 Welcome, everyone. I think we're going to try to get started. Good afternoon. Thank you all for coming. No. Is it working any better now? Good. Okay. All right. So terrific to see so many of you here this afternoon. And on a beautiful spring afternoon, one of the first lovely sunny days we've had in a while, I think it's a real testimonial to the importance of this issue that so many people are here today to hear Ambassador Dobryansky speak. Before we move on to our guest speaker, I want to say a word or two about an event that we're going to have here at CSIS next Tuesday at 10 a.m. that we hope many of you will be able to come to. And that is going to be the launch of the CSIS Commission on Smart Global Health Policy. The commission is comprised of 23 extremely accomplished individuals from the global health community but also from many other walks of life. We have individuals who are leaders in the private sector, in the philanthropic world, information technology, finance, media, former and current members of Congress, as well as leaders from the foreign policy and security communities who are coming together to form this commission, which between now and the end of the year is going to examine U.S. health investments to date and to look ahead to how these investments can best be leveraged in the future. Producing a report by the end of this year, which we hope will be of use to the administration as it looks ahead for the next five years and next 10 years, planning really what the U.S. should do to build upon the very important, successful initiatives that have already been put in place. I believe there's some information in the back about our schedule events for next Tuesday. We'll have opening remarks from our two co-chairs, Helene Gale, who's the president and CEO of CARE, and Admiral William Fallon, who is the retired former commander of the Central Command and the Pacific Command. We'll also have an address from one of our members of Congress, Congressman Keith Ellison, as well as two roundtable discussions. So please, if you're able to join us, we'd really be very delighted to have you with us. Now, turning to today's topic, Afghanistan is a country that's been in turmoil for more than three decades. No one has suffered more during that period than the country's women. The statistics tell the story and are quite sobering. Female life expectancy at birth is 43 years. Almost 54 percent of all Afghan girls are married before their 18th birthday. One in eight Afghan women will die giving birth, and only 12 percent of Afghan's women are literate. Just in the last few days, I think we've all probably seen the very courageous effort by a group of women in Kabul to protest a law that threatened, very fundamentally, some of their most basic human rights. And on a positive note, I think there's now been some commitment to turn back that proposed legislation. We're very fortunate to have with us today someone who not only cares deeply about Afghan women, but has translated that concern into action, affecting change on the ground and mobilizing resources to make things better. Ambassador Paula Dobrianski served as Under Secretary of State for Democracy and Global Affairs from May 2001 to January 2009. She was responsible for a broad range of foreign policy issues, including democracy, human rights, labor, refugee and humanitarian affairs, and environmental and science issues. Presently, she is a Senior Fellow at Harvard University's School of Belfer Center for Science and International Affairs, and is a Senior International Affairs and Trade Advisor at the law firm of Baker-Hustler. Dr. Dobrianski has also served as a Senior Vice President and Director of the Washington Office of the Council of Foreign Relations, and her prior government appointments include positions as Associate Director for Policy and Programs at the United States Information Agency and Deputy Assistant Secretary of State for Human Rights and Humanitarian Affairs. On a personal note, I need to add that I had the real pleasure of working for Paula from 2001 to 2002 at a time when we were staffing up and she was directing a task force on Afghan humanitarian issues, and I can attest to the fact that her achievements in her resume are all exactly as described, but more importantly, in addition to that, she's a wonderful colleague and a terrific mentor. So thank you for joining us today, Paula. Good afternoon to all of you, and thank you so much, Lisa, for that very warm introduction. And let me just say that the center here is very lucky to have Lisa. We were very sorry when she left us at the department in her first departure, but it's very fitting today, and I'm really honored that she's introducing me because she was very pivotally involved in the development and the implementation of the U.S.-Afghan Women's Council, and not only in terms of the other issues that you had mentioned. I also would like to congratulate Steve Morrison, who's back there, to really a very vibrant program here focused on such a broad range of global health issues. I have to say from having come out of the State Department, one thing that I'm very heartened by is that this issue, the issue of health as a national security issue, is very much integrated into the work of the department, into the work of a foreign policy track. And I think that what you have done over the years here at CSIS and the development of the center has had really a very direct impact on that. So really thank you and also your team. I am very heartened by the fact that, given the beautiful weather outside, those of you who are here this afternoon, really thank you for coming. I would like to divide my presentation up into a number of parts. I would like to first just talk about a little bit about what the situation had been in Afghanistan up to 2001, and then to look at the kinds of statistical changes that have taken place to talk thirdly about a number of programs and then the next steps. Let me just start with, as we know, in fact, at the time when the U.S. Afghan Women's Council was launched, it was launched by President Bush and President, President Bush and Karzai in January of 2002, at that time it was striking to us the Afghan women were very precise in terms of what agenda they not only wanted that council, but by the way, anyone interacting with them to focus on. The area of education was a very significant important one. It was one of their priorities, the area of economic empowerment. Secondly, thirdly, certainly the area of health. Fourthly, the issue of rights, legal rights, political empowerment, if you will. And then also let me mention another area that came a little bit later, but it's integrated into all of these, and that is looking at the next generation about the welfare of children in Afghanistan. So they were very precise in saying these are the issues that matter. I was very struck by the fact that health was definitely one of the priority areas. And clearly Afghan women understood and understand that not only their children, their communities, but the welfare of their nation at large will be affected if in fact health issues are not addressed. And better access to health care not just only in the cities, but throughout Afghanistan will in fact matter. So I have to say that access to health services is improving. It's improving overall through the training of a new health care personnel. And under five mortality is decreasing. As quality of services delivered is in fact improving, and immunization rates rise. But let's look at very specifically what are the conditions before and where is it in fact now. Before and looking at in 2001, and this is overall only 9% of the population had access to basic health care. Men, women, children. 42% of trial deaths were from preventable diseases. One out of every four children died before their fifth birthday. And the maternal mortality ratio was the second highest in the world at 1,600 deaths for every 100,000 live births. And Afghanistan with limited minimal government capacity obviously has faced a very special and very tough challenge to build its national systems and its institutions and infrastructure to be able to provide health, quick health improvements and access to all Afghans. Looking at now, what are the statistics? The statistics basically have changed in many ways and I think very much an improvement, but there's a ways to go. 82, and this is by the end of 2008, 82% of the population now has access to basic services. There has been a 22% drop in the number of children that died before their first birthday. National immunization coverage of children under one year of age has increased from 31% in 2000 to 77% in 2006. Tuberculosis cases fell by 60% thanks to a tripling of the number of treatment facilities and the massive immunization campaigns on the ground. UNICEF has played a significant role and there are others in this regard. And more than 90% of all children are now immunized against polio. Another important statistic. I cite these for you because I think it's noteworthy that even at a really what constitutes a challenging time for Afghanistan in its own evolution that there has been a focus in terms of improvement in this area that's been undertaken by the Ministry of Public Health. It has been in a very targeted way assisted by many interlocutors in the U.S. government, not only the Department of State, the Department of Health and Human Services, the Centers for Disease Control, among others, and by the private sector. Many institutions that have given up their time and have made a very strong commitment of being on the ground and really helping the Afghans build capacity. I want to also just mention to you, USAID, I have a frontier from our colleagues at the United States Agency for International Development, a one pager that basically in a nutshell gives you what it was in 2001 and what has changed and the statistics. So for those of you who've taken notes, but if you'd like to have this, these are up here on the table and I think is a very good summary of the kind of progress that has been made. Having said that, let's go to a third set of issues. That's the before and where we are now. There are the key areas that really matter in terms of advancing healthcare, healthcare services in Afghanistan because you have to at first ask, why is it that this happened in the first place? Well, one of the fundamental reasons is you have a country that has been ravaged by war and conflict for decades. Secondly, because in that context then you don't have and didn't have on the ground access to healthcare workers in many of the main cities and throughout the rural areas. Thirdly, as Lisa cited at the outset, you have a high rate of illiteracy. So even if you don't have access to healthcare workers, then there's the challenge of being able to read through, enhance your knowledge base about health related issues. So that is also a third problem. Fourthly is institutions that were crippled and literally demolished during the years of conflict. So you don't have an agenda or a blueprint for action that had been able to be put together. And then you go into a fifth area, that is Afghanistan has been isolated over the years geographically because of the circumstances on the ground and then no less the issue of the circumstances and the cultural issues on the ground in this case, meaning specifically during the time of the Taliban when you look at that, the issue of how a woman would get access to healthcare services. She would have to be accompanied by her husband, by a male member of the family, what have you. So that kind of ready access for needs that were imperative. So looking at that, what are the fundamental areas that have been addressed and are being addressed? I mentioned to you the Ministry of Public Health and I want to commend the Minister of Public Health, the one who is in place now and who has been in place for a good number of years, Dr. Fatemi, who I will never forget our first meeting of the U.S. Afghan Women's Council with him. It was an extremely substantive meeting. It was one that was extremely action-oriented. It was where he was telling us quite directly these are the areas that we plan to target. These are the areas that we need assistance in and this is how we plan to go forward. I have to say that not only for myself, but other members, both governmental and non-governmental members of the council were very impressed with his focus, with his very enthusiastic demeanor and looking at where things have been and where they are, I have to say I think that his leadership has contributed quite significantly, in fact, to that effort. Here, I'd like to mention that a first objective, an objective of all the stakeholders, not only the U.S. Afghan Women's Council, government and NGOs all at large has to be is how to build capacity to create greater Afghan ownership. Because what is important here is sustainability, is inculcating standards, having guidelines, having also networks that are established that are going to sustain and empower the Afghans to move forward, regardless of whether there are ebbs and flows of groups that come and maybe go out of Afghanistan. That kind of capacity is important. It's important to strengthen human resources capacity. It's important to have a focus on training, to have a reservoir of those health care workers who are able to go out to rural areas and to help rural communities. Particularly in the area of the issue of tackling maternal mortality, here it's been very important in terms of the midwifery programs. And I'm going to say a bit more about programs a little bit later. But in this area, it's important that there is support for health care workers, those dealing not only with the issue of overall training, midwifery, but also the area of diseases that are related specifically to children. So that was the first area, which is absolutely essential for all stakeholders to embrace. A second is one that I've referenced, and it has been very much part of the U.S. government's efforts. It's a priority of assistance through USAID, among others, and that is creating health care standards. I mentioned that before, that's critical, and that was an area that the Minister of Public Health has placed a premium on. You have to have that in order to build capacity throughout Afghanistan and not just only in the cities. Here I think quite significantly is that there are packages that have been assembled, and there are in fact two standardized health care packages, the basic package of health services and the essential package of hospital services that have been assembled in Afghanistan and in fact which the Ministry of Public Health has collaborated with USAID, with CDC, the Department of Health and Human Services, among others. Again, that is absolutely critical, not only for those operating, but also bluntly speaking, even for building an increasing public trust in Afghanistan in government services. The third area is naturally financial support. I'm stating certainly the obvious here that clearly financial support is necessary. Although there has been this improvement from 2001 to 2008, now 2009, there's a lot of work that remains certainly to be done. A lot of work that needs to be done. So in this area it's absolutely essential. I understand that, and I'm going to cite this and I believe it's also in the material from USAID, that in terms of the, there are 13 provinces that in fact have been targeted for health funding through the Afghan Ministry of Public Health over the next five years, and it's some $236 million to help manage the delivery of those two programs that I've mentioned to some five point, excuse me, 8.5 million people. Again, that's important, it's significant, and I really wanted to highlight that. Now let me transition a little bit and to say a bit more specifically about the US Afghan Women's Council. I wanted to give a broader picture at first, as I've mentioned, about the past, about the present, about some of the broader objectives, but I want to talk a bit about some of the targeted work of the council and what it has been seeking to achieve here. There had been a number of health related programs that were very much driven by not only Dr. Fatemeh, relevant to the council, but also by the Afghan Women's Participants, the Afghan Women's Minister, and all of them were focused on this, starting with Seema Samar, and then Masooda Jalal, Habiba Sharabi, and then no less up to the present minister. All of them placed a priority on a midwifery program. So the US Afghan Women's Council felt it was important to try to support, in addition to work that was being done, assistance in this area. And let me just step back and say this for those of you who may know and some who may not know. The council is a public-private partnership. It was housed in the State Department in the Office of Global Women's Issues. In fact, one of its previous directors is here today, Charlie Ponticelli. And at the end of the administration, it went over to Georgetown University. And there, Dr. Phyllis Moghrab, who is the head of the Child Support and Development Health Center at Georgetown, is its vice chair. And Jack DeGioia, the president of Georgetown University, is one of its co-chairs, along with the minister of women's issues and also the foreign minister. And let me mention, in fact, Ambassador Steve Steiner, who's here today, who is in Ambassador Milan Revere's office at the State Department, which is the office of Global Women's Issues, as designated by Secretary of State Clinton, has responsibility, in fact, for this area. So you have the base in Georgetown University, but you have a tie into the U.S. government, and in this case being the State Department. And I just want to say, also, we're very appreciative of the fact that not only Secretary Clinton, but also Ambassador Revere are strong supporters of the work of the council in all its areas, no less in this area. Let me come with that backdrop. Let me come to the Midwifery Program. One of the areas focused on is the, what's known as the REACH project, Rural Expansion of Community-Based Health Care. It basically trained Afghan women to become midwives and community health workers. And in addition to this training, the program also took measures to prevent different kinds of, take action to prevent different kinds of illnesses through immunization programs like polio, tetanus, malaria. It provided educational health information and also improved health services related to postpartum hemorrhage. The program reached 12 provinces. And in fact, the program ended in 2006. Specifically, they had trained actually some 65% of all of the midwives in Afghanistan. So you had more than 3,300 community health workers. We were very lucky. We met in fact in 2004, the first graduating class of that program actually at the Malalai Hospital in Kabul. Let me mention a second. A second is the Women's Teacher Training Institute. I mentioned education. There's a direct correlation between education and an understanding of health issues. Here, in fact, as launched by USAID, there's a Learning for Life program. The Learning for Life program, it's an accelerated health program focused on literacy about basic health care and also bolstering the cadre of health workers in rural areas. Here, there was synergy between what USAID was doing and also the contributions of the U.S. Afghan Women's Council because there was a link between the Women's Teacher Training Institute actually and this particular program, Learning for Life, which as the focus of the Women's Teacher Training Institute was to train educators in literacy and to literally dispatch them out, throughout Afghanistan, they would be able at the same time not only be able to enhance the literacy level, but at the same time to also be able to provide assistance and information in this area. So there was a great deal of synergy in this area. I want to mention a third area, and that is of burned victims. There have been many young women, especially affected in this regard. I know that you've read articles and stories about young women whose faces have been burned for reasons that defy truly any rationale and reason. You have many burned victims, women, children, and here there were two programs that I especially want to mention that really I think underscore the nature of giving in our own country where basic American citizens came forward. They had no ties to Afghanistan, no ties, but were very desirous of helping and sharing their capabilities and assistance in this area in order to help burn victims throughout Afghanistan. The first is what's known as TriWest Medical Alliance, in which the council teamed up with TriWest Medical Alliance in fact to bring burn victims and an awareness program in fact there. There were three target provinces of Kabul, Nangahar and Harat, and over 5 million Afghans directly received burn prevention training through district level training, school trainings, and patient education. They also provided in fact not only materials, but they also in this case provided access to radios, television. They started a program in which they were broadcasting into some areas that were very difficult to get to, and in fact there were radio and television public service announcements that they were able to broadcast. This year the program is expanding into Parwan, Langman and Logar provinces. The other one is the Grossman Burn Center at Sherman Oaks Hospital in California. Here you have two individuals, Peter and Rebecca Grossman, who basically reached out and have very actively brought burn victims to the United States for treatment. There have been many who have come to California and specifically to the facility there for treatment. They also are now establishing a facility on the ground in Kabul with the goal of also providing training. I mention these to you because it was very striking and very heartening to me as being a former government official and actually being approached by American citizens who as I said, in cases just as individuals came forward and really wanted to contribute and to help to the growth and the advancement of Afghanistan. I want to mention finally, yesterday there was, I felt, an important meeting that was convened at Georgetown University. Dr. Maghreb chaired the first U.S. Afghan Women's Council meeting at Georgetown with a focus on the issue of health. She identified that one of their goals and objectives, in fact, is to strive to establish a broad network and a network among a wide variety of not only non-governmental, but also to inform our U.S. government and to share in this collaborative effort in a public-private partnership. I mention it because of two reasons. First, it was striking to me hearing yesterday a bit about the Abbott Fund. And I don't know if there are any representatives of Abbott here in the room, but they made a very compelling presentation about improving maternal and child health in Afghanistan. They have been on the ground there since, I believe, from this fact sheet since November of 2005. And from what I've read, they're really doing quite significant work in terms of providing for vaccinations, nutritional assessments and health workshops. But what was significant is, and that I'm very heartened by, and it's the second point, is that at the meeting yesterday, it's very clear that one of the key agendas will be to expand the kind of alliance that exists as part of the council and to ensure that there are strong collaborative efforts. They're comparing notes as to areas that are being addressed, what areas aren't being addressed, and how, as a strong alliance, they can go forward and really make a further difference on the ground. And I was also very heartened by the fact that you had a combination, as I said, of both governmental and non-governmental participants yesterday, and that really underscores the whole spirit of the U.S. Afghan Women's Council. So with that, let me just say, before we open it up for comments and questions, this area is an area that is a priority, not only for Afghan women, but for Afghans. It is a priority for the United States, I think, publicly and privately. I think, thirdly, what has been significant here is a focused agenda and having also interlocutors in the Ministry of Public Health that also have been terrific partners and have made a difference, and a mutual goal and objective of sustainable approaches, of how you can make a difference for the long term, not just for the short term. And finally, let me just say that Lisa began in introducing me by mentioning the events of the recent days, and I have to say that the Afghan women have always demonstrated a great deal of, I think, courage, and I have seen time and again in whatever area we talk about just tremendous steadfastness, leadership and commitment on their part. And it's certainly something that has motivated those of us that are very, very committed to these issues, knowing that we have such strong partners. Thank you so much, and I look forward to your questions and comments. So we have time for questions, but I'll have to say I can't resist maybe taking the prerogative of the chair and posing the first one myself, so if you'll excuse me. Paula, one thing that I think in many different geographic settings we've learned in the area of women's health is that men have to be a very important part of the picture in terms of improving attitudes and access and just the whole surrounding set of pieces that need to be a part of the puzzle so that women can get the care that they need. If one looks at the news broadcast from Kabul of last week with these courageous women coming forward but meeting with a very negative and violent reaction, one has sort of a disturbing impression of the possible or the potential to shift men's attitudes. You've been now involved for more than eight years. What is your take on this? What can happen? What can be done? What kinds of things can outside partner support that can help shift those attitudes? I think that's an excellent question. Let me first start with the fact, if I can, of the U.S. Afghan Women's Council, as I mentioned, you have not only in this case formally an Undersecretary for Democracy and Global Affairs, but now a president of a university and also a vice chair. So you have Dr. DeGioia at the same time Dr. Maghreb. But you have on the Afghan side the Minister of Foreign Affairs, Minister Spanta. And then at the same time you have the Minister of Women's Affairs. I'll start with that because in terms of the running of such an entity, it was, I think, very important in having the involvement not only of Afghan women, but Afghan men. And I will give an example where the previous foreign minister and the current foreign minister had a foreign minister of Dullah Abdullah and now foreign minister Spanta had, I think, an important impact. One of the proposals made by the council was to enhance the number of women in the diplomatic corps. And to appoint ambassadors because there had not been here to four women ambassadors in different, posted in different countries. There have been a number. I'll say I hope that it will increase more. But it had an impact, a direct impact in that sense. Okay, second. Moving more broadly. In terms of programs and initiatives, in fact it was very, I think, important that Afghan women themselves have said how important it is to involve men. The training program at the Women's Teacher Training Institute, by the way, is both for men and women. We had the benefit of going, seeing it, and why? Because the way in which their educational system is structured in terms of courses for young boys and courses for young girls. Here we witnessed a collaborative effort and in which you had young men dispatched to rural areas and young women. You want to have literacy elevated at all levels. Thirdly, and importantly, many of them had, when I say many, many Afghan women had suggested and proposed that it was important having resource centers and community centers in different localities. And as part of that, to reach out to the mullahs and to, in fact, have their involvement in a variety of discussions. Some of them initiated some kind of discourse and found that that kind of support was important. Things like immunization programs and literally having them systematized and having an outreach to an entire community. That kind of engagement through a community center and through, for example, the mullahs I think has had an important impact. Coming back to your point and about what's happened on the ground, that represents some, but that does not represent all. And I think what it should say to all of us that it's necessary to look at ways of bridging differences. There may be some whose minds may not change, but I think there'll also be some whose minds, you know, will evolve or are interested in looking at the benefit of all and how to go forward in a thoughtful way. I want to also remind that you do have women in parliament. The women of Afghanistan chose to have a number of seats and by law they have a percentage of seats in both the upper house and the lower house. And many of them are very politically active. They've come here to the United States. They've gone to other countries and they're networking. So there too they know that as politicians that not only in their own communities but they have to build coalitions. So that's another area in which many of them are very focused on. Building coalitions with other male legislators in areas that will matter to their welfare. Open the floor to questions and I think what we'll do is take questions in groups of three and I'd ask you please to identify yourself, please. My name is Nazira Zinkarimi. I'm correspondent in Ariana Television from Afghanistan and I'm from Afghanistan too. You know, I know about women in Afghanistan situation. Also you mentioned a lot of progress in Afghanistan but still they have a lot of problems, especially the Taliban. They get more power day by day and this is a big issue for them to prevent them to even care about their health and everything and also civilian casualty. This is the other problem and also most of them they have a mental problem and you mentioned that some women came for treatment to California. There is another program for the people or the women who have a mental problem and they continue this program for them. Thank you very much for your comment and then question. First let me say one of the messages that I did end on and I hope I was clear, I wanted to share what has changed because when you look at the statistics in 2001 and then where it is now, I think it's important the progress that has been made but my last comment was specifically that there's a ways to go and we have much work before us to do. There are many challenges in many sectors relevant to health that exist. I think there's especially a strong desire to achieve much, much more in outlying provinces and areas that maybe have not gotten as much assistance here to afford. On the issue of mental health, I'm really glad you raised that because as I looked around the room and I was thinking all of you, it's a little bit warm in here and I'm speaking to you and I had more examples to give. It was one of the examples I was going to mention because actually we very much appreciated Zora Rosek who was Charlie Ponticelli's interlocutor. She headed, in fact and I believe still does, the women's office in the Ministry of Foreign Affairs. She raised this as a priority issue at one of our first U.S.-Afghan Council meetings. She said that it's absolutely essential, you can't imagine how many people in and throughout Afghanistan, men, women, children, that their state of their mental health has been affected by years of war conflict and how to deal with it. And I will tell you it's a topic that not only we have discussed significantly but also one in which we have tried to put them in touch with those individuals who are experts in this area and how they could specifically address this area. I know it's one that I'm pointing to Charlie, I know it's one that you spent time with because it was a priority for her and it was not only for her individually but it was one that was mentioned quite often. Let me just say that on this, it's been part of very much the issues addressed of the Council. We have put them in touch with different interlocutors but I will say and I'm not a doctor in a medical sense but from the doctors that they'll say this takes time. You know it's not something that's going to change overnight. Forgive me, I don't know if you'd like to comment a little bit on this but you did spend time with Zora on this if I may. Call on someone from the audience. I did have the chance actually to get together with Zora Rasek. She was my counterpart when I was working for Paula on the Afghan women's issues. So I had lunch with her just about two weeks ago. She's continuing to work on this issue and continuing to build the partnerships that Paula mentioned. Let me just say that as Paula was speaking and she mentioned some of the really high profile partnership initiatives that have been launched under her leadership and her role at the U.S. Afghan Women's Council but there are many others that really didn't get the headlines and as Paula was talking I was thinking in particular of one group of women from Kentucky that I spoke to. I was asked the last minute to speak to a visiting group of women and unbeknownst to me there was a woman in that group about 30 women who's a dentist and she went back to Kentucky and mobilized a group of dentists and doctors and they went to Afghanistan, set up a temporary clinic and in the space of I think it was two weeks treated about 2,000 patients. No headlines, very little attention to that. There's also a small group based in Baltimore called Afghans for Civil Society. Pat Karzai runs that. One of the nurses, Baltimore based, that she works with. Ellen, I forget her last name but she went over to Afghanistan with a couple of boxes of the rubber syringes to help clean the babies after they're born because there were thousands of children who were dying before that if they were born without breathing the doctors and midwives didn't know what to do so they would lay the children on the floor and most of them would die. And now with just basic construction and with very rudimentary implements children are living. So I think there are just some incredible partnerships the psychosocial trauma, Sora has told us very forcefully will be the problem for the coming generation and it will take time as Paula said but I think that we need to continue to look at partnership and creative solutions. I know that there's a lot that's being done through telemedicine now and I think that there's a bigger role that technology could play but I think it's an excellent point you made. Thank you very much for those additions. I make two fast footnotes because we have other hands. And I just want to underscore by Charlie mentioning that it really does underscore one thing that truly was heartening for me as I said as an undersecretary was the outpouring of support from in and throughout the United States whether people had a connection to Afghanistan or not and one of the things that also evolved which I think is terrific is the State Department has a gift fund in this area and why? Because there were people who said we want to support but we don't know who or where or how to contribute and I think that has provided a very good mechanism for those that are undecided or don't know who to go to and as Afghanistan itself is solidifying its own NGO and operations because what you'd want is resources to go directly in during this time. It's been I think a good avenue for garnering those types of assistance and then directing it forward into Afghanistan during this transitional period. Maybe take three questions together. Okay, sure, sure. So there was a gentleman in the center here. Thank you very much. My name is Metab Karim and I'm originally from Pakistan. I have been a professor and have a political program at Aga Khan University in last ten years. Currently I'm working on a book on World Muslim Demographics based here in Washington. You have given some really interesting support of Afghanistan about which most of us are familiar with and you did mention about three areas in which women have come forward, political participation, education and health and I don't know why you omitted one area which is very important is the birth control family planning. I'll just give you some very interesting statistics. Iran next door to Afghanistan has average number of children for women too. Uzbekistan in the north is three. Pakistan in the east is four. Afghanistan is more than six and it is directly related to that percentage of women who are using birth control from 70% in Iran to about 55% in Uzbekistan to 30% in Pakistan and we have very limited statistics on this issue in Afghanistan. A lot of students of mine who were from Afghanistan working doing their degrees at Aga Khan University did the thesis with me and it's barely 10% of women are using birth control. Of course one area which has already been mentioned men are of this group. There's very little participation and support of them including politicians in the family planning in Afghanistan and I think that's an area which really needs to be looked at because maternal mortality, infant child mortality they're all related to having children. Thank you very much. Thank you. I'll comment after the three. Thank you. Over here in the back. Hi Ambassador, I'm Jean Bonventry. I'm a former DOD and I'm helping CSIS to look at national security and global health issues. I wanted to get your impression what is the role or what ought to be the role of health issues and specifically women's health issues and what Ambassador Holbrook is trying to accomplish in Afghanistan and Pakistan. In other words is there a role for health diplomacy in that sort of work. Thank you. The lady in the back row if she still wants to ask a question. Given the evident success of the global array of outsourced professional services to Afghanistan and the religious shifts on others and the evident growth of women's attention there some mandated some if you will subversive what is the status of indigenous development of a full array of former medical education as medical schools in Afghanistan and specifically what roles are women playing in achieving that status. Okay. Okay. All right. On the first thank you so much for your comments, sir. Concerning family planning. You're right. I didn't. In fact I'm looking here. There are a number of things I didn't mention and let me give as an example by the way you know I was citing the work for example of the Abbott fund. They cite and let me give a statistic. They said that just from their work alone and this is now not others taking into a statistic but there's some 58,000 women that have received reproductive health services. They also talk about in fact the kinds of clinics that they have held relative to family planning. I will just simply say to you that yes that is an important component. All of these matter in terms of dealing with maternal mortality and it is one that a number of stakeholders already operating in Afghanistan in fact are doing so. On the second question, the gentleman formally from you said DOD and now here at CSIS. My answer is immediately yes. I know the focus is on the issue of enhancing the coalition and the troops, number of troops into Afghanistan. I know also secondly there is a discussion and a debate going on outside in the foreign policy community about what one should do beyond the enhancement of troops. I personally come down very strongly on the side of continued assistance to Afghanistan in areas that it needs assistance so that it can solidify itself, its foundation, that it can also through areas like this which do matter to peace and stability and the welfare of a community. So as I began with all of you I mentioned how health, I see it as a national security issue. It's one that matters. I believe here that it has to be part of an overall integrative strategy vis-à-vis Afghanistan, not just solely military. Thirdly also all three of these are excellent comments and questions. Yours is a very good one. I will tell you I don't know the statistics offhand but I will say that I don't think it's very sizable. I do know that there are some women who are doctors. In fact, we even met a number of them but I will tell you I don't know the statistics on this except to say that my impression is the number is small. But the ones that have achieved a status of doctors, in fact there was one former minister who was quite well known actually who actually I think is like one of the most renowned doctors in Afghanistan, happens to be a woman. But you don't have many on that track and let me come to a second comment. I did have the benefit of last fall going and meeting with young students from the universities and again this is a subjective comment when I asked the young women, what is it that you want to be? What is it you want to do? Most of them were looking at political tracks for themselves. Interestingly enough, this was not an area that I heard many of them say, well I want to be a doctor and that's the path that I'm going to go on. So you do raise a very important point and actually in addition to the gentleman, the first comment, your comment and even the third, all of these matter in terms of how we go forward and areas that to help Afghanistan, you know, family planning matters, it matters in terms of how it fits in our overall strategy and it certainly matters in terms of the kind of education and direction. Right now though, as I said, it may be a subjective comment on my part but just from listening to young women, most don't seem to be going in that direction. Please, gentlemen. I'm going to take three or four again. Take three, okay. I'm Dr. Tajidil Millatmal. I just came from Afghanistan. I'm an MD and I was the ex-president of the Afghan Medical Professional Association in America. There are a lot I would like to share and I would like your specific attention to a few things. First of all, thanks for encouraging us that things are going very well in Afghanistan and thanks for admiring what's happened best. But let me share with you some things which is probably very, very painful and we need to understand. First of all, I believe we're the Americans. We are very naive understanding Afghanistan. People are just telling us over there what we want to hear. That's not what reality is. I travel throughout Afghanistan. I'm doing social research now. That's not my field. I shouldn't be doing medical services which I really want to do. But in reality, actually, everything is close for people who want to do some things. As the president of the Afghan Medical Association, we tried as hard as we can do to get there and to assist the Afghan people, the whole entire medical association. We were blocked. Fatimi is a good friend of mine. He was senior in college for me. He's from my same province. I know him very well. But actually, they are the one who is blocking the service for the public. When we went there to construct and pay some assistance in some work in Afghanistan, they were the one who were blocking us. In fact, a PhD graduate from Pakistan was trying to establish a lab in Afghanistan for advanced medical testing. He was forced to leave and not to work in Afghanistan. That is the very thing. But I'm coming to the point. There are a lot of avenues that we can do better. For example, there are a lot of Afghan medical professionals here in the United States who are not licensed. They are willing to go back to work. If we can just do a little bit, sidetrack for them, frame them for a little while, take them back to Afghanistan. They know the English, they know the culture, they know the medicine here in this country. They can serve a lot, not only for treating, but also for teaching. The second issue is that there is a lot of foundation that needs to be built. Right now, Afghanistan Medical Service is not based on the government capacity. In what I've always been disturbed with, the news that when you talk to somebody, you say, hey, the government doesn't have the capacity, what is NGO? That is destroying a country's foundation. That's what we, took to the Afghanistan or to other countries to really destroy the foundation of the country itself. So what we really need to do is to the state of the supporting these NGOs to give the capacity and the possibility to the ministry itself because they can sustain. So, for example, establishing some public schools that the very basic understanding of public health is not there. So, I'm very optimistic about what you have done and what we could do. But, optimism is not enough. We need to kind of look at that and think of it differently. We have too many kind of associations in America. None of them can do anything in Afghanistan. Doctor, I'm going to thank you for your comments. And just in the interest, we have some other folks I'm sure you'll be willing to stay around for a few minutes if there are some of these bigger issues we can discuss afterwards but maybe in a smaller conversation. So, another question please. I'm Doctor Donald Thompson from George Mason University. Doctor Dobryonsky, thank you for your encouraging presentation and for your vision and leadership and advocacy over the last eight years on this important issue. I am a medical doctor and spent a little over a year as a surgeon of the two senior DOD command through March of 6th to April of 7th and spent many wonderful hours in Doctor Fatimi's office and walking the halls of Rabia Bulkie and Malalai Women's Hospital with him and had the pleasure of helping to implement the burn prevention program that you discussed. Got that going, found the right NGO to implement them, still helping them with that. Based on what happened then the challenges that we had with finding resources to go to solutions that actually build capacity in the Afghan government to manage and deliver healthcare for their own population is there or should there be a leading and coordinating champion at the US government level that would help synchronize help facilitate the interests that we've heard from for instance the Abbott Foundation the gentleman's comments about Afghan physicians who would like to go back but such interest from outside government on these broad health sector reconstruction and development activities that actually develop sustainable capacity. So that's one question and the second half of this is given the current security challenges is there a a partnering mechanism a civil military partnering mechanism with the Defense Department and with the NATO forces there that might allow more health development to take place in insecure areas and perhaps lead to some stability and security in those areas. Thanks. Let's take one more question right behind you. Good afternoon my name is Mary Fallon I am not with any professional organization but I have had the good fortune to spend some time in Afghanistan as a spouse of the former Central Commander. Thank you Ambassador for your remarks and certainly for the encouraging statistics and of course there is still much work to be done I heard a comment the other day on NPR and I was just wondering if you could comment on it and that was suggesting that the drugs are being used more widely now by the women in Afghanistan and the problems that that will present and is there an outreach program to educate the women in Afghanistan about the downfall of this. There are good questions. By the way there were two other questions. Should I take them? Yes please. The gentleman there and I think you had so okay. If that's okay. Jim Halman from the Center for Disaster and Humanitarian Assistance Medicine we provide direct financial support to Malawi Hospital as well as to Kabul Medical University. I hope you'll find encouraging in relation to the previous question. The current chancellor of Kabul Medical University is actively promoting enrolling more women. Over a third of the several incoming medical school classes are women about 50% of the incoming nursing classes women and the target is to get that up to about 70 or 75%. At least at Kabul Medical University I think there is some very encouraging news things are going in the right way. Thank you very much for adding that and you have one. Yes. My name is Kamila Castellanos from the Rendon Group and I apologize if you've covered this already. I might have missed it. But I'm just curious about the she family law that has been discussed so much in the news lately. I think it's been pretty controversial and much has been said about it for a long time. Let's begin with the gentleman who was talking about the association establishing and what I heard you say in a way was trying to establish a type of maybe medical core and also looking at building capacity of the ministry. I have two comments. These are very good ideas and suggestions. Dr. I believe is coming to the United States one. Two, you have people here in this audience who are in the U.S. government now at the State Department at USAID and at the Department of Health and Human Services. And they all heard your comments, your proposal. It would seem to me that you know I know that when we sat down with him we discussed a range of ideas with him. The challenge is where you begin and how you do it all. You certainly I think that there's a lot to be done here. I think the proposals as I said my own view and comment to you is I think having a cadre of those from and throughout the United States that have been tapped into for their expertise I think makes sense. Charlie mentioned there's a lot more being done also with telemedicine and in which by the way you don't even have to necessarily go there and where that could be really established. So I would hope from those of some of my former colleagues who are here I hope that will be presented to Dr. Fatemi. I think it's a good suggestion and no less that our governmental institutions look at it per se. Your point about also the ministry is I think a key one and that is that the ministry has to be ultimately empowered. I think that that's what their desire is of I think that it's evolving I think for sustainability that's absolutely essential and I think that's a goal and an objective and I think that's what we are trying to do governmentally through the various packages which have sought to empower the ministry in this regard. In fact I believe that the ministry is one of the first ministries actually that has been given direct resources. The answer is yes to that. So very good points and I'm glad you used this occasion to say it because there are many in this room I think that could help with that and your ideas. Second is the question about you know a coordinator. Let's see yours coordinator. In this regard well that was the first about whether or not should there be a type of coordinator. I know in the last administration there was I genuinely I don't know if there is in the specific sense of the term meaning located in the bureau. In the bureau at the state department there's always been traditionally separate from our ambassador and separate from other interlocutors one person who was very engaged in the bureau of South Central Asian affairs. Having said that your question though links with the previous question from our colleague from DoD over here because we have a special envoy Richard Holbrook and in his role it seems to me there are a lot of pieces that would be coming together my own view is I think it does help and it does make sense because there are so many different aspects of providing assistance and you have different agencies USAID does a tremendous amount of work in this area then you have the work that's undertaken by the bureau itself then you have the work of DoD of which you were part and others here in this room have been part and I could go on Health and Human Services, CDC there are a lot of components so in that sense it does my view, personal view is it does make sense having a kind of co-ordinative role I'm not sure whether specifically the mandate of the envoy is the one for that because it probably makes sense having somebody who really devotes you know full amount of time to it alone there was that position I hope that's still the case I think it was about civil military you know and about you know does it work and is that an area to be advanced I will say yes for those that are desirous of doing it because let me give an example this is a little bit different I remember at the time of the military operation in Mazar-i-Sharif and after it was over in 2001 I remember that actually UNICEF was in the process of trying to immunize different communities and actually the US government was a bit of a bridge between UNICEF which wants to maintain its own independence in its immunization campaign and then at the same time the kind of coordination that had to exist with the military but yet being divorced from and also where the independence of either NGOs or international organizations are not compromised and let me give one when we were in Bamiyan I have to say I was very impressed New Zealand is in charge of the provincial reconstruction team in Bamiyan they really made a very strong case and appeal in ensuring that they provided to NGOs and others working there but at the same time distance so that they could do their work and not be encumbered in any way or compromised by not having a direct tire affiliation if that was the desire of the organization and it has worked and I think Bamiyan is a good example of that but let me add for those of you who may not know the governor of Bamiyan is Governor Surabi and as one I believe the first governor of Bamiyan and also the first female governor she's quite a task master she really has a very robust agenda and I think she's done a good job in really focusing all the interlocutors on the ground as to what she wants and that has helped as well the last on yours in terms of the family law let me say that you know in terms of the past and the discussion in the present the council just met just its subcommittee on health and it doesn't take positions okay but I could tell you that yes this has been in fact an important discussion in fact the Woodrow Wilson Center Dr. Esfendiari we may know she put a publication together that focused on laws in Muslim societies and one of the areas was devoted to this when we held one of our US Afghan women's council meetings do you know that everyone on the Afghan side said please please we want this translated in Dari Pashto and in fact that's one of the things we did do as a collaborative effort so yes it has been discussed yes the way that the council was looking at it was in a comparative way and thirdly right now the council you may have missed earlier is in Georgetown University's hands and I'm sure there will be issues that they will definitely have discussion continue discussion on it thank you for that last question please last question these all have been great questions 20 years ago I apologize I didn't answer your question and I will come back to it but no go ahead please I apologize for that in 1989 can you take my heavy Russian accent when you happily engaged in Georgetown I was there so with this bloodshed what do you think Russia will be cooperating partner or burden for US smart power over there okay what you heard about Bagram Air Base and that's enough I was going to say I don't know what you heard about Bagram Air Base I don't know but let me apologize I skipped over yours I was looking at my notes my writing is too small for myself your question is a very good one about drugs whether statistically it's gone up for women I genuinely I don't know but what I can tell you is there have been users many in the rural areas I think that it's related to a number of factors part of which is you have the real challenge of getting alternative livelihoods so changing it completely throughout Afghanistan and livelihoods and crops that as it has been said will out compete in terms of the income that's coming in it's been very challenging for many rural areas secondly the woman who mentioned earlier in the session about mental health you have many women who have said that they have turned to this because just of you know to lose themselves so it is a key issue it's a key area which the United States government has focused on extensively and over administrations and even so much so a number of you may have seen I know that there have been a number of people who have looked at what has happened in Columbia looking at lessons learned how maybe what has been done in Columbia could be also applicable in some parts to Afghanistan also the United Nations very very focused on this no less the Bureau of International Narcotics and Law Enforcement as well as the White House Office of Drug Control and Enforcement the issue is is how the challenges especially of as I've mentioned the types of trade-offs in this regard are addressed because that's been one of among a number of issues another issue is of course lawlessness that exists in different communities in rural areas which this has brought in a lot of income so women have been very much affected by that sir in terms of your question about Russia I will tell you honestly we have collaborated with a wide variety of countries in Afghanistan many in fact humanitarian issues and areas I know that during my tenure in government there are times we had discussions very broadly about global issues and the neighborhood but I'm not I will tell you honestly I'm not familiar with the programs that may or may not exist on the ground in this regard there are a lot of countries that have invested monies I mentioned New Zealand not only in the sense of their military but it's striking to me actually they feel ownership of Bamiyan province and have done a lot the prime minister of New Zealand has done a lot there have been a number of countries and interlocutors I would say that more it has been in the vein of discussing the areas stability as I said the neighborhood in that context Paula thank you very much I'd also like to thank our province thank all of you I apologize that our air circulation system is not working quite up to par here this afternoon but I think it's a sign of your devotion to the issue that you all stuck with it so thank you very much for that I was going to say a special thanks for that and thank you to Paula please