts. Second, he refuses the flattering word. The dismantling, he says, was not merely cruel; it was also stupid— a gratuitous demolition of American standing from Africa to Latin America, undertaken by men who never troubled to learn what they were destroying before they destroyed it. The moral tradition of the Church has an exact response to each of these, and I mean to speak both before I am done.

Public Man-Made Death

Begin with the counting, because Elon Musk has denied there is anything to count. No validated medical funding was stopped, he has posted; legitimate life-saving funding continued. This is false, and Gawande dismantles it with the patience of a man who has done the arithmetic. Two independent accounting — one from Boston University, one published in The Lancet — arrive at the same figure: in the single year since USAID was destroyed, on the order of seven hundred thousand human beings have already died who would otherwise be alive. The Lancet study calculated that the agency had saved some ninety-two million lives over the previous two decades. Representative Ro Khanna has cited the projection that four and a half million children alone may die by the end of 2030.

Gawande insists, rightly, that we resist letting a number that large collapse back into abstraction. So let us be concrete. He cites World Health Organization estimates that where emergency health services reached eighty million people in 2024, that figure fell by more than fifty million in 2025. Among the abandoned, he says, were fourteen million people suffering severe acute malnutrition, two and a half million of them children— children for whom an American-made peanut paste, carried by community health workers, had been cutting the death rate to less than one percent. It is gone. Pregnant women driven from their homes now deliver, and die, with no one to attend them. In South Africa and Mozambique, tuberculosis deaths are climbing again — and, as Gawande put it, they have the names of the people who died.

That phrase is the hinge of the whole matter. For the second cruelty of this policy is that it has also destroyed the counting itself. The inspector general at USAID was fired, the auditors intimidated, and the American data-collection apparatus — by common consent the finest in the world — dismantled along with everything else. And so the deaths will become knowable only slowly, over years, in the very places least able to record them. To kill the poor is the first sin. To abolish the ledger in which their deaths would be written is the second, and in some ways the more chilling, for it is the sin of a man arranging in advance not to be caught.

A Child in Machar

Two weeks ago, Elon Musk issued a challenge to the world. There is not even a single dead child, he wrote. They cannot cite a single name of someone who died out of the “millions” they falsely claim have died. Not a single name! When Nicholas Kristof, who had gone to Africa and done the reporting, answered him by listing the names of children who had died, Musk called him an obscenity and a liar, and suggested that Representative Ro Khanna, who had cited the projections, belonged in prison.

Let us take the man at his word, then, and give him what he asked for. Gawande’s team of reporters has by now documented twelve hundred individually identified people who died directly from the shutdown of American aid. Twelve hundred names. Let me offer one more.

Gawande went to South Sudan — the youngest nation on earth, a country the United States helped to bring into being. In seven subcounties there, the local administrators keep their own registries of the dead, and their own records show a tenfold increase in mortality since the aid was cut: forty-two children died across those subcounties in 2023 and 2024; two hundred and fourteen have died since. And behind the tally stands a person. In a village called Machar, Gawande met a woman named Nyajiek Gai Guol. Her two-year-old niece had fallen ill with pneumonia — an illness a functioning clinic dispatches without difficulty. But the clinic was gone. To reach care they traveled three hours, on foot and by canoe. The little girl arrived still alive. She died of organ failure shortly after. Completely avoidable, Gawande said. There were, he added, numerous cases like hers.

I do not know that child’s name. Gawande did not record it, and perhaps no one outside Machar ever will — and here we arrive at the true obscenity of Musk’s challenge. He demands a name from the poorest people on earth after his own enterprise destroyed the registries that would have written it down. The inspector general at USAID was fired. The auditors were intimidated into silence. The health-surveillance apparatus was dismantled along with everything else. And now he stands in the wreckage and shouts that no one can produce a name. It is the logic of an arsonist demanding the receipts.

But God knows her name. That is the whole of what I have to say against him. It is the vocation of a priest to insist that she was not a rounding error in a budget projection but a person of infinite worth, in whom Christ was present, whose death has a cause and whose cause has authors — and that her name is written, and kept, and will be read aloud on a day when the wealth of the man who demanded it will purchase him nothing at all. When I write, as I did in April, of the seamless garment, this is the thread I mean. She is the thread.

Two Presidents

When the definitive history of this era is written, it will have to weigh two American presidents against one another, and the scales will not be kind.

In 2003, President George W. Bush created the President’s Emergency Plan for AIDS Relief. PEPFAR is credited with saving on the order of twenty-five million lives, overwhelmingly in Africa: the largest commitment any nation in history has ever made against a single disease. Whatever else the historians record of that presidency, this will stand beside it — that he spent the treasure of a rich nation to keep the poorest of the earth alive.

Set against that the ledger of the present administration. The agency that carried so much of this work consumed less than one percent of the federal budget — by Gawande’s reckoning, less than ten dollars per American taxpayer per month. That is the sum for which it was fed, in Musk’s own gloating word, into the wood chipper. President Kennedy, in founding USAID, had understood that aid abroad was also aid to ourselves — that the same American generosity had helped eradicate smallpox, driven back polio, and turned defeated or desperate nations into partners; thirteen of our top fifteen trading partners once received our help along the way. All of it — the accumulated moral and strategic capital of sixty years — was demolished to save less than the price of a monthly streaming subscription per citizen. When the history is written, it will record that one president saved millions and that the other killed them; and it will record that he did it cheaply, and called the saving of children waste.

The Mad Max Gospel

Why? Pressed for a motive, Gawande describes not a calculation but a worldview: the conviction that the world is a Mad Max arena of the dominators and the dominated, in which cooperation is naïveté and mercy is weakness — in which, as his interviewer bluntly pressed, saving the lives of children can be waved away as woke, perhaps because the children in question are not the right color and do not live in the right hemisphere. This is not a policy. It is an anti-gospel, the precise photographic negative of the one the Church proclaims.

And it arrives wrapped in a detail no moralist may pass over in silence. In the very season these deaths were being counted, the President enriched himself and his family by billions through cryptocurrency ventures, and Elon Musk became, by the reporting, the first trillionaire in the recorded history of our species. The poorest child on earth was told there was no longer ten dollars a month for her survival, while the men who told her so ascended to fortunes without precedent in human history. The medieval theologians had a word for this inversion of right order — iniquitas — and Saint John Paul II had a phrase for the way such choices harden into institutions that go on killing long after the choosers have moved on: structures of sin. The poor are abandoned; the predatory are enthroned; and the arrangement calls itself efficiency.

This is what I mean when I say that the powerless die. In a world governed by the transactional, they die first and they die unrecorded, because they have nothing to trade and no leverage to compel. It is the oldest arrangement of fallen humanity, and it is the very one the Magnificat was composed to overturn.

A Priest’s Vow of Memory

Gawande observed something in that interview I cannot, as a priest, let pass. He believes these men sense their own accountability — that Musk rages online precisely because he fears the verdict of history, and that the President is reported to ask, aloud and in private, whether he is going to hell. Gawande, a surgeon and no theologian, diagnosed the fury as cognitive dissonance: the unbearable gap between the benefactors these men wish to be remembered as and the monsters the evidence discloses.

I will not pronounce on any man’s eternal destiny; that judgment belongs to God alone, and I pray, sincerely, for the conversion of both men. But I will say this much. The question of hell is not an idle one, and it is telling that it should surface, unbidden, in the conscience of a man who has done what has been done. Scripture is not vague about where the deliberate abandonment of the dying places a soul. It is the office of a priest to say so — not in cruelty, but because admonishing the sinner is itself a work of mercy, and because silence before this would be its own grave sin.

So here is my commitment, renewed. These dead will not be permitted to dissolve into a spent news cycle. To pray for the dead and to keep their memory is a spiritual work of mercy, and I intend to keep performing it for as long as I am able. The seven hundred thousand — and the child in Machar who stands for them all — will be named in this space, and in my intercessions, for as long as God gives me breath.

What Scripture and the Church Require Us to Say

In Lethal Dominos I wrote that the Catholic tradition calls what was done by a hard word, and that I would not write the word a second time. I have decided I was wrong to withhold it. Let the tradition speak the word in its own voice, so that no one may accuse me of speaking it in mine.

Scripture is not delicate here. The bread of the needy is the life of the poor, the Book of Sirach declares; whoever deprives them of it is a man of blood. To take away a neighbor’s living is to commit murder (Sirach 34). Isaiah’s woe falls not upon private malice but upon public policy: Woe to those who enact unjust decrees, who rob the poor of their rights and deprive the needy of justice (Isaiah 10). And the Second Vatican Council, in Gaudium et Spes, gathered the constant teaching of the Fathers into a single sentence — and addressed it, let it be noted, not only to private consciences but to states: “this sacred council urges all, both individuals and governments, to remember the aphorism of the Fathers, ‘Feed the man dying of hunger, because if you have not fed him you have killed him’” (§69).

If you have not fed him, you have killed him. That is not my sentence. It is the Church’s — ratified by an ecumenical council, drawn from the Fathers — and it settles the question of the word. To pull the bread from the mouth of a dying child, to feed into a chipper the very machinery that carried the bread, is, in the plain and ancient judgment of Catholic moral theology, to kill. Donald Trump and Elon Musk have done this not to one child but to some seven hundred thousand, with millions foreseen by the men best positioned to know. When Gawande was asked for the final toll, he said it twice, so that there could be no mistaking it: It’s millions of deaths.

I think, in these days, of Saint Óscar Romero, shot at the altar for the offense of naming aloud the machinery that ground the poor of El Salvador into the earth. He teaches me that there is a cost to the naming, and that the naming is required regardless. A Church that will not call the killing of the poor by its name has already begun to mislay the Gospel it was ordained to guard.

Let it be recorded plainly, then, since the Church has lent me the words: two men, entrusted with more power and more wealth than perhaps any human beings who have ever lived, used a fraction of that wealth’s mere counting to take the bread from the mouths of the dying — and called it efficiency, and called it a weekend well spent. Before God, and before the poor who are His own, that is not efficiency. It is blood. The Lord has already told us how such a reckoning ends: whatever you did not do for one of the least of these, you did not do for me (Matthew 25). He attached no exemption for those whose government had assured them the spending was waste.

I first tried to reckon with all of this in April, in Tearing the Seamless Garment: USAID as a Pro-Life Reckoning for American Catholics — the essay in which I argued that the destruction of USAID was, for Catholics, a pro-life question of the gravest order. The May update followed the consequences as they began to cascade. I did not imagine I would still be counting the dead in July, nor that the count would have grown so large, nor that I would one day be able to put a village’s name and a child’s face to it. But that is the discipline the seamless garment imposes: to keep looking, to keep naming, and to keep praying for the metanoia - the change of heart - that even now — even this late, even for these two men — remains possible. If you have not read where this began, begin there. And then let us, together, refuse to forget.

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Monsignor Arthur Holquin, S.T.L., is a retired Catholic priest of the Diocese of Orange, California, and retired rector of Mission Basilica San Juan Capistrano. He writes at Liturgy and Truth.