To save the life of his badly malnourished 3-year-old son, farmer Yusuf Bulle had to travel from a remote area of southern Somalia to the capital, Mogadishu, where a rare health unit presented the only hope.

After 15 days at Banadir Hospital, the child was deemed out of danger.

"My home is located 90 kilometers (56 miles) away, with no health services and is in desperate need of support," he said.

One of the world’s poorest countries faces a crisis of health care exacerbated by this year's dismantling of the U.S. Agency for International Development by the Trump administration.

The loss of USAID funding has devastated many Somalis who know they can’t depend on a government that is focused mostly on defeating the al-Qaida-linked al-Shabab.

The aid group Doctors Without Borders warned in August that funding gaps were “undermining health care in Somalia,” citing the suspension of USAID funding in the closure of 37 health and nutrition sites in and around Baidoa city, 250 kilometers (155 miles) away from Mogadishu.

Bomb and gun attacks by the militants have reduced in frequency and intensity in recent months, leading some to see success in President Hassan Sheikh Mohamud’s “total war” against al-Shabab.

But hospital administrators, civic leaders and others point out that the latest push in a yearslong attempt to defeat al-Shabab has come at the expense of health care and other public services.

The Ministry of Health was allocated $91 million of a national budget exceeding $1 billion this year, with those funds tied mostly to projects backed by outside groups.

That's a significant improvement from last year's $52 million, but almost all of that increase came from donors, said Mahad Wasuge, who runs the Somali Public Agenda think tank.

And as the United States has shown, donor money comes and goes.

Even with the major setbacks in foreign funding this year, “security remains the number one priority” for Somali authorities, Wasuge told The Associated Press.

Many areas outside Mogadishu don’t have any functioning public hospitals, he said, with people forced to trek through often insecure areas to receive care at the ones still functional in the city.

Those facilities include Banadir Hospital, built with Chinese support in 1977, and De Martino Hospital, established in 1922 by Italian colonialists.

Officials at those hospitals said much of their work would stop without assistance from the United Nations and international groups.

Many patients come from Baidoa.

Sometimes they don’t have the means to return after receiving treatment.

Even at Banadir, Mogadishu’s main public referral hospital, expectations of the Somali government aren’t high.

The unit looking after malnourished children depends entirely on donor funds channeled through the humanitarian group Concern Worldwide, said supervisor Dr. Mohamed Haashi.

In addition to milk and food for mothers and babies, Concern Worldwide also pays the salaries of 13 people still employed in the unit after 37 others lost their jobs with the Trump aid cuts, Haashi said.

At De Martino Hospital, director Dr. Abdirahim Omar Amin said he worries about what will happen when contracts with two humanitarian groups expire at the end of 2025.

When the AP visited, the hospital was looking after dozens of children suffering from diphtheria, an infectious disease of the throat preventable by vaccination but now spreading in rural areas.

In the medical lab, Amin pointed to the equipment and said everything was acquired with donor funds.

“Now it looks like donors are fatigued,” he said.

“We only have two international NGOs working with the hospital at the moment.”

Most services at the hospital are provided free of charge, thanks largely to funding from the International Rescue Committee and Population Services International.

Patients with conditions not deemed urgent are asked to cover some costs.

“The Ministry of Health is supposed to give support to this hospital because this hospital belongs to the Ministry of Health,” Amin said.

“I hope, even if [the humanitarian groups] left, the Ministry of Health will replace their position.”

In response to questions from the AP, Deputy Health Minister Mohamed Hassan Bulaale said the government is working with some partners in "developing a contingency plan” after the loss of USAID funding.

He didn't elaborate.

In some ways, the hospital’s history mirrors Somalia's scars.

It once sheltered displaced people after the fall in 1991 of Siad Barre, a dictator who had held the country together and whose removal triggered fighting by warlords from different clans.

Many public facilities across Somalia were destroyed or have since fallen into neglect.

Somalia’s federal government, based in a heavily fortified area near the airport in Mogadishu, still struggles to assert itself even with support from African Union peacekeepers, U.S. airstrikes targeting al-Shabab and a range of security consultants from nations jockeying for influence in a country with strategic access to the Indian Ocean and Gulf of Aden.

The countries include Turkey, which bankrolls a hospital with intensive care capabilities in Mogadishu.

“Even the limited number of public hospitals that have started to function properly lately are heavily dependent on donor money,” said Wasuge, the civic leader. “They don’t get direct government budget that allows them to provide better health care services.”

The Banadir and De Martino hospitals are where the most needy people are referred for care.

Mogadishu’s main referral hospital for COVID-19 patients during the pandemic, De Martino, receives the “most vulnerable” wherever they come from, said director Amin.

Amina Abdulkadir Mohamed, a jobless woman who was at De Martino recently to give birth, said she went there because she knew she would not be asked for money.

“I was told there is free medication,” she said.

Mohamed Adam Dini, who represents Somalia's Puntland state in the national assembly, described the federal government’s priorities as “deficient” because of its overwhelming focus on ending “anarchy."

“A lot of diseases have been spreading” unchecked, Dini said, adding: ”There is no national health care plan, as we don’t have a national political plan.”

AP video shot by Jackson Njehia and Mohamed Sheikh Nor

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