 Good morning, everyone. Thank you for joining us. I'm Steve Morrison from CSIS. I had the Global Health Policy Center. We're delighted to hold this forum today. We're particularly delighted to be able to pull in at the outset of this forum. Jacob Elhilo, the UN resident and humanitarian coordinator in Damascus. I'll say a few words about Jacob in my introduction of him in a moment. I want to, first of all, give a special thanks to the speakers and the moderators on the panel that will be here over the course of the morning. I also want to offer a special thanks to my colleagues. Ian Goddisman, in particular, has worked really indefatigably to pull together with his partners in Damascus, this forum. Today, it may be subject to some technical difficulties. We don't do that. This is new terrain for us. But I'm confident we're going to have a good discussion and be able to hear live from Jacob in Damascus. I want to also offer a special thanks to Lindsey Hamergren, who from our side has pulled all of this together. This is the last week of substantive work by Lindsey before she moves towards graduate school at GW and a master's of public health starting this fall. Many other people have contributed to this. Brie Bacchus, Ryan Sickles, Katie Peck, Sahiel Angelo, Beverly Kirk, who's worked on a video. We'll be releasing a video shortly that tracks with this subject. A few quick remarks. We're now more than three years into a profoundly cruel internal war in Syria that has generated a human crisis. Unlike anything really that we've seen in a very long time in scale, the colossal scale, the reach of this inside Syria and into the surrounding region, and the continued growth and expansion of that human crisis. We're here to talk about that. We're here to talk about it from multiple angles. An estimated 160,000 people have been killed since the conflict began in March 2011. That is a pretty astronomical mortality rate for an internal war. And right now, it's hard to see that there's a political settlement or military victory in sight. But that does not argue against a continuing to struggle at multiple levels with what can be done to begin to arrest and reverse this. We hear a lot about the Assad regime's sustained violence against civilians, the way in which regime violence has been used as a tool of war against civilian populations. We hear a lot about attacks by armed militant groups. And the fact that over 9 million people, 9 million Syrians, have been driven from their homes, that's nearly half the population. 3 million of that population have crossed into Lebanon. 100,000 new refugees per month continuing to spill into the region. They crossed into Lebanon, Jordan, Turkey, Iraq, Egypt, severely overburdening the host countries in threatening region-wide instability. Syrians that are displaced within their country struggle to find security, medical care, and housing. As we'll hear today, there have been profound obstacles in getting humanitarian access to that population of an estimated 3 million folks that people like Yakub struggle to reach. The Assad regime and increasingly also armed factions routinely block safe delivery of humanitarian relief and defiance of international norms. The Security Council passed UN Resolution, Security Council Resolution 239 in February 22. And it's now four months, almost full four months since that point of passage. And we'll be talking today about whether that has opened windows of any kind at an operational level in terms of negotiated local truces, the sort of work that occupies the UN operation in Damascus on a daily basis. In the meantime, at the macro level, people continue to direct our attention to the fact that Syria is becoming more chaotic. And an expanding haven for violent Islamic extremists. And that growth of power by radical Islamic extremists is now extending quite aggressively into neighboring state of Iraq. We'll spend a lot of time today talking about the wanton and deliberate targeting by the Assad regime of health workers and infrastructure. Talk a lot about the medical professionals who have been jailed or detained or died and the collapse of care and what that has meant in terms of downstream public health consequences, both treatment of cancer, diabetes hypertension, risk of childbirth, a generation of children who find themselves without schooling, vulnerable, traumatized, ill. And in terms of downstream impacts, the fact that Syria has become an exporter of polio in this recent period. And that in early May, WHO Secretary General Margaret Chan designated it, designated a global health emergency, and designated particularly Syria, Pakistan, Nigeria, and Cameroon as particularly important players. The US has joined with other partners internationally in being very supportive and very generous in the humanitarian response. Over $2 billion committed in a fairly short period of time. That is a staggering commitment. It's one that we should be very proud of. It's one that raises questions of sustainability. Countless Syrian and international personnel on a daily basis risk their lives to deliver assistance inside Syria and in the surrounding region to navigate a security environment that is ever changing. This has provoked this crisis, this human crisis has provoked a debate. It's provoked a crisis of conscience over the international community's difficulty and failure so far to stem the massive suffering and transcend the multiple obstacles that the Assad regime and others impose. We do know that these costs and the repair of them are going to take our profound long lasting, their worsening, and they will take years to overcome. And there are no easy answers to this. We know that there's active debate around whether to how to pursue local truces and negotiated access, whether there should be defiance of national boundaries to expedite national relief cross border, whether there should be a return to the Security Council for continued and greater and more aggressive action. Increasingly there are calls, and we'll hear more about this later in the day, for arming moderate opposition. And we will hear more about the fact that in the ultimate resolution of this war, there will be a need for some form of an effective coalition of the willing and a shift out of the current deadlock and a return to diplomacy and negotiated settlement. We'll look at these issues, as I said, from several angles. And we're going to begin this morning with Jacob Elhilo, the UN resident and humanitarian coordinator in Damascus on live video. We've asked him to do a few things, to provide an overview of humanitarian relief and the operational environment that he's worked on. He's been there since August of 2013. He comes from a remarkable 23-year career in UNHCR and the UN High Commissioner for Refugees, working in the toughest places. He was the director more recently, before coming in August in 2013 for three years. He was the director of the Middle East and North Africa Division, the second office at UNHCR in Geneva, a very tough post. Before that was served for several years in Iraq, 03-06, a critical period, served in Tanzania and the Gulf Cooperation Council based in Saudi. He has a bachelor's of law from University of Khartoum. He's a friend and someone we've known for a very long time. And he's agreed to talk about the overview. He's talked about what it's meant after UN Security Council Resolution 2139, the efforts at TRUSES and negotiated access, how the shifting security environment. He'll talk about those operational challenges. He'll talk about the difficulty of navigating delivering support to four million people who are within reach from the government side, serving that population while trying as well to serve populations that are in opposition-controlled territory. In a period in which NGO capacity and retaliation is a high risk. He'll talk about the sustainability, the sense of how do you carry forward and sustain international interest in this period. We'll be followed immediately afterwards, Nancy Lindborg and Rabi Torme from USAID and the International Medical Corps will continue the conversation around humanitarian operations. That'll be followed by a panel looking at the destruction of the health sector and the public health consequences. Len Rubinstein will moderate that with Andre Gittleman from Physicians for Human Rights, Ron Waldman from GW, and Muriel Brennan from CDC. And then we'll close over lunch with a broader discussion around the policy options. Mike Gerson from Washington Post, one campaign, Kathleen Hicks, head of our international security program and a former senior policy official in the Obama administration of the Department of Defense in Zahir Salul, founder and leader of the Syrian American Medical Society. So with that, I'd like to, first of all, thank you all for coming and I'd like to turn the floor to Yaqub and ask him if he could open up the discussion with 15 or 20 minutes. Take more time if you care to and we will, as we talked about earlier, when we get to the point in the program where you've had a chance to cover this terrain, we'll open to the audience for some question and comments to come back to you. Yaqub, thank you so much for being with us. We really appreciate this. We know you have a rigorous schedule. So thank you. The floor is yours. Thank you very much, Steve, and a very good morning to you all in Washington from here, all of us here in Damascus and in Syria. Steve, thank you very much for giving us also this opportunity to be with you this morning and to try, even if in a modest way, bring to the discussion some of the key issues that we or key dynamics that we continue to battle with on the ground, trying and trying and trying to reach as many civilians as possible in Syria with humanitarian aid, but also trying to navigate what is a complex web of development and daily occurrences as this conflict, as this vicious conflict continues to rage. Steve, you spoke about the bigger picture and how Syria today represents probably the most difficult challenge that the world is facing. It certainly is one that is unprecedented in recent times in this part of the world, given its scale, the speed with which the catastrophe is unfolding, but also the profound impact it has had so far and will continue to have on the lives of people in Syria, certainly, but also in the region. I will try to quickly try to describe the context in which we operate, but also the situation as it stands now in Syria. Until three years ago, this country was a middle-income country. Until three years ago, this was the third largest refugee-hosting country in the world, coming only after Pakistan and Iran, both of which, as you know, caused large numbers of Afghan refugees. Syria was the third, because in addition to the 540,000 Palestine refugee population that lived here for decades, Syria also hosted large numbers of Iraqi refugees, but also many others from many other countries in the region and beyond. So this was only three years ago. Today, half of the Syrian people are displaced, as you rightly said. Today, and this is according to a recent study, put out by the Center for Strategic Research in Damascus, supported by UNDP and UNRWA, three-quarters of the Syrian population lived in poverty, and in fact, 20% of that live in acute poverty. Unemployment is over 50%. 2.5 million jobs have been lost over the last three years, and the story with the Syrian refugees is well known, and now their number is reaching 3 million, a projection that sadly is coming to pass, as was put out by UNHCR late last year. So this is Syria today. This is Syria, which until three years ago was one of the safest countries on Earth, and today, even movements within Damascus and any other urban setting need to be for most people with great difficulty, and certainly for UNHCR and other personnel in armored vehicles, and that is also true to many of our partners operating in Syria today. So this is the environment, and this is the result of three years of vicious conflict that a solution to it remains very, very elusive. Late last year, we projected that the number of people requiring humanitarian assistance in Syria this year, in 2014, would be 9.3 million people. See, we are now actually at the moment of reviewing, this is the mid-year point, we are reviewing our chart that is the humanitarian assistance strategy, and it is already clear that the number of people needing and requiring humanitarian assistance has gone up and will go up by the time we reach the end of this year. This is also the moment when we are looking at what is it that we have been able to achieve, despite all the difficulties and the constraints. And I will talk to you about whether 2139 has helped or not, and I will talk about what other channels and possibilities we continue to pursue in order to reach as many civilians as possible and deliver aid to them. The security situation, because of this conflict, I can best describe it, it's a very clumsy conflict also. There are many sides to it. It is very difficult to map out who is who, and that is obviously easier when you are referring to the government side. But even there, there are many operatives within the government side involved in this conflict. But the task becomes even more difficult, if not impossible, if you want to map out the operatives on the opposition side, because their number is large and their ideas are different and their places of presence are also multiple. And they are spread in many different parts of the country. So it is in an environment like this that the humanitarian workers in Syria strive to reach and deliver. It is in an environment like this, where ironically, even if it's a country at war, and it is a country where the government has lost quite significantly, in many of its parts, it is also a country where the government continues to operate as if, you know, not much has happened over the last three years, where systems and procedures and bureaucracy and hurdles are a fact of life. Even if they have delayed significantly our ability to reach and deliver, they have also not, and thankfully, not completely barred us from doing so, where the need for simplification is obviously quite evident. So it's almost a schizophrenic situation where it's a country at war, and we have seen many in that situation where the central government does lose a lot of its grip and power, but as far as Syria is concerned, I'm afraid that is not necessarily the case, and that is partly some of the challenge that we face in dealing with an ever-growing humanitarian situation, but an ever-growing complex web of procedures and systems. By the same token, trying to reach people and deliberate is equally challenged by the multiplicity of actors, as I said, on the part of the opposition, but also in some instances, the lack of understanding even of what is it that we're trying to do when we try to reach places to administer all you vaccines or try to reach places to fix water pipes, as we see today in Aleppo, where sadly again, water is becoming a weapon of war with a direct impact on the lives of no less than three million people. So it is a security environment which is highly unstructured. It is a conflict that is highly clumsy, adding to the challenge. This has impacted directly people in every sense. This is a conflict that is now in its fourth year, and Syrians are resilient people. They are extremely resilient people. They are patient and they can withstand pressure, but this is having a toll on them. This is eroding on their ability to cope. This is really the reason why three quarters of the population is now living in poverty. And this is the reason why many are driven away from their homes because of insecurity, but also others who are moving seeking services elsewhere in the country or out of the country all together, as we have seen with the many refugees who have chosen to cross borders. The UN and our partners continue to be present. Not only in Damascus, we are in Homs. We are now also in Aleppo. We are in the northeast in Qamishli. This is the far northeastern corner of the country, very much near to the theater of happenings as we see now on the Iraqi side in Ninoa Governorate just across the border where over the last 24, 36 hours we have also been observing the dynamics there with the ISIS taking control of a number of locations, but also perhaps most notably the city of Mosul. This will definitely have an impact on the situation in Syria in security terms, no doubt. And that is very much clear will be the case in Derizdur Governorate where ISIS already has a significant presence in Raqqa Governorate, which is totally under the control of ISIS and in Hasaqa Governorate where despite the presence of government forces, but also Kurdish militias, I am confident and sure and concerned that the developments across the border on the Iraqi side will certainly have an impact on the Syrian side. In humanitarian terms, we already understand that some Iraqis have crossed the border and sought safety on the Syrian side in Hasaqa Governorate. This is just an example of how ever changing the situation on the ground is and how dynamic it remains to be, but also how complex it continues to grow with multiple humanitarian challenges. We've just come out of the poll you scare and in many ways it can be described as a successful story of being able to reach 3 million underfives and administer the vaccination, but now we have measles scare and with the water shortages and the summer setting in, we are also gearing up for other complications, cholera included, which are yearly occurrences in terms of water shortages, triggering related diseases and pandemic outbreak, but this year we have the additional compounded problem of using water as a weapon of war. As I mentioned earlier, and this is the case in Aleppo where water has been obstructed and the network has been sabotaged and damaged, in this case by opposition groups, feeding the city of Aleppo. So the UN and our partners continue to work in this environment. At great risk, we have come here all accepting that this is a mission that is not without risks and the risks are real and the risks are high. So far the humanitarian community since the beginning of this conflict has lost 51 of our own. The great majority of that number of heroes who have fallen in the line of duty come from the Syrian Arab Red Crescent, our major partner in Syria. The volunteers have paid the ultimate price in their quest to deliver on their mission, but also UN personnel have lost their lives. And one, at least in the case of one NGO in 2012, also a humanitarian worker paying the ultimate price. So this is a mission that is not without risks and all have accepted that. But my concern is that the risks continue to grow as does the enormity of the humanitarian challenge itself. Now, of course there are, and it depends who you're talking to, there are glimpses of hope as to whether attempts at local reconciliation will help us do better. Every time we cross a line, I consider it to be a truce, even if it's for a day or two or three days. Every time we cross a line from a government controlled area into an opposition controlled area, it has to be backed by a ceasefire. And more often than not this works, but at times it gets seriously ruptured if not totally and brutally violated. As you may recall in February, this year when we went into the old city of homes for the first time in a year where UN and SARC humanitarian staff with a lot of civilians on the ground came under shelling while the humanitarian mission was inside the old city. This is just an example of, even with the best of intentions and all the guarantees and assurances from all sides, these things happen. And that is where wrong place, wrong time in Syria today kills. There is no other way to describe it. And this is again the environment in which the humanitarian workers continue to operate. But local truces in my view, and I think they need to be studied much more in depth because if they have an impact, I would say that impact is on the reintroduction of a normality of life for the civilian people. Irrespective of the political considerations, irrespective of whether these are considered to be surrenders or withdrawals or giving up or giving in, irrespective of that, when they happen, they also lead to creating an environment in which civilians either can live without the fear of having a mortar landing on their roof and that possibility persists, or those who have left also have the ability to come back and stay in their area of origin. They are not consistent. They are actually quite clumsy. These attempts at local reconciliation, many of which have certain common features, but a lot of them have their own specificities. And in fact, the UN has not been involved in any of them, and there are many, except perhaps in the case of Homs, where in different ways the UN was involved. First, through a total and a full humanitarian operation in February, leading to the evacuation of civilians and delivery of aid into the old city. And second, in May, where the evacuation of the last remaining fighters and the surrender or the release of 70 prisoners also took place. The second experiment involved the UN, but not the humanitarian UN. It involved the resident coordinator, the office of the joint special representative in Syria, supported by the UN department for safety and security. And that was deliberate. It was done to firewall, if you wish, humanitarian workers from being involved in what was essentially a military operation, or at least a military negotiation, leading to the return of the old city of Homs to the government, but also the safe passage of no less than 2,296 fighters out of that location into another area controlled by the opposition. Many of these efforts, Steve, take place in cross-line settings. Planning and preparing for these interagency missions is a nightmare because it entails talking to everybody, as I mentioned earlier, but even with that glitches do occur. We, of course, look still quite anticipating you to see if, in the coming period, in the coming immediate period, there will be a breakthrough concerning another provisional security council resolution 2,139, and that is using cross-border deliveries to reach more communities, especially those living in areas that yes, and to international borders, specifically in the north, and that is the Turkish-Syrian border, and in the north, and in the east, that is the Iraqi border, as well as in the south, and that is the Jordanian-Syrian border. With the developments in Iraq over the last few hours, the crossing point at Al-Yarubiya is now controlled reportedly by ISIS, so that's an immediate showstopper, even if there was a possibility to use that crossing to bring it from Kurdistan into northeast Syria. This new development obviously means bad news for us, so we still remain hopeful that the northern border and the southern borders will be allowed for us and our partners to be used, including through areas or points not controlled by the government. 2,139 has helped create an opportunity, but I will not go as far as saying that it has changed the dynamics fully. 2,139 has maybe allowed us to bring aid from Turkey into northeast Syria to Qamishli Nusayibin crossing point, which I think was a good example of using humanitarian dialogue to unblock some of the political blockages that seem to be there between the two countries, but that was obviously not enough and not sufficient, but it was a good start. What we are looking for now is more of that, including areas or points controlled by the opposition, but even when that happens, and I hope it does happen soon, because it will augment and complement our efforts to try and reach and deliver in a much more systematic and predictable way, even credible way, I would say, it will add to our credibility if we are able to use all means possible to reach civilians in a timely fashion. Even when that breakthrough is in hand, and I do hope it will be, let's not forget the environment in which we will be doing this. Let's not forget that in northern Syria, there is a conservative estimate would put no less than three to 400 armed groups in the area operating. It is said that 87 nationalities are fighting in Syria today. They come with different ideas of what needs to be done in Syria and with Syria, and they are there, and they are encountered, as we encountered them exactly four weeks ago when we tried to reach villages north of Aleppo, delivering aid. So we came across Chechen fighters, and we came across local commanders, and we came across other obstacles that really so humanitarian aid as either unnecessary, or if it is necessary, it has to be used according to local terms, as seen on Harvard by the local commanders. So negotiating access has taken another dimension in Syria, and we have taken it to a different level, I should say, and here I will say it very openly, that to do so you have to talk to everybody, and I think everybody in the room understands what I'm talking about. We really want to do that, and what is it that I'm talking about? Delivering aid and reaching communities and people in need, but also doing so in a way that preserves the safety and the security and the physical integrity of your own stuff. To do so, we have to talk to everybody. The final point, and I'm sorry, I already spoke maybe too long. This is the situation now. It is a complex situation. It is a dramatically dire situation, because the impact of it on the individual civilian in Syria is truly quite profound, and the damage that has been done to the social fabric in this country, but also the physical destruction that has inflicted the infrastructure, entire cities and neighborhoods, but also service delivery points. And this is very true to hospitals, you know the statistics, this is very true to schools, you also know the statistics, and it is now said that one out of every four schools in Syria is out. Is out of service either because of damage, serious damage or total destruction, or it is being used as a military facility, or being used to shelter internally displaced persons. The same is true to the health facilities, but despite all these challenges, I think it is good not to forget that efforts to continue to try and deliver, and if WFP, the World Food Program, is today able to reach 4 million people. This is a massive operation, by the way, to try and reach 4 million people in an environment like this. It is really impressive, the amount of logistical planning, but also the volume of movement of convoys and trucks. On average, WFP is moving 4,000 trucks every month to reach that many people with food aid. This is just an example. The same applies to health deliveries, although there we have significant constraints placed by the government, especially when such deliveries of health supplies are to go into hot spots, contested areas or areas controlled by the opposition, we really have significant challenges there, if not total obstruction, especially when it comes to trauma kits and surgical equipment. But these are some of the day-to-day battles we continue to fight here, and I hope this can be overcome in the coming period either through a realization by the government here that to deliver such supplies and medicine, even if it is to people in opposition-controlled areas, is not to mean fearing fighters, it is to mean treating civilians who otherwise face the true risks of death if they continue unattended to. That is all to say. It is an environment in which the perpetual nature of this crisis and the elusive political solution to it that remains to be the case, I fear things are going to get worse. I fear that no matter how we perfect our humanitarian deliveries, we will be chasing behind the problem, and I fear even when we do that well and reach as many people as we want to reach with aid, we will be doing important work, urgent work, that will save lives, but it will not solve the problem. The problem in this country has been, is and will continue to be a political problem. That can only be resolved in my view, and this is not just my view, I think this is the view of the United Nations, including at the level of the Secretary General, it can only be a solution that is reached through political dialogue. So final word, Steve, this is a conflict that has gone and lasted for far too long. It should not have happened in the first place. The world should not have allowed it to bring the Syrians to their knees. The civilians have suffered and they continue, and they will sadly continue to suffer, but that has happened and the whole world was watching, but it is one where I hope that the force of logic will be the one that the world will adopt to try and find a way out of this disaster rather than the logic of force. Steve, thank you very much, over to you. Thank you. Thank you, Jacob. Thank you, Todd. I think what you have presented to us this morning, extremely rich and forceful in the candor and the realism that you bring to this task and the sweep, the comprehensive sweep at trying to capture in 20 or 30 minutes, this is what you confront. It's quite remarkable and it's quite powerful. You'd put quite a focus in your remarks upon the shift that's underway towards more consideration around cross-border and cross-line. I mean, the pressure's building to find a way forward in a terrible and risky situation. Maybe you could say a bit more about what will it take, what will it take in terms of consent on the government side towards moving ahead in that way? That's one question. A second question is how do you get assurances that in your negotiations with the multiple armed entities that you require their protection or their consent? And when you think, and third is about capacity. We know that NGOs that operate, UN agencies that operate are, they do not have an infinite capacity. They do not have an infinite capacity to take risk. So how do you begin to, if you have expanded access by cross-line or cross-border and you are working assiduously to get consent from the government and a confidence level with armed groups that you can enter that environment, how do you then persuade your partners that this is a worthwhile risk to accept? Thank you, Steve. Thank you very much. All along the discussion on cross-border has been quite an intense one. Here in Damascus, but also elsewhere. But here in Damascus, the government's position so far has been, we have no problem with any crossing point along any border with any neighboring country that you can use to bring in aid and reach communities needing that aid in Syria. The only condition is that such crossing point needs to be quote-unquote a legal crossing point, legal crossing point. And that means, when we ask, what does that mean? A legal crossing point is one that is under the control of the government and is one the use of which will not compromise the sovereignty of Syria. And when they say that, by the way, Steve, I think, first of all, I don't think there's any country in the region or maybe even in the world that knows the UN and its dealings in New York better than Syria. They've been doing this for six decades. So they know what UN resolution, UN Security Council resolutions are and what they mean, and they use them. And in this case, they're using Security Council resolution 2139, which speaks about preserving the sovereignty of Syria, which speaks about adhering to the principles enshrined in the guiding principles. And even if there is no direct reference to the General Assembly resolution that talks about this, but reference is made in the Security Council resolution that any such efforts or operations will have to be in consultation with and with the consent of the country or the government concerned. So they use that effectively. This has been the case ever since before 2139 came to being, but also after and especially after. I know that for the moment, there are frantic efforts in New York, perhaps facilitated by Russia to try and reach a consensus, producing a new resolution, this time on cross-border operation. The viewpoints are still different, but what is interesting is that, and this is something we have verified here in Damascus over the last couple of days, with very senior government officials as to whether it is true that Syria is ready to consider cross-border efforts and deliveries. And the answer is yes. The answer is yes, but of course there will always be caveats and expectations. But the fact that we have moved this half an inch step towards hopefully realizing a breakthrough on allowing deliveries cross-borders, including through crossing points that are not under the control of the government. This will be a very important breakthrough, and I will not emphasize enough how important that will be, but I will also not be too romanticizing of it because the majority of the people are not living next to the borders. The majority of the people are very far from the borders, and some of them continue to be in enclaves of besiegement, mainly by the government, but also by the opposition that are far from the border. So even if we are able to reach more people through cross-border deliveries in the coming period, if there is a resolution, which would be very good and very important, and then we will talk about how to actually do it in such an unstructured and highly volatile and ever-shifting security environment. That's a real question that we also have to confront, even if we have a resolution. But let's also not forget that the majority of the people are not waiting for cross-border deliveries. The majority of the people are in other parts of the country, sitting nowhere near any international border. Everyone in this conflict has played a very significant role in creating the problem. That is definitely true to the government, but that is also true to the opposition groups, and we talked about that there. But again, it takes risk to actually go there and meet and sit and solicit the support. And before that happens, it takes a considerable amount of contact through Skype and through even cell phones, but mainly through Skype to try and put the fundamentals of what is it that we are trying to do? Why are we coming to see you? What is it that we are bringing for how many people, the routes that we intend to take? And it's never as simple or perfect as I make it sound. It is really a daunting task because of the multiplicity of actors. And some of them are really not small actors among the opposition groups. And therefore, getting the support of them all is unquestionable, because without it, you end up running into problems and we do run into problems. So, touch wood, so far we have been lucky, but incidents have occurred, as I said, in the old city of Homs, but also elsewhere. And we have managed to just use that one simple thing, that this is a UN and humanitarian partner mission that is not coming escorted, that is not coming with weapons, that is not coming with a political agenda or a military agenda. We know you have an estimated number of under-fives and we know that the civilian population in your area is X, Y, or Z. And this is what we would like to actually do, deliver that aid, counting on your facilitation, but also counting on your protection of the supplies, but also the staff who are accompanying them. So that will always continue to be a requirement. And I'm sure in the room, there are many with influence and leverage or contacts to continue impressing and reinforcing this message that in Syria, the United Nations humanitarian agencies and our partners are ready to talk to everyone, coordinate with everyone, cross-line, but also hopefully cross-border in the not-too-distant future. But that will take indeed the cooperation of all on all sides to this conflict. Capacity, it is probably one of the, if not the most complex and in scale, probably one of the largest crisis, humanitarian crisis we have in the world today. Its intensity is there and it speaks for itself the impact of the civilian population, but also the regional implications of this conflict have been talked about many a time. And they are not just ideas or suggestions. In fact, the direct affront to regional peace and security is already happening as we see in countries like Lebanon. And this will be compounded by recent developments in Iraq. But also it is a situation that continues to grow by the day, yet the capacity is so limited. And this is the irony that I referred to earlier, that we are in one of the most complex humanitarian situations on earth, yet whether we like it or not, we continue to deal with many actors in this conflict, but we certainly continue to deal with the government that continues to see things its way. And in many times or many instances continues to suggest or assume that we are still in 2011 or in 2010, i.e. not much has changed. So that is a daunting task to try and battle such daily battles, but also to fight for more staff, for more offices, for more ability to move around the country in order to deliver on our mission. And we have been able to do so, but we need to do a lot more. And for that to happen, we also will continue to require a lot more capacity, both national and international. Over to you Steve. Thank you. We're getting near to the end of the time and I know it's evening there and we've taken quite a bit of your time. What I want to do is invite our audience, we could take three or four quick comments or questions. We'll collect those, come back to you. I apologize, Jacob, that you cannot see the audience, but it is full, I promise you. If there are any comments or questions, there are microphones here. Please put your hand up and identify yourself. If there aren't any, I can come back to Jacob to close on one issue that I would like to raise. But are there any interventions from the audience? Yes, please. And just be very succinct, identify yourself and pose your comment or question. There's a microphone behind you. Question for our colleague, heroic colleague in Damascus is, aren't we legitimizing the role and the importance of the different factions by treating them as leaders? After all, many of them are thugs that are following a false ideology or a personal interest most of the time. So by giving them importance, by seeking, as you say, their protection, aren't we perpetuating this wrong situation? That's my question. Thank you. Do we have any other, do we have any other? Yes, right behind here. I'll come back to you. We'll bundle together three or four maximum and come back to you and ask you to close. Yes, sir. Hi, I'm Gary Sargent. I run a small consulting firm. I spent a couple of years in Beirut, so I understand sort of the region. My question really is how much is the border between Lebanon and Syria effective? Are you getting aid through there or sort of what those transportation issues are? Thank you. Yes, right here. I'm Chris, fellow at the United Nations Information Center. So my question would be on the Palestinian refugees. And I wonder how the living situation for Palestinian refugees in Syria right now. And I know some of them fled to Lebanon previously where the living situation for them is dismal. So I wonder, what is the UN? If the UN has any resolution on that, thanks. Okay, any others? So the issues are around, are you legitimizing, is this legitimizing factions that should not be legitimized? Question around the border with Lebanon, I believe it was. And then a question around Palestinian refugees, status of Palestinian refugees. Right, back to you. Thank you, thank you, Stephen. Thank you to the three speakers. We are not legitimizing anyone. Our aim is to reach innocent civilians wherever they are in any part of Syria and deliver to them urgently needed humanitarian assistance, especially when that has been seriously disrupted because of the destruction that has inflicted basic social infrastructure and delivery of services. So that is the goal. And for us to realize or attend this goal, as I said earlier, we cannot ignore the fact that there are operatives on the ground. Some of them may indeed come from a background that the first speaker has described. But today they are, you know, the law in that spot where they are operating and by engaging them and by talking to them. I don't believe we are legitimizing their authority or their presence, but we are pursuing a mission that can only be realized under the current circumstances through such means. And this is unfortunately the case in any of these conflicts that we see around the world where vicious civil wars and internal strife has produced so many of these so-called leaders in their localities and with whom we had to deal. And that is why it is important that a solution to this problem is found. It is already too late in many ways. It's certainly too late to the tens of thousands of people who have been killed and those who have been maimed and seriously injured. It is too late, but there are still 20 million Syrians who live in Syria and they have not given up yet. So our duty and responsibility also is not to give up and to employ all credible means possible to reach as many civilians as possible and deliver on this mission. The border with Lebanon is actually the only lifeline we have out of Damascus is through a crossing point at a location called al-Masnah that leads from Damascus to Beirut. So that is if today we have to reduce staff or evacuate staff or even when we do our regular travels in and out of this part of the country, it is only through the Lebanese border. And it is also through that border that the bulk of what we import, especially medical supplies and non-food items, the bulk of that comes through the Lebanese border at al-Masnah. Of course, we use other entry points and that is the ports in Latakia and Tartus. We hope to be using the borders north and south, but for the time being we do use one point along the Turkish-Syrian border that is Kamishli and one along the Jordanian-Syrian border and that is Nasib. But we hope to have more of these crossings that will increase our ability to reach people faster and much more predictably. The pre-conflict Palestine refugee population in this country was 540,000. Half of that population is now displaced. They no longer live in the places, the homes or the locations where they lived in March 2011. Half of the Palestinian population is displaced. And in fact, 70,000 of those have become refugees, perhaps for the second, if not the third time, because they left Syria again and the majority of them are in Lebanon today. You may have noticed, my colleague from the UN Information Center that when I speak about the people, I speak about civilians and I don't speak about Syrians because Syria has a lot of Syrians, no less than 19, 20 million, but there are also others and I make specific reference to the Palestinians. So in order not to exclude anyone needing humanitarian assistance, I use civilians. And that is why the Palestine refugee population in Syria continues to receive particular attention because of the double damage. If I can put it this way, that has inflicted them. Yarmouk camp is a global story today and the besiegement there that has lasted for far too long. Although in recent times, thanks to the efforts of our colleagues at UNRWA, some of that besiegement has been relaxed but the problem persists. Yarmouk problem is just one reminder of how the plight of the Palestinian people in Syria is double compared to anybody else. Over to you, Steve. Thank you, Jacob. We're getting to the end of our hour here. This audience that's come to hear you this morning is a diverse audience of Washingtonians, mostly who are drawn from advocacy groups, from US agencies, from other think tanks, people that are associated with implementing NGOs, those associated with international agencies. So it's a diverse group that have come to hear from you. We're very grateful to you for taking so much time. I think this is very valuable. Your voice, the voice from Damascus, from people like you who are working so assiduously to tackle these complex and dangerous problems, that voice is often not heard in the kind of vivid way that we've been able to do here today and I want to thank you for that. I'd like to ask you to close with a thought for us in terms of advice. In America, we have a certain numbness to this crisis. There are many reasons for this, but people have commented on this. The, perhaps we'll see a change in the opinion climate in America as new data comes forward, but that numbness is a problem for us. The US government has been extremely generous, putting $2 billion of assets towards this. Congress on a bipartisan basis has been very generous and supportive, but we need to move beyond this and we need to be very assiduous and very careful in preserving the sustainability of these programs. So what is your advice? What is your advice to this audience here about how best to stay the course and sustain hope in this situation? Steve, I would be presumptuous if I have any advice to give to such a gathering of experts in today's event, but perhaps a couple of things. Maybe first, thank you before asking more. I thank you to the American people because over $2 billion has been given to support humanitarian efforts in the Syria crisis and that is indispensable support that we continue to rely on. This is the fourth year of this conflict and that fatigue that seems to be creeping in in addition to the numbness that you've referred to, I fear is going to, even if this is the center of all prices in the world today, I fear it is going to be overshadowed by other happenings around the world and that fear is perhaps backed by what we see today in terms of the financial support to these humanitarian efforts. The American people and the US government have given over $2 billion, the requirements in Syria and in the region for 2014 is $6.5 billion and of that, so far this year, both inside and outside, a billion dollar has been paid. So we still have a long way and this is almost the middle of the year, so thank you to the American people for having been so generous, but we continue to a sustained effort to support the humanitarian efforts on the ground because without that we will really be taking away from the last hope that millions of Syrians and others living in Syria will be deprived of that glimpse of hope that they are not alone in this. Moving forward, perhaps, I think it is not undignified for the world to actually say that a political solution is indeed the only solution and the way out of this and for that to happen, I think the world needs to take a step back and perhaps even a deep breath because if there was a strategy concerning Syria for the last three years, it certainly hasn't worked. It has not worked, but what it has done is led to the suffering of people and it has destroyed many parts of this beautiful country. So if that is the goal, then it is a working strategy and I don't think anyone in the international community has that interest. So take a step back and a deep breath and maybe give political dialogue a chance, but really one that takes into account the very real dynamics that are taking place on the ground, overdue. Yaku, thank you so much. This has been an extraordinary conversation this morning for us and we're very grateful and we're very grateful to you for your courage and your commitment in this and to all of your staff and I hope we can stay connected. We will, obviously, there will be many other opportunities downstream where we would very much welcome the chance to re-engage with you and hear again from you on how things are going both by this means or if you happen to be here in Washington by person. So please join me in thanking Yaku Belhilo. Thank you, thank you very much. Thank you. Thank you, Yaku. Have a good evening and amazingly this connection worked. It did work and beautifully. So thank you so much for giving us the opportunity. I send you all greetings on my behalf and the entire team in Syria in all locations. Thank you for your support and we stay in touch. Thank you.