 My name is Todd Summers. I work here at CSIS in the Global Health Policy Center. I'll be moderating the next panel, which is going to take about an hour to talk about the humanitarian issues that were raised previously. As we heard, there are over 9 million people in various stages of humanitarian assistance need, either inside Syria or in the borders of that country. It is a crisis that is unparalleled and raises a number of very important questions. We have two great speakers here to talk about the current situation and the plans for moving forward. We have with us Nancy Lindberg, who's the assistant administrator for the Bureau of Democracy, Conflict and Humanitarian Assistance at USAID. And we have with us Robbie Torre, who is the Vice President for International Operations for the International Medical Corps. Both of them have been working assiduously to address some of the humanitarian challenges that have been raised. Just to give you a sense of the format, what we're going to do is each of the speakers is going to be providing some introductory comments for seven to ten minutes. We've asked them to give us a broad overview from their two perspectives. And then we're going to turn right to you for questions and answers. So this is a chance for you to engage. We'd like the questions to be short. And we'd like them to focus on this particular topic, which is humanitarian assistance. There are other sessions later today that will get into some of the other issues. So I'll try to keep things focused a little bit and moving at pace. So Nancy, thank you very much for coming. Thank you for your hard work in this area. Over to you. Great. Thanks, Todd. And thanks to Steve and CSIS for hosting this great link to have. I mean, one of the sort of interesting features of the whole Syria conflict is it really has been played out on Skype and the YouTube. So it's a very different kind of conflict because we are so up close to it. And yet, as you mentioned, Steve, it has become a numbing conflict because of the size and the complexity. And violence and the impacts of that violence have seriously escalated, especially just in the last year. We are now up to 9.3 million people who need assistance and 6.5 who are displaced inside, plus another 2.8 million who are outside. These are impossible to comprehend. So one way to think about it is it is as if the entire city of New York plus all of Buffalo, Rochester, Yonkers and Albany were deserted as if everybody had left all of those areas either to become displaced within New York or leave the state altogether. It's just staggering to really think about that kind of impact. And I think as we hear a lot, 5.5 million of those are children. Our children who are losing hope of a future, they've been out of school often for up to 3 years at this point. Syria was a middle income country. Estimates are that in the 3 plus years of conflict thus far, they have lost 35 years of development gains. If you ever needed a more stark illustration of the absolute devastation of conflict, it's not just the here and now on people, on health, but it's also the impact it will have on this country for a generation to come. If the conflict were to stop tomorrow, it would take several generations to get people back into their homes any semblance of normalcy again. I also want to note, we heard from Yakub about the $6.5 billion U.N. appeal and just to pause for a moment on the enormity of that appeal which dwarfs any other appeal. All of the global appeals put together do not equal $6.5 billion. And this is in a year where for those of you, and I'm looking out and I see that there are a lot of people who are deeply engaged in this kind of work and probably know this crisis very well, remember that this is a year in which we've had three of the highest order, actually four of the highest order humanitarian crises. They're called L level 3s. And so in addition to Syria, we also have South Sudan which is now spilling over into its neighboring countries. We have Central Africa Republic and we had the typhoon in Philippines in December. So we are straining the humanitarian system in terms of resources, in terms of the kind of people who can go out and do this kind of work. And we are looking ahead to a conflict that has a little hope of being resolved in the near term and if it is the impacts that will continue. So the United States, as Yaqub mentioned, has been the largest single donor to the humanitarian effort thus far. Secretary Kerry was in Lebanon just a week or so ago and announced an additional $290 million, which brings our total contribution to Syria and the region to $2 billion since the conflict began. I mentioned the escalation. We have, over the past two years, continued to increase our humanitarian assistance as quickly as we can, both in terms of funding provided. We have increased our partners from 12 partners a little over a year ago. We now have 27 partners working inside Syria. And we have consistently used an approach that works through every possible channel. We have all the kinds of partners that we possibly can, UN, international NGO, local NGO, internal networks, in an effort to reach all parts of Syria through all the means possible. And we have focused particularly on those life-saving areas of water sanitation, of health, and I know you're going to have a panel on health later. But I do want to flag that this has been an especially difficult conflict because of the absolute egregious targeting of civilian facilities with a special targeting of doctors, of nurses, and of hospitals. And the health system, when we first started, we focused on providing health that focused on trauma care for those who were wounded. However, as the system, the entire health system has just crumbled, it's increasingly had to focus on the kind of health that is just every day for people, including fighting the kind of diseases that are now unfortunately becoming a risk of epidemic polio and measles. Food, we're the largest donor of food both inside Syria and in the region. I do want to note that regionally, working with WFP, we've moved into a debit card to enable refugees to go to a store with a debit card and buy what they want at a time that is convenient for them, which has been life-changing for the refugees. It's also injected about $500 million into the local economy. So, as we look at how do you sustain our efforts in a long, complicated humanitarian disaster, it's continually looking for those ways that not only save lives, but look at ways that we can build resilience both inside and outside Syria. Looking forward, we're continuing to push on access, and you heard from Yaku, how difficult access is. We really think about it as, first of all, all the constraints that the regime puts on that assistance that's delivered out of Damascus, and it's a constant set of blocks from enabling you to leave Damascus with that load today to getting visas and permission for staff to enter into the country. It's a constant harassment, it's a constant control of what kind of assistance can go where. There are an estimated about 3.5 million people who are out of reach of the Damascus-based operation because, as you heard from Yaku, they're very constrained in going across line or across the borders. So there has been an effort to look at all the channels that we're able to use to get assistance to all parts of Syria. 2139, the UN Security Resolution that was passed about three months ago, is very explicit and it expresses very explicitly the sense of the Security Council that there is a demand for access across border, across line, into besieged areas, and also to cease the bombing of civilians. Three reports have been given thus far, none of them have indicated any kind of promise. There is a deep need for all parties to step up to honor that. There's a vigorous conversation going on in New York right now. Looking ahead, I want to just flag two additional challenges on top of all of those. And there is, on the horizon, another drought that we're starting to see. There was a drought in 2008 that some people attribute to a hastening of some of the conflicts inside Syria. We're seeing another drought that threatens to further reduce food that is still produced inside Syria. They've already lost about 40% of their productive capacity and this could bring it down even further. Prices will go up, food will become even more scarce for those who are inside. And then the second is the disease possibility. We've seen the polio outbreak and now we're very concerned about measles, which is even more difficult to provide vaccinations for. So I look forward to the conversation, but I just want to close with, I've been going to Jordan and Turkey and Lebanon, not able to get inside Damascus, but I've seen the same group of women over the last three years in Jordan, sorry, in just the last year. And it's really hard to not lose sight of the impact on just people. And when you have a chance to talk with the Syrians, again, this was a middle income country. People often had to leave with absolutely nothing. You have primarily women and children who have been deeply affected and children who we really are in danger of losing a generation in a region that can ill afford to lose a generation of children who don't have access to schools or who are just now getting into schools that are hugely overcrowded, but thanks to the generosity of Jordan and Lebanon. There's an urgency not just for saving lives in an environment where the violence is escalating, but there's an urgency with the hopelessness that's starting to settle in with people who have lost everything. And so one of the things that is very important is to continue not just to provide the resources, but continue to let the Syrians know that the American people are standing with them. We are providing critical life-saving assistance and we are deeply concerned about the impact this is having on their everyday lives. Thanks, Nancy. Robbie, your International Medical Corps works in over 30 countries. You've been doing this now for 12 years, I think. This has got to be an unprecedented situation even for your organization. Nancy, you had run Mercy Corps before, so you have both seen this also from the NGO side. Can you tell us a little bit about what this looks like from IMC's perspective and where you see opportunity and hope moving forward? Absolutely. Well, first of all, thank you Todd. And I wish it was 12 years because I would have been three years younger. It's been 15 years with the International Medical Corps. You know, International Medical Corps works in the region. We started initially in Iraq in 2003. Then because of the influx of Iraqi refugees in the region, we worked in Syria, Lebanon and Jordan and we've been in Syria since 2007. And we registered to work there. And it's been, you know, it's been challenging but also it had its impact. And most recently, over the past couple of years as well, we were registered in Turkey and we're working in Turkey. The complexity of the conflict is immense. We're not talking about, you know, one party fighting another. We're not talking about sectarian ideological conflict that has tremendous regional impacts. And we know what's going on in Syria although unfortunately we don't hear about it in the news. If you go on TV, you never hear about Syria anymore. We're hearing about Iraq now, which is a good thing, although it's been happening for quite a while. It's unfortunate that it's happening. But people started to forget about Syria, what's going on and the suffering of people in Syria. We're talking about 9.3 million people displaced. We're talking about the host community that's struggling in the neighboring countries. And I want to talk a little bit, you know, Jakub covered Damascus and Syria pretty well. But I really want to talk about the host communities in the neighboring countries where, you know, for example, in Lebanon you have over 1 million refugees and the entire population of Lebanon is about 4 million. Just look at that. And Lebanon is struggling from its own political issues where up till now they still don't have a president unless something happened today. But we still don't have a president in Lebanon. The economy is still struggling and then you add a million refugees in addition to the Palestinian refugees, in addition to the Iraqi refugees that have been there. And what you end up with is an already weak infrastructure that's completely collapsing. But Jordan, they have camps in Jordan. But there are a lot of people living outside of the camps in urban areas. And that's also impacting the infrastructure. And I think one of the things that the humanitarian community as a whole needs to look at is how to approach this differently. We cannot continue working the same way we've been working for the past 20, 30 years in terms of focusing on the refugees and really not focusing much on the host community, especially in a situation like in the region where there's tension, there's potential conflict that could erupt anytime in Lebanon. And we've seen what's going on in Iraq now, which is also amazing because they have refugee population and now we're talking about close to 500,000 IDPs that fled Mosul into Erbil. And who knows, the conflict is going to continue. I think we need to start, you know, take a step back, as Yaqub said, and look at what needs to be done. We all know that refugee situations in the Middle East are never short-term. The Palestinian refugees, when they fled in the 40s, we thought a year or two, they're still refugees. Iraqis, they fled in 2006 and 2007, they're still there. Now we have the Syrian. Let's be realistic, the Syrians are not going back anytime soon. I think the Turkish government initially hoped that they would go back within six months to 12 months. Now they realize that they're there to stay and they're changing their approach as well in terms of asking for assistance when initially they didn't want anybody to assist them. In a country like Lebanon that's really on the edge where there's tension between the refugees and the host community, we need to change our approach. We need actually to focus on the host community rather than the refugees. The entire focus has been on the refugees with the hope that the host community would benefit. Refugees have their needs, but the host community actually have their needs. We need to start focusing on the host community. We need to build the infrastructure so they could cater to the refugees and let the refugees benefit from the investment that we do in the host community rather than the other way around. We also need to start delivering aid differently. The debit card approach where you give, you know, a debit card to a Syrian refugee and tell them, you know what you need. Go ahead and buy what you need. It's the right approach. You know, getting non-food items, distributing them the first time in an emergency grade, but keep on doing it over and over again then you end up with somebody who has, you know, seven buckets. They don't know what to do with them, but they really don't have, you know, food. We need to be smarter than that. This is the 21st century. There's a complexity in the conflict that's taking place now in the 21st century that we didn't experience in the early or in the 20th century. We need to start thinking smart. We need to start being effective. We need to start planning for three to five years because, you know, I hope the level of funding that the U.S. government and other donors will be, will remain the same for the next three to five years. But reality is, you know, look at Darfur in 2004-2005. It was all over. Where's Darfur now? How much money is going to Darfur? If this conflict continues, and as we see, there is no real end in sight. You know, we're all hoping for a political solution because it is the only solution. But we need to be smart. We need to be cost-effective. We need to be efficient. And we need to build capacity. The Syrians have tremendously entrepreneurial people. They're resilient. We need to focus on them. We need to build their capacity rather than just assist them in terms of providing, you know, what I call Band-Aid assistance. So let me, let me start there and then we'll turn to the audience. But I want to probe a little bit about this question around when to move from crisis to a long-term response when you sort of need to do both at the same time. Yaqub mentioned that this is a catastrophe. He mentioned a clumsy political situation. The movement of people is substantial and changing every day. So there is an imminent, urgent crisis today. And yet you're also arguing for a long-term response where the tents need to be moved to houses and you need to start building infrastructure and economic capacity in schools and hospitals. How does that go over with the host governments that are probably not so happy to be talking about long-term engagement with refugees, even if that's probably what we all know is the case? And how is the U.S. looking at the sort of need to both be urgent and long-term and it's thinking, Robby? The division between emergency and development sometimes is a fake division that we create or because of different pots of money it's created. I think the approach should always be, you know, you address the emergency need but also look at what needs to come next. You know what I mentioned in terms of, you know, there's a refugee population. It's there. They have urgent needs. It is an emergency. Any time there's a refugee population it's an emergency. But what I mentioned in terms of focusing on the host community, building the capacity of the host community, you know, definitely focusing on the host governments as well that have invested millions and millions of dollars in a refugee population that they had no choice. Focus on building the capacity, the municipalities, the hospitals, the clinics, the schools. So they can see actually that the refugee population is not just a burden. It could be actually an opportunity as well for their government to provide for their own population. I think that approach of linking the relief or humanitarian development is the only way forward in a complex situation like Syria. The same thing in Jordan. You know, Turkey is on a different level but it's the same approach that needs to apply throughout the region. Nancy? Absolutely. I would distinguish however between inside Syria and the crisis that's occurring there and the crisis that's occurring in the surrounding region. You want to look always at all the ways you can help people not just survive a crisis but maintain dignity and create opportunities for the future. The difficulty inside Syria is that the bombing continues and you know, we're hearing that there are fewer clinics being bombed these days and that's because there are fewer clinics to bomb and so there is a limit to what one can do inside Syria although there are efforts to help some of the communities, especially in the northern area, look at how they can function more normally and have garbage services and things like this. In Lebanon and Jordan, there is a very different opportunity and I completely agree with Robbie that there needs to be and there is a shift happening where we have to take a different approach. There's been an effort within the international community to develop something called the Comprehensive Strategic Response Framework and it's understanding that we have these artificial dichotomies in our international humanitarian architecture and our development architecture that does not serve us well in these kinds of environments. So there was mapping done in Lebanon, for example, where it showed that the greatest convergence of poverty overlaid exactly with the greatest convergence of refugees so that one needed to look at all simultaneously. Two years ago, the Jordanian government was very determined that we not shift the USAID bilateral aid program to do anything differently. That attitude has significantly changed with the continued influx of refugees and we have now pivoted our bilateral program. We have about a $660 million development program that also includes loan guarantee funding. It adds up to about a billion dollars of assistance that the US provides Jordan every year. Much of that is now focused on looking at how do you help communities that are hosting refugees and experiencing tremendous strain on schools, hospitals, electrical systems and water. About a year ago, we were able to deploy a really important fund that we have called the Complex Crisis Fund that enables us to move quickly to do different kinds of programming and we began looking at the water systems in northern Jordan. This is one of the most water scarce countries on the planet and with this influx of refugees, there is a depletion of the water availability that is critical for us to address. Schools, hospitals, we've got to increase the capacity of both of those so that they can continue to take in the Syrian refugees. Robbie noted the statistic, but one of the ways to think about it is that the 10% of Jordan that is now Syrian, if that were the United States, it would be as if we absorbed another state of California, which is hard to imagine our country being that receptive to that many refugees coming onto our shores and so Jordan and Lebanon have done an extraordinary job of welcoming these refugees at great cost to their own infrastructure and so we need to shift how we provide assistance, especially looking at the long-term nature of this because it's much more expensive to deliver through the international humanitarian system than to help the country provide that. Both Jordan and Lebanon have done what they call resilient strategies and there's an effort underway right now to see how we bring these streams together for what will be a long-term crisis. Yeah, it sounds like the food aid approach with the card, as you mentioned Robbie, is one step to actually start to move toward the development approach as well and has the attraction of injecting money into local economies and maybe helping to address some of the cost to the host countries of dealing with such a massive influx of people. Yeah, so just on that, because when I was in Jordan a few weeks ago, I visited a supermarket, it's part of a chain that participates. So as the women who were using these cards told me, they have reclaimed their dignity because they don't have to go queue up to get a voucher and then go to the supermarket at a certain time. They have these debit cards, which by the way they didn't have before in Syria. So it's this sort of exciting new frontier for them and the supermarket has benefited. This one store has had about a 20% increase in their sales and this by the way is a supermarket that was founded by a woman who had 17 children and then she founded the supermarket. Just a little amazing fact. Something to do in her spare time. Yeah, it's now run by four of her sons. But Jordan has had somewhere around 250 and 300 jobs created because of this food program. As I said about 500 million dollars have been injected regionally into the economy because of this food program. So it's a really important way to rethink how we provide assistance so that it has these benefits. This is possible because the United States, it has more flexibility with our food aid reform thanks to some small gains that we had last year in Congress. All of our food assistance in the Syria crisis is cash. We cannot provide commodity to that crisis. We need to have the continued flexibility that cash gives us to do those kinds of innovative programs that make such a difference in people's lives. So I urge all of you to help us continue to have a cash program that lets us do that kind of important work. Yeah, that's been a real interesting debate here in Washington. So we're going to open it up to you to ask questions. Just like in the last panel, we'll try to group them. Just ask people to try to be brief and make it a question. This is like Jeopardy. There has to be a question mark at the end. So let's let our panelists have most of the airtime here, sir. Well, first, thank you for the presentation. I was in Lebanon in September. That's the land of my ancestors. And I was impressed by the number of well-pressed women and children begging on the streets of Beirut. But my question is basically political, religious, and technical. From the political standpoint, the government is always headed by a Christian president. That's one of the things. Then the religious part is that the south and the center part, 50% of the territory is Muslim. And the central northern part is Christian. And talking with the director general of health, one of the issues that he and others mentioned is that people prefer to use the Christian health services or the Muslim health services according to the religion. So I wanted to ask you, how do you manage that situation? Because actually you have almost two Lebanon's now. And people being Muslim and going to the Christian part or going to the Muslim part receive different kinds of possibilities. So I would like to know specifically what is being done or what can be done to strengthen the health services in Lebanon. Thank you. Thanks. Up here in front, and then we'll catch you in the middle and then we'll move over to this side. You guys have to come up with some questions over here. Thank you for this very interesting panel. My name is Eva Jarawan. I'm with the World Bank. I'm here on my personal capacity. I have a question to the panel. You mentioned supporting the host countries. Could you give some specific examples on the kind of things you have been doing, the kind of activities? We hear a lot about assistance to host countries, but when we talk to people around Lebanon, they don't see it. Could you give some examples? Great. And there's one hand in the middle just in the back. Hi. My name is Mary Zell. First of all, thank you so much to our panelists. I'd like to ask you about assistance to civilians inside Syria where a major challenge must be a lack of information. So what are your most important sources of information when you're choosing to allocate your resources and how do you vet those sources of information? Thank you. Great. So those are three good questions. One is you're obviously doing with a complex environment, religion being one of the very important aspects in the area, but there are clearly some other ethnic and cultural challenges here. How does that impact on your ability to deliver aid and to build capacity when it is often segregated? The second question is around how you're providing assistance in neighboring countries, maybe some specific examples. And the third is around civilian support. I do know Jim Kim was just in the region and so the World Bank, I know you're here on your personal capacity, but Jim Kim was just there. So there is kind of some movement in the development arena in this area. So Nancy, do you want to start off and Robbie? Sure. Let me start with you. What are we doing in the host countries? Clearly there's an effort to align the contributions from all of the development partners and do so in a way that supports what is increasingly a country-led plan that the World Bank has helped both countries develop, these resilient strategies. There is an effort for both Lebanon and Jordan to really create greater ownership of this overall response. So it is not just support for the refugees but support for their countries as they host those refugees. The United States USAID budget has moved to have greater emphasis on those communities that are hosting, but looking at things like schools, hospitals, water infrastructure. So in Jordan, for example, we've expanded 67 existing schools and we've fast-tracked work to build 20 additional schools, just as an example. Similarly in Lebanon, we're working with a focus particularly on education. In both countries, to their great credit, have opened their schools up to Syrian kids. Most of them are double-shifting so that the Syrians go in the afternoon. It's more difficult in Turkey because you have the language barrier. But we have to make sure that you don't crowd out the Lebanese and Jordanian children. So when we talk about not losing a generation, and by the way, there's a really important campaign called No Lost Generation that I invite people to explore, because it is seeking to focus resources and attention on this generation regionally that is currently threatened. So we have put a lot of focus and attention, about a billion dollars into Jordan and about 60 million dollars into Lebanon. I just want to make one comment on the well-dressed beggars, which is I think a symptom of, you know, again, a lot of these families are middle-class, they've come across the borders, they're starting to deplete their savings. Many of them are not in camps, they're not even registered, usually headed by women. And they're so far into the crisis now that savings are gone. Sometimes, you know, the fathers and husbands have been killed or they're still somewhere inside Syria trying to look after whatever they have left there. And this is a devastating feature. And when I was there in Jordan meeting with refugees just a few weeks ago, you know, some of the kids are working for, you know, a pittance, and that's the only support that they have. It's not legal for the men to work. And so not only do you not have income, you do have that loss of dignity that as it just drags on, it's what's the hope for the future. Finally, on what are our sources of information? We triangulate from our partners' information, from the needs assessment that the UN does. There was something called the CENA, which is a needs assessment that was done independently in the northern part of the country and another needs assessment done by ACAPs. So we look at all of that. What does ACAP stand for? ACAPs help me. Who knows? Don't ask me. It's an acronym. Yes, thank you. Too many acronyms in our brains. But it's another means of gathering information. So because of the way access is made so difficult inside Syria, you really have to triangulate all of those sources. We have a disaster assistance response team, both in Turkey and in Jordan, and we have what's called a response management team here in Washington. And those teams, they spend a lot of time gathering, collating, scrubbing the data to help us understand where do we need to invest to make sure that we're really reaching all parts of Syria. Robbie. Sure. Those were interesting questions. I'll start with the religious aspect of things for the refugees in Lebanon. I think it's a combination of things. First of all, the families in Lebanon and families in Syria, they have a lot of close ties. Some of them are related. So obviously they go towards the area where they might have some family and usually most of them are long religious lines. But also at the same time, they go, for example, to the Christians, if they want to practice their faith, the Christian area is because they have churches, they have the same churches, the same thing with the Muslims, they go to the same mosque. I don't think the division is, you know, these are Christians, we don't want to live with them or these are Muslims, we do not want to live with them. I think they find more comfort there because they have a lot of things in common. In terms of how the health services are reaching them, the National Medical Corps has been working in Lebanon since 2006 since the conflict between Hezbollah and Israel at that time. This is when we started. We started in the south, then the Bekaa Valley, and we expanded. We're working throughout the country, and I mean in the south, in Sur, in Saida, in Marj Ayun, in the Bekaa, in Zahle, in Arsal, in the North, in Akar. I can name them all because I'm originally from there, I can kill. So we work in everywhere. And it's a combination of things. We provide healthcare through clinics that are already existing that we support because we want to build the capacity. But also we have what we call mobile clinics that go from one area to the other depending on where the population is. And it doesn't really matter whether it's Dru, Sunni, Shia, Christian. It doesn't really matter. Which addresses a little bit of your question in terms of what are we doing? I think a lot of NGOs are doing great things in the refugee, both in Jordan, Lebanon, Syria, Turkey, and Iraq. One of the problems that we have is that in those situations we don't use too much visibility. We don't wave our flags. We don't put our stickers. And we tend to support the host government as much as possible or the clinics that are already existing by providing the medicines and medical supplies, pay salaries, just to get them to provide service to the people as well as to the refugees. And in a way that made it seem as if organizations are not doing much, we are. It's the same thing that we hear over and over again, what is the U.S. government doing? We don't see the USAID logo anywhere. Well, the U.S. government has invested $2 billion, but they also understand the complexity of the situation and they also understand the security implications that having a U.S. flag on your vehicle might have in a country like Lebanon or Syria or other places, especially now with the spread of violence in the region. So just because it's not visible, it doesn't mean it's not there. There's a lot that's being done and I can give you a list of locations as well in detail. It's impressive that in the previous crises, putting a white flag with a red cross on it would be giving you some margin of safety and now it seems that that becomes a target for a barrel bomb. So the rules have changed or gone away in many ways to the idea that somehow you would label the people that were there on a humanitarian mission to give them some form of protection and now when you label them, you make them targets. It's a sad and onerous development in this crisis that hopefully you don't see spread to others. Let's go to other questions. Do we have any over here? Yes, good morning. My name is François Arma. I work with APTA Associates. I have a question about doctors and health workers who, I mean, I was struck to hear that there was a significant loss of life amongst them in Syria. So I imagine this also being a flight into other countries. So considering the fact that host countries are straining under the demand for health services, I wonder if there's any way that these refugee health workers could be used for services. But I also hear that men can't work. So maybe women can. I'm wondering if there's a way to do something to help the host country. Good question. Others? There's one over here. Sorry, I'm sort of embarrassed. I'm asking a second one for the day. But having been in Lebanon and having been a guy in the 1990s that did a lot of humanitarian work, Peace Corps with guns. I'm a former Special Forces officer by trade. My question to you would be, how is this as a humanitarian operation different than some of the stuff we dealt with in the 90s? It seems to come back 20 years later. Oh my God, we're doing the same stuff we did under an administration in the 1990s post Somalia with Haiti, Rwanda, Bosnia, and some other things. And just wondering comparison-wise differences and if you have that background. Thanks, great question. Anything else? Adam McCollison? Tom McCollison from Uniform Services University. This will probably be viewed as a very naive and probably controversial question. But one issue that might be brought up by some would be this massive aid to support the result of a war that seems to have no end that requires a political solution could be viewed by some as perpetuating a war by solving the problem that's been caused by others and not passing a responsibility back to those who created the problem in the first place of the participants in the war. Is there any concern about that? That by creating this massive aid, in Syria, that's helping somehow perpetuate the conflict? I think I read an op-ed that actually made the case that such a good humanitarian response was somehow perpetuating the political crisis. So good to hear you respond to that. So three questions there. Healthcare workers, including those that are refugees, is an opportunity to maybe use some of those to address the crisis. And I'll just add to that. And we're going to have a panel that follows this one that's going to deal more specifically and be great, Robbie, in particular. I know you've had some work dealing with healthcare workers and how this crisis has affected them both in and out of Syria. How is this humanitarian response different from those you've had in the past? You've had three or four level three since you started? I bet that wasn't part of the recruitment strategy for you and the job. So is this one different? And does the fact that there is now this deliberate targeting of humanitarian workers using food and water and health services as an instrument of war has that changed the characterization of the humanitarian response? And then Tom's question, is in some way ameliorating the suffering and addressing this so well somehow helping to perpetuate the problem? Nancy? I'll just make one comment on the doctors because I was in Turkey recently and there is a move to let and they have already let some of the doctors work in Turkey to serve the refugee population there because of the language issues, the shortage of doctors. And I know Robbie can probably say more about that but that is very much recognized. When I said the men can't work, the women can't work either but it's more of an issue that I hear about from the men who I speak with. In terms of the other two questions, I mean these are the textbook questions about any complex crisis response and Syria with that question will generate a whole new compendium of difficult lessons that you look at. I would, in response to how do I compare this to Haiti, Somalia, Rwanda? I mean that list could continue on including, you know, CAR, Central, South Sudan. What is absolutely the same about all of these crises is that fundamentally a failure of governance that they all share a lack of an accountable, legitimate, inclusive government. In fact, I have as a money making project I'm going to write a dummy's handbook for dictators in how you can help ensure that your country dissolves into war and collapses, that you, you know, you marginalize people, you don't deliver services to your citizens, that you are repressive, that you have ineffective institutions that you don't invest in governance and they all share that. And I run a bureau at USA called Democracy Conflict and Humanitarian Assistance. Those are linked for a reason because in the absence of a legitimate, accountable, democratic government you cannot manage conflicts which happen in every country. We have them here all the time. They're just manageable. And you are unable to respond to crises whether they're disaster or... So that is, and as we look at shrinking aid budgets as we look at shrinking ability to invest in support for developing more accountable and legitimate governments that's exactly why we need to do so. That's why these are poster children for better development. In terms of the humanitarian operations that have gone in there and here, you know, there are a lot of similarities and there are a lot of differences based on the particular environments. Access, security and resources are probably the three words that mark all of these humanitarian responses. The big difference is in Syria, you still have a government that is blocking and impeding access, claiming sovereign rights, even as they do not provide for their citizens as they try to kill their citizens which is an utter violation of the responsibilities of sovereignty. And so, you know, in the others you had utter collapse. Here you have a state trying to hang on to sovereignty even as they barrel bomb their citizens. So that's a big difference. Again, on the refugee doctors, it's getting better. A few years ago, three years ago, they wouldn't allow any physician to practice because of the difference in education, language, even between Lebanon and Syria, the Syrian physicians study everything in Arabic and Lebanon, they study it either in French or English so there was an issue there. There's been quite a bit of pressure that's been put on governments to actually allow Syrian physicians to work. It's working in Syria where they can work in clinics that treat refugees as long as there's a supervision from a Turkish physician which is fine. In Lebanon, it's not official but they can work a little bit but we still have miles and miles to go. There are a lot of physicians that are extremely qualified that are not working in the region and one thing we've seen about actually Syrian physicians, when they flee the country, if they flee with their families, they make sure that the families are fine then they go back to Syria most of the time to treat Syrians there because they know that their skills are needed there and that's why we always see a high number of physicians being killed in the conflict. It's because they're targeted but it's also because they go back to do their job which is heroic. Nancy answered the questions about the difference between different humanitarian emergencies. What I would say about the conflict in Syria and the recent conflict is that when you look at Syria, you've got a government you've got multiple opposition groups they're all fighting you've got cross-line, you've got cross-border you've got ethnic issues you've got the entire region and the entire region at large involved in the conflict which is different than conflicts before but also for humanitarian agencies in the 90s, humanitarian agencies were not targeted. We might get hit once and wide by a group of thugs but now humanitarian agencies have become a target for many groups because they see us as an agent of change or an agent of success and they don't want to see that and I think for an NGO like us that's a major, major issue for us. On the aid making things worse my answer is going to be naive actually what's the alternative? How many people die and then why are we building a government for? The only way to continue doing it is making sure that people survive build their capacity, make sure that we don't lose one generation after the other until a political solution I do not see actually humanitarian assistance and the money that's being pumped in there as actually prolonging the conflict I think it's just making sure that people survive until a solution is reached. So we have a few minutes left and we have one question Alan over there we have Chris and then one over here so let's take these last three questions and then just to give you a heads up I want to close with a little bit of the hope Nancy you talked a little bit about focusing on the lost generation there's some amazing videos that have been produced recently I watched some last night they're quite impactful but it would be great out of this Jakub talked this morning about a situation that's dramatically dire the phrase glimpses of hope several times so help us see where there is light at the end of this tunnel so that we have something to aspire to so Alan Yes I'm Alan Moore with the Stimson Center and also for more than 30 years a member of the board of the IRC of the International Rescue Committee I was reflecting on this question of numbness among donors and compassion fatigue and six and a half billion dollar ask which just seems so ambitious not that it's not not legitimate and then I'm also thinking about the characterization of the challenges of dealing with refugee populations and the local host governments nothing new about that that has been going on since there have been refugee encampments I saw it on the border of Thailand in 1980 and there's an education process for the politicians and for the for the American public there's this notion that and this is true on boards of some of these enterprises and you've probably experienced this we want to go in we want to help deal with the immediate emergency we want to give people temporary support so they can go back home increasingly around the world of course they don't go back home and B even while waiting to go back home they can be very disruptive to host governments I guess I'm remembering some of the discussions in the board of the IRC over the 30 some years as board members were resisting getting into the development piece because historically it was always very temporary they've come around a long way by continuing to focus on the needs of the refugees and having that be the focus and say this is a strategy for dealing with them this is not mission creep into the needs of the local governments I would love your if you want to comment I just thought I would share that but comment on the ongoing challenge among donors of if you expand the mission do you risk further numbing willingness to contribute he didn't tell you he worked in the senate for a long time too Chris good morning and thank you both and Todd for what's been a very good panel following up on the last actually couple questions and certainly from the beginning we've talked about how this numbness of compassion the fatigue and even to some extent even though all of us obviously are aware of this to some extent because of other prices in the world and other reasons it just it hasn't necessarily stayed as a top line thing in people's minds all the time and so with the fact that even if miraculously the political settlement occurs tomorrow this is something that clearly will the transformation of the region other countries the refugees many of whom will not go back not for a while particularly from the IMC perspective but perhaps with your other partners how is that reflecting or not reflecting in terms of recruitment because clearly the people that are doing this wonderful work in these amazing situations we're going to continue to need lots and lots of people who continue to have that compassion and the willingness to do that so looking at this is obviously not months or couple years but going on for a long time how do you see that as in terms of continuing to replenish the workforce of what will be needed thank you one last question here it could be brief because we're running out of time I will be my name is Allison Campbell I oversee humanitarian media and communications at internews and I wanted to ask talking of doing things differently like the humanitarian front and the focus on resilience and agency I wanted to ask the discussions to what extent we may be recognizing information as a form of aid a really critical and empowering form of aid in and of itself and to what extent we may see investment new investment in programs that encourage two-way communications feedback conversations between affected populations of humanitarian agencies and also the possibilities of leveraging technology and local media to provide refugees and host communities with the information they need to make decisions about their lives how to engage with one another with the humanitarian and just generally become more active agents in their own survival great so good closing questions Nancy you noted in the beginning that this is unlike other crises this one's played out pretty well in terms of social media and press and though that doesn't seem to have necessarily stimulated the kind of grounds well of support that we'd like so do you see information both as a tool to help people in the region become more agents of their own change but also as part of the assistance effort that you're doing a question around the ability to continue to recruit the numbers of people that you need I'm sure both of you address that challenge and then Alan's questions are on the IRC these organizations that have been traditionally focused on jumping in during the catastrophe and then letting others take over the long term how is that divide working now so Robbie you want to start and then we'll let Nancy close sure I'm going to start with a recruitment issue with the question about recruitment issue one thing that's actually an advantage working in that particular region is that there's high local capacity national staff are well qualified be it in Syria, Jordan Turkey or Lebanon or Iraq and the focus for us is if we send expatriates their job is to identify a counterpart and train them in addition to that the training and capacity building identification of national stars working with the host government building the capacity of the the clinics the hospital the host government because at the end of the day NGOs come and go that's what we leave behind capacity training and infrastructure and building the capacity of the local government with the hope that they will actually cater for the population be it their host population of the refugee going back to what I was advocating for initially focusing on the host community and let the refugees benefit which lead me to the second issue about the refugees and the focus between refugees or humanitarian and development one thing that's different recently over the past few years is the large number of urban refugees rather than your typical refugees in a camp setting and this is where it gets really complex because you cannot you know if they're in a camp you know you've got your target there in an urban setting you cannot go and ask are you a Syrian or are you Lebanese or are you Jordanian you just have to treat them I'm not recommending a relief agency to do both relief and development every agency's got its own mission but there's partnerships that could be done as well if an agency is specialized in relief this is when you look for a partner that actually could follow up or build on what you do and work as a team but you know the complexity of the refugee situation has changed the tension between the host community and the refugees has always been in existence for thousands of years and now with the urban refugee issue with the you know windling of free sources if you look at Lebanon they're facing a drought probably that's the worst drought in 100 years and guess what when people are not going to get their water guess who they're going to blame the Syrian refugees although the Syrian refugees consume less than 10% of the deficit but that's the mentality this is why we're trying to move away to ease up the tension by working with both the host community as much as possible on the information technology media listen absolutely I think information could be used it could be better used although there has been quite a bit of use of the social media that's how this whole thing started in Syria but there's also the fear of misinformation which is rampant in the Middle East so we have to be careful about the source of information and how it's disseminated and the target and it has to be really strategic but it's critical I think it's something that needs to be worked on I know many agencies are working along that in terms of getting the information to the host community and the refugees but it needs to be better coordinated there's quite a bit that's going on but I would always worry about the misinformation for political reasons as well thanks Nancy quickly on the aid workers Ravi that was a really good answer I would add however that I do think we are worried about having very seasoned experienced workers able to go globally given what's happening around the world right now and we need more secondly on the information piece again I echo Ravi I would also say that we have as in many emergencies we definitely invest in trying to look at ways to improve information flows Ravi mentioned that we are not requiring partners to brand inside Syria for security reasons and you know I just want to underscore what a very difficult environment this is one partner alone just one partner has had 69 of their staff killed 54 injured and 27 detained this is really dangerous inside Syria however we do want to use all the ways that we can to help the Syrian people know that assistance is reaching them that it is coming from people who care about them including the people of the United States and that is a feature of what we are looking at resilience is a big initiative that we have moved through USAID for the last 3 years which is fundamentally about doing assistance differently and we have come up ahead of these crises and we have applied it primarily in areas of cycles of drought and floods and hurricanes we are seeing it become more and more a concept that is talked about in these long-term crises like the Syria with the regional implications and through partnerships through thinking differently about the kind of work that we do and we take that on board so that we are not always just delivering bucket after bucket and I think there has been some excellent work that has been done on this and kudos to a very large community of people who have taken that up you would ask what do we feel optimistic about and so I would just close by saying what we find all the time in these kinds of crises is that in the midst of just the horrors of this conflict of humanity you also see the best the extraordinary courage of the doctors who are leaving their families and going back into often very dangerous situations often being bombed along with their patients and the nurses we are seeing people open their homes to other families to their neighbors, to their friends both inside Syria and in the region and the incredible courage of the aid workers many of whom have come from outside the country in a very very dangerous environment so it's the courage it's the resilience of the human spirit and it's the hope that you see with Syrian children who have gotten back to school I visited a class of ninth grade girls in Jordan who had been out of school for three years they were back in school who knows what they had suffered but their ability to be there in the classroom and seize a moment with some measure of hope for the future is in itself extraordinarily inspiring so the hope is in those moments and in those ways that people rise to the challenges and the challenge for us is to not go numb not to let these numbers be overwhelming to remember those faces and to continue to find the ways in which we can provide that help and that hope and so I just I thank Congress, I thank the American people we should all be very proud of the generous response that the United States has made and continue to do so thank you and thanks again for CSIs for hosting us Thanks in the quality of this one Robbie, last thoughts, where do you see hope in this? It's a sad situation what's happening out there but there's a lot of good work that's being done by Syrians, by neighboring countries by NGO and UN workers and what I would say is there is hope our job is to make sure that this hope continues until the solution is reached and for everything there is a solution it might take time, but there is a solution and hopefully the solution would be for the best of the Syrian people let's not lose faith just because we don't see something doesn't mean that it's not happening there's a lot of good work hundreds of thousands of lives are being saved every year and that's critical we need to keep that and we need to be extremely proud of what we have achieved and our job is to continue to make sure that that hope is getting there it's helping people to survive until the day when there's a solution Thank you very much we're going to move to the next panel and thank you Nancy and Robbie we're going to get off the stage and move to the next panel which is going to talk about the health sector and the decline of public health in the region it's going to be moderated by Len Rubenstein from the Bloomberg School over at Johns Hopkins and the former head of Physicians for Human Rights so Len can you come up with your panelists and we'll exit