No sanitary pads mean no school for teenagers like Achol, who lives in one of the world's biggest refugee camps. Then again, most of her teachers have been sent home already.
Thanks to swingeing cuts to the US aid budget under President Donald Trump, life at Kakuma camp in northern Kenya has got a whole lot harder.
Girls opt to stay home on their period, food rations have shrunk, tens of teachers have been fired and the vital cash transfers that once kept families going have almost run dry.
"The funding cuts affected even the community because they used to receive some food and cash-based transfers but it was also cut off," said Elizabeth Mukami, a headteacher at Future Primary and Junior School, one of the schools in the camp.
Fifteen-year-old Achol, a refugee from South Sudan, used to be given sanitary pads by her Kakuma school but supplies have run so low that teachers only hand them out for emergencies.
"I do not feel comfortable coming to school in such a state," she told the Thomson Reuters Foundation.
Achol, who did not want to give her last name, attends the Future Primary and Junior school in the camp, which is home to over 300,000 people, most of whom fled civil war in South Sudan.
The school is run by the United Nations refugee agency UNHCR and Finn Church Aid (FCA), which received U.S. funding before Trump's administration gutted foreign aid.
Ruth Owen, manager of international communications for FCA, said essential psycho-social services – be it the monthly pads for menstruating girls, help with mental health or special needs provisions - had all been axed due to Trump's cuts.
“Enormous mental distress is already evident in people who are suddenly left without support," Owen told the Thomson Reuters Foundation.
Owen said the Trump administration had rescinded its funding of $7.87 million (Sh1014 million) – money that had been earmarked for a range of FCA projects she planned for Uganda and Kenya this year.
The United States is the world's largest humanitarian aid donor, giving at least 38 percent of all contributions recorded by the United Nations.
It disbursed $61 billion (Sh7.9 trillion) in foreign assistance last year, just over half of it via USAID, according to government data.
So the cuts have affected millions of children like Achol, who has lived with her five siblings and mother in Kakuma since they fled South Sudan in 2017 after their uncle was killed.
"They gave us books, bags and uniforms. We were also given a hygiene kit that had sanitary pads, toothpaste, (ear) buds, a handkerchief and a toothbrush. All this stopped in February," she said, a month after Trump took office.
"In March, I got some pads from the Red Cross Society. But in May, the school told us they only had a few for emergencies. So, I did not come to school for a week."
Margaret, a 16-year-old from South Sudan, did get sanitary pads this month but is worried about what June holds.
"If help does not come, I will not come to school for a week," said Margaret, who did not want to give her last name.
Mukami said she could no longer provide learning materials or food to her more than 7,000 pupils from South Sudan, Somalia, Burundi and Democratic Republic of Congo, among other countries.
"We are looking for support from donors, particularly for the employment of teachers," Mukami said, but the US cuts meant they were no longer able to buy sanitary pads.
And if girls miss school because of their periods, they were more likely to drop out of education altogether, she said.
"We have learners who are supposed to write national examinations this year. They will be affected. Some teachers are forced to take two classes at once," said Mukami.
A UNHCR spokesperson said teacher numbers across the camp had fallen from 1,289 in January to 1,083 in May.
Joseph Ochura, sub-county director in Turkana County which is home to Kakuma, said one camp school had lost nine of its 20 teachers due to the USAID cuts.
"I have been trying to run around to borrow one teacher here and another here to go and make up the deficit," he said.
Food rationed, cash transfers out
Mercy Juma, who runs communications in Kenya for the World Food Programme, said the agency still provided school meals for children from refugee communities but worried that cash-based transfers could soon end.
"WFP will be forced to halt all cash assistance for refugees in Kenya from June unless additional funding is received," Juma said.
Funding shortages have also forced WFP to cut food aid to refugees across Kenya to the lowest levels ever recorded.
Mukami said about 400 students had dropped out of her school this month alone - and she blames the food rationing.
Achol dreams still of becoming a doctor but is now only eating one meal a day at home, which makes studying hard. If that meal is cut, she will be too hungry to continue school.
Temperatures at the camp regularly top 40 degrees Celsius, so Margaret said her mother was saving her meagre cash transfers to buy slippers and stop her feet burning en route to school.
"If there is no money, I will not get the slippers. I will miss school. It is too hot here to walk barefoot," she said.
