Economic sanctions imposed by the US and/or EU were associated with 564,258 deaths annually from 1971 to 2021
The Toll of Economic Sanctions. The Toll of USAID Cuts
By Anil Madan
The Lancet is a highly regarded British peer-reviewed general medical journal.
In July 2025, it published an article titled Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis.
In August 2025, it published an article titled Effects of international sanctions on age-specific mortality: a cross-national panel data analysis.
Economic sanctions cause large, measurable increases in mortality, with effects comparable to those of armed conflict. Pic – St Vincent Times
An editorial in The Lancet summarized the findings on sanctions. Most importantly, the data analysis demonstrates that sanctions do kill. Economic sanctions imposed by the US and/or the EU were associated with 564,258 (based on a 95% confidence interval range 367,838-760,677) annually from 1971 to 2021. These findings align with a previous article in The Lancet Global Health showing that economic sanctions aimed at low-income or middle-income countries resulted in a 3.1% increase in infant mortality and a 6.4% increase in maternal mortality annually between 1990 and 2019.
The editorial notes that sanctions are restrictive foreign policy tools with the punitive aim of coercing behaviour change, such as stopping human rights violations or promoting democracy but despite the growth in the frequency and duration of sanctions, their success rate of achieving the stated aim remains at about 30%.
The core findings of the studies are that economic sanctions cause large, measurable increases in mortality, with effects comparable to those of armed conflict. The 564,258 annualized death rate is a toll higher than annual battle-related casualties.
The most significant effects were in children under 5, with mortality rising 8.4 log points or just about 9%. The increases in deaths for adults and older adults were significant as well and for all groups, the mortality rate increases the longer the sanctions remain in place.
The study shows:
* Unilateral sanctions (especially US sanctions) have the largest mortality effects.
* Economic sanctions (trade/financial restrictions) are more harmful than non‑economic ones.
* UN sanctions show no statistically significant mortality effect — suggesting multilateral regimes are less damaging.
The reasons why sanctions produce such effects are intuitively obvious, and include harms to health through reduced access to medicines and medical supplies; declines in public revenue and health system capacity; disruptions to food security; and constraints on humanitarian operations.
As the editorial succinctly states: “All economic sanctions ultimately function as sanctions on health… undermining people’s right to health.”
Sanctions disproportionately harm children, women, marginalized populations, and civilians in low income or conflict affected countries
The Lancet article on cuts in USAID is the first comprehensive, 133 country, evaluation of the projected impact on mortality over a 20-year period.
What USAID funding achieved (2001–2021)
For the twenty-year period from 2001-2021 USAID funding has been one of the most powerful drivers of mortality reduction in Low- and Middle-Income Countries (LMIC).
The authors concluded that “91,839,663 all age deaths… were prevented by USAID funding,” including “30,391,980 deaths in children younger than 5 years.”
High USAID funding levels were associated with:
* 15% reduction in all‑cause mortality.
* 32% reduction in under‑five mortality.
* 65% reduction in HIV/AIDS mortality (25.5 million deaths prevented)
* 51% reduction in malaria mortality (8 million deaths prevented)
* 50% reduction in neglected tropical disease mortality (8.9 million deaths prevented)
Significant reductions also occurred in:
* Tuberculosis
* Malnutritio
* Diarrheal diseases
* Lower respiratory infections
* Maternal and perinatal conditions
Considering the type of projects that USAID funds, it is not surprising that it has had such large impacts. The funding includes:
* HIV treatment (PEPFAR)
* Malaria control (PMI)
* Vaccination programs (GAVI)
* Maternal and child health
*Nutrition and food aid
* Water and sanitation
* Humanitarian response
* Education and health‑system strengthening
These are precisely the interventions that most effectively reduce mortality in LMICs.
Consequences of cuts
The article models the consequences of the 83% cuts announced in 2025 and the potential termination of USAID funding from 2026 onward. The study concludes: “Current steep funding cuts could result in more than 14,051,750 additional all age deaths… by 2030,” including “4,537,157 deaths in children younger than 5 years.”
The authors warn that the shock would be “similar in scale to a global pandemic or a major armed conflict… [but] would stem from a conscious and avoidable policy choice.”
Although sanctions and USAID cuts differ in intent, the Lancet articles show they produce strikingly similar mortality pathways.
Sanctions and USAID cuts have shared catastrophic effects. Both cause:
* Health‑system collapse
* Medicine shortages
* Food insecurity
* Increased infectious‑disease mortality
* Increased maternal and child mortality
The scale of mortality is staggering.
* For sanctions the annual toll of 564,000 deaths is likely to continue.
* USAID cuts are projected to cause 14 million deaths by 2030, including 4.5 million children
The ultimate policy question is whether the health toll is a justifiable trade-off for whatever perceived benefits sanctions or USAID cuts may generate.
As the world’s most powerful nations learn that their multibillion-dollar arsenals are vulnerable to cheaper, asymmetric warfare tools such as drones and low-cost missiles, we might see a reduction in defence budgets and redeployment to building storehouses of drones and missiles. This should allow nations to channel more resources to health and economic initiatives that efficiently keep people alive, and away from weapons system designed to kill them… and inefficiently at that.
Cheerz…
Bwana
Mauritius Times ePaper Friday 17 April 2026
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