Trump administration officials apparently felt that shuttering the U.S. Agency for International Development and killing billions of dollars in foreign aid was too subtle and failed to convey the real depths of their depravity. So the president’s lackeys figured out a way to make their monstrous intentions crystal clear.

A State Department memorandum prepared for Secretary Marco Rubio pitched the genuinely horrifying idea that the U.S. should threaten to withhold funds for HIV treatment in Zambia, where 1.3 million people require daily HIV medications. For good measure, why not also threaten to cut funding for tuberculosis and malaria medications?

This is all in service of forcing Zambia to give us better access to the copper, lithium, and cobalt minerals within its borders. It’s tough to get much more direct than telling a country that President Donald Trump has no problem whatsoever with letting people die if he doesn’t get his way.Zambia isn’t alone here. Indeed, this sort of thing is now standard operating procedure for the Trump administration, which has already forced at least 17 African countries to sign similar agreements. Those countries will all get far less aid than they received under previous administrations, and also have to agree to increase their own health care spending substantially.

These “deals” are not really deals, as none of the countries that are being pressed into this can effectively negotiate when their health care funding needs are so dire. And countries aren’t just needing to agree to the bad bargain of getting less U.S. aid while simultaneously somehow finding more of their own money to spend: They also have to agree to give the United States all patient record data and prioritize using faith-based health care providers.

This is part of the Trump administration’s America First Global Health Strategy. The “strategy” is simply that the only thing that really matters is the health of Americans, and therefore we need patient data from all these countries to help us detect disease outbreaks sooner.

Given that the Department of Health and Human Services is run by nightmarish ghouls who don’t believe in disease but do believe in eugenics, this explanation doesn’t really hang together. That’s because it isn’t the actual reason we want the data.

The move is intended to force all of these countries to share all pathogen data they collect with U.S. health companies first, giving them first crack at developing vaccines and other treatments before any non-U.S. competitors

And if that wasn’t bad enough, what if, for some countries, the State Department just threw in some non-health-related demands too?

Nigeria, for example, needs to agree to the crummy health care deal, yet also agree to address what Trump alleges is the persecution of Christians in the country.

And there’s Zambia, which can’t get the abysmal funding offered by the administration—less than 50% of what it used to receive—unless it signs a deal to let American businesses get more access to their mineral deposits

The memo isn’t shy about this tradeoff.

“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale,” it reads.

Imagine thinking this was a good and noble way to act. Imagine thinking it was a good idea to write this down.It isn’t even really possible to determine how many people the Trump administration has killed with all of these aid cuts. Worldwide, at least 200,000 more children under the age of 5 were projected to die in 2025 versus the previous year. Cuts to international food aid have created an entirely avoidable hunger crisis. A study published in The Lancet last month projects that the foreign aid cuts could result in at least 9.4 million more deaths by 2030. About 2.5 million of those will be kids under 5.

We’ll likely never know exactly how many deaths Elon Musk and Trump caused with their efforts to root out “waste” and “fraud.” But there’s no question that it’s an unbelievably high and terrible number—and that the Trump administration shows no signs of stopping.