Almost all not American. Thalidomide was never approved for general use in the United States -- in fact, the FDA rejected it six times. As a result only 17 thalidomide babies were born here. Today, it is used for several conditions, but never in pregnant women, or women who might become pregnant.
Yes. One of the Wikipedia articles I linked above, talks about and has a photo of an official receiving an award from the then US president, from preventing thalidomide from being approved for use in the US (early on).
And yet there were deaths.
So, not only American.
Plus, the article itself says many non-American deaths happened.