The health system of Eswatini, the last monarchy in southern Africa, is on the verge of collapse as the United States scales back more than 20 years of large-scale aid related to the human immunodeficiency virus (HIV). Local hospitals, which have been absolutely dependent on U.S. funding, are suspending major medical services and laying off large numbers of staff, leaving thousands of patients without appropriate treatment.
On the 17th (local time), The Washington Post (WP) focused on the situation at the 'Miracle Campus' hospital near the capital of Eswatini, Mbabane, and reported on the local healthcare crisis. This hospital, operated by the Christian nonprofit organization 'Luke Commission,' was once a key facility that treated about 25% of the nation's HIV patients.
According to WP, Eswatini is the only monarchy in Africa and one of the countries with the highest HIV prevalence rates in the world. It is estimated that about one-third of the total population of 1.2 million people is infected with HIV. Since 2003, the U.S. has played a key role in combating HIV in Eswatini through the President's Emergency Plan for AIDS Relief (PEPFAR) by supporting antiviral medications, testing facilities, and medical personnel.
However, as recent PEPFAR funding has sharply diminished, the functions of Miracle Campus have effectively ground to a halt. Major departments, including obstetrics and gynecology, chronic disease management, and preventive care, have been closed, and nearly half of the 700 employees have been laid off.
This reduction in aid is a result of U.S. President Donald Trump's foreign aid cut policies. However, some point out that the Eswatini government has exacerbated the shock by failing to establish an independent healthcare system. They argue that due to excessive reliance on U.S. support, the country did not create the infrastructure needed for healthcare independence in a timely manner.
Structural problems within Eswatini also appear to have worsened the crisis. According to an internal report obtained by WP, local authorities purchased unnecessary or soon-to-expire medications at high prices, and some pharmaceutical companies provided luxury vehicles, travel expenses, and cash to officials to secure contracts.
As a result, among citizens and social activists from neighboring countries, there is a growing distrust that the responsibility for the collapse of the healthcare system lies more with the overall corruption in the institutional sector than with individual leaders. Ignatius Dlamini, a political activist from South Africa, criticized, "The king of Eswatini, who has 16 wives and drives luxury cars, is deepening the corruption in the public sector."
Dr. Echo Vanderwal, an American physician who established Miracle Campus in 2006 and has operated the hospital for decades, and his wife, Harry Vanderwal, are strongly opposing the government's proposal to fully transfer the hospital. Dr. Echo Vanderwal expressed deep distrust in government capabilities, stating, "That would be the biggest mistake."
Experts warn that the sudden halt in U.S. aid could pose a serious threat to African countries on the brink of ending HIV. Nkosi, a senator and former Minister of Health of Eswatini, noted, "The confirmed cases of HIV infection in Eswatini are significantly decreasing," but expressed concern that "a public health emergency could arise at any time if support is cut off."