PUBLIC POLICY UPDATE March 21, 2013 WASHINGTON UPDATE Fiscal Year 2013 After the House passed

a continuing resolution (CR) last week to fund the government through the end of fiscal year 2013, the Senate followed suit this week with a significantly changed CR. The Senate version included several new spending bills (not including the State, Foreign Operations Bill) and adjusted spending levels (so called "anomalies") for dozens of other programs, including for Global Health and humanitarian assi assistance. As expected, the final CR capped spending at $1.043 trillion for FY FY2013 13 and, according to Congressional Budget Office estimates, allocated $42 billion for the base international affairs budget plus $11.2 billion for Overseas Contingency Operatio Operations ns (OCO), for a total of $53.2 billion. It also continued sequestration, such that $85 billion will be cut from the federal budget, acrossacross the-board, board, for the remainder of FY2013, with $59 billion coming from discretionary spending (including the International onal Affairs Budget). In For FY2013, this will leave $984 billion in discretionary spending, post-sequestration, sequestration, and approximately $50.5 billion for international affairs. Before taking off 5% for sequestration, the final bill: Increases funding for Glob Global al Health to $8.47 billion, including $2.75 billion for USAID health programs and $1.65 billion to the Global Fund. It reduces PEPFAR funding to $4.07 billion. Increases funding for humanitarian programs within OCO for the International Disaster Assistance and Migration and Refugee Assistance accounts, totaling $4.2 billion for the two accounts. Increases contributions to the Multilateral Development Banks. The bill funds multilateral assistance at $2.82 billion, nearly $200 million above the House. Of particular par note are increases for the Global Development Facility, the International Development Association, and the Inter-American American Development Bank. Increases contributions to International Peacekeeping Activities to $1.9 billion. Authorizes the State Depa Department rtment to transfer money between accounts so as to provide greater flexibility. After the Senate voted to pass the bill 73 73-26 26 on Wednesday, the House moved quickly to pass it on Thursday, without change, by a vote of 318 318-109, which sent the bill to the president resident for his signature, thereby avoiding a government shutdown that would have taken effect on March 27 deadline if no agreement had been reached. Fiscal Year 2014 Both chambers also began to consider budget resolutions for FY2014 2014 this week. week On Thursday, the House passed the so-called called Ryan budget (named for its Republican author, Rep. Paul Ryan of Wisconsin) by a vote of 221-207, 207, after rejecting numerous alternative budgets from conservatives, progressives and others. As we reported last week, it sets discretionary spending 1

at about $966 billion, which would be the budget cap after sequestration next year. It insulates the Pentagon from those sequester cuts, however, by maintaining defense spending at the presequester level of $552 billion and lowering the nondefense cap (including the International Affairs Budget) to $414 billion. The House Budget Committee recommends in their budget resolution that the discretionary International Affairs Budget should be $38.703 billion, not including Overseas Contingency Operations (OCO), which is yet to be determined. This base level of $38.703 billion would be $3 billion (7%) lower than current FY2013 sequestered levels. Meanwhile, the Senate began consideration of its budget blueprint, written by Sen. Patty Murray (D-WA), and is currently in the midst of a "vote-a-rama," in which dozens of amendments to the budget are considered and voted on in rapid succession. To date, several amendments have been proposed that affect international affairs. Two of these amendments have been proposed by Sen. Rand Paul (R-KY): one to cut foreign assistance in order to fund domestic infrastructure projects and another to withdraw the U.S. from the United Nations. We will follow this debate over the next few days and provide a recap in the next weekly update. As we reported last week, the proposed Senate budget caps discretionary spending at $966 billion for FY2014, but reflects the current sequester assumptions, which would limit defense spending to $497 billion and nondefense (including IAB) to $469 billion. It recommends that the discretionary International Affairs budget should be approximately $45.6 billion, not including OCO. This is about $4 billion (9.6%) higher than the current, FY2013 sequestered levels, and $6.9 billion (18%) higher than the level $38.703 billion that is in the House budget resolution. UPCOMING HEARINGS There are no upcoming hearings next week. HEARING SUMMARIES Public and Outside Witnesses Hearing House Committee on Appropriations State, Foreign Operations, and Related Programs Tuesday, March 19, 2013 Witnesses: Ambassador Michael Klosson, Save the Children Dr. Dean Schraufnagel, American Thoracic Society John Gillies, Basic Education Coalition Rev. David Beckmann, Bread for the World Michele Broemmelsiek, Catholic Relief Services Jennifer Katz, Drugs for Neglected Diseases Initiative Alex Palacios, United States of the Global Alliance for Vaccines and Immunization Ashley Bennett, Global Health Technologies Coalition Dr. Neeraj Mistry, Global Network for Neglected Tropical Diseases David Glassman, Helen Keller International Samuel A. Worthington, InterAction Margaret McGlynn, International AIDS Vaccine Initiative Jeffrey Wolff, Eliminate Project, Kiwanis International 2

Andrea Koppel, Mercy Corps Loyce Pace Bass, LIVESTRONG Foundation Rachel Wilson, PATH Dr. Joanne Carter, RESULTS, Inc Lynn Stratford, U.S. Fund for UNICEF

Testimony and Questioning: Chairwoman Kay Granger (R-TX) Thanks to all witnesses for attending. All written testimonies will be given the same consideration. Ranking Member Nita Lowey (D-NY) Thanks to Chairwoman Granger for her work; looking forward to continuing the bipartisan tradition of this subcommittee for the FY2014 bill. Development and diplomacy programs protect our national security, maintain U.S. global leadership and promote economic growth. Leaders from all communities have stressed the importance of civil society and the private sector in translating policy into action. Proud of the progress shown in global health and combating killer diseases but profoundly aware of the need to sustain progress, which will require resources. Ambassador Michael Klosson Strong U.S. leadership is vital for humanitarian and development programs, particularly vulnerable children. The most dangerous day for a child is the day they are born. U.S. programs work to: o Support significant reductions in child mortality; o Empower frontline women health workers; o Build knowledge and capacity in local communities. When the U.S. leads, it galvanizes others to act: o U.S. led calls to end preventable child deaths in a generation, leading to 117 nations to sign pledge of support for this initiative; o U.S. and Ireland collaborated on 1,000 Days initiative; o USAID support during the Horn of Africa crisis provided shelter for Somali refugees crossing the Ethiopian border. Continued U.S. investment is the right and smart thing to do, advancing our long-term interests when others grow, we grow with them. Some people believe Americans dont care about this type of U.S. leadership; we believe they do. Young people from across the country will come to our Washington advocacy summit next month to show just how they can inspire others. Ranking Member Nita Lowey (D-NY) 1. Can you briefly address the issue of working together with frontline health workers? Klosson: o The most vulnerable populations are well beyond the main hospitals. So how do you get proven interventions to these people? Answer: frontline health workers. (Note: this includes midwives, community health workers, etc.) o But there is a real deficit in these numbers; we need more attention on it. o We would like to renew last years resolution (H.Res. 734, 112th Congress). 3

Dr. Dean Schraufnagel Here to testify for funding for tuberculosis (TB), an infectious disease than can affect anyone through human mobility: no one is safe until the world is safe. In 2011, 8.7 million people contracted TB, 1.4 million people died of TB 64,000 were children. Although investment has paid dividends, drug-resistant TB remains a major problem: o 5% of TB cases have developed resistance to two main drugs; o When this happens, treatment takes longer and a cure is less likely; o 650,000 people developed multidrug-resistant TB in 2011. Best way to prevent this disease at home is to invest in programs abroad. The U.S. is largest bilateral supporter of TB prevention and control in more than 30 countries: USAID programs save lives. Global mortality rate for TB has dropped by 40% over last few years; we must not let the disease intensify as it did in the 80s and 90s. For FY2014, we recommend $400 million for USAIDs global TB program and $1.6 billion for the Global Fund. Chairwoman Kay Granger (R-TX) 1. We need to treat more people, but we also need to detect earlier. Where are the tests in that area? Specifically Xpert? Schraufnagel: o Xpert was developed by a U.S. firm and tested in high-burden countries. Part of this research is supported by USAID. o In terms of value, this research is going towards the places with the highest prevalence of TB. John Gillies The Basic Education Coalition appreciates the support of this subcommittee to provide hope for children. For FY2014, we recommend an investment of $925 million in international basic education, with at least $750 million of that coming from the Development Assistance (DA) account. This is the same requested amount as FY2012 and FY2013; while we recognize the difficult choices made by Congress, this funding supports sound U.S. investment in education. U.S. assistance works hand in hand to create better schools, provide opportunities for young people, particularly girls, and build local capacity. For every $1 spent abroad, as much as $10-15 dollars is generated in U.S. jobs. Numbers of children worldwide dropping out of school has decreased by about 47 million since late 90s. But 61 million children are out of school; half of those children live in conflict-ridden countries, many marginalized by gender, disability or ethnicity. We cannot afford to reverse the level of resources previously committed. Ranking Member Nita Lowey (D-NY) 1. What are we doing to maintain achievements in girls education in Afghanistan? Gillies: o There are major challenges there.

But continued investment and focus on the issues of girls and equality will be a long-term one because it is such a deep societal issue. We need sustained interest in this area.

Rev. David Beckmann The world is making dramatic progress on hunger, poverty and disease. The work of this committee is vital to that. Bread for the World is concerned about the programs and agencies focused on helping the poor; in my written testimony, those agencies are listed on the back we support continued funding for their work. We also support foreign assistance reform. o Previous and current administrations have worked to make these programs more effective, including USAID reform, food aid reform, and Sen. Ted Poes (R-TX) aid transparency and evaluation bill. We recommend an increase in funding for child nutrition from $95 million to $200 million a year. The return on investment in child nutrition is extremely high. Chairwoman Kay Granger (R-TX) 1. I know that you are concerned with not only what we do but how we do it. In terms of direct assistance, are countries ready to receive this? Can they handle it, do they have the bookkeeping, distribution channels where do you think it is being done well and where does it need more careful attention? Beckmann: o The World Bank has been funding programs that work. Many countries have sophisticated systems, institutions and structures that work. Michele Broemmelsiek Catholic Relief Services (CRS) urges you to fund poverty and development accounts at minimum FY2012 levels. Country ownership: o USAID has provided funds for governments; we should define this more broadly to include civil society. o Country plans have marginalized civil society engagement. o CRS has led participation and input from local civil society into Feed the Future plans, but efforts to include civil society have been met with inactivity except in Zambia. o Meaningful input from civil society should go towards development, implementation and evaluation. o Financing through cooperative agreements are more effective than contracts, enabling local ownership, flexibility and sustainability. Strengthening local capacity: o Success depends on local context; o PEPFAR supports transition to locally maintained programs with local partners; o Need to find cost efficiency but we must also increase availability of health facilities; patient outcomes are at risk; o Local organizations see continued support for local partners as vital. On local government ownership, exclusive focus on government-to-government support will leave out faith-based health networks. Ranking Member Nita Lowey (D-NY) 5

1. I know CRS has been critical to response in Mali and the Sahel; can you share any advice on how the U.S. can help the people in the Sahel region? Broemmelsiek: o U.S. government has been very generous in adapting programs to be immediately responsive. For example, we had Food for Peace programs in Mali that enabled emergency response. Jennifer Katz Drugs for Neglected Diseases Initiative (DNDI) requests: o Funding for USAIDs neglected tropical disease (NTD) program at $125 million; o Investment in research and development; o Expansion of the list of NTDs. Worldwide, 1 billion people are infected with at least one of the 17 NTDs. NTDs damage worker productivity and destroy lives, particularly for vulnerable women and children. They are a huge factor keeping 1.4 billion people in cycles of poverty. DNDI focuses on developing treatments for most neglected diseases. USAID program for NTDs was launched 2006 but only focuses on five of the 17 NTDs and does not allocate research and development funding to develop new treatments. Strongly urge strong robust global health funding. Chairwoman Kay Granger (R-TX) 1. In your testimony, you say 1,500 new drugs were approved between 1975 and 2004, but only 21 of these were directed towards NTDs. Which diseases cause the highest number of deaths? Katz: o African sleeping sickness, Chagas disease and visceral leishmaniasis. Alex Palacios GAVI requests funding for FY2014 at $175 million to the GAVI Alliance and funding of $750 million to the USAID Maternal and Child Health account. GAVIs work has led to greater immunization coverage, and we have reached 370 million children with crucial vaccines. With its partners, GAVI is introducing new vaccines into developing countries and aims to prevent the deaths of 4 million people by end of 2013. With UNICEF support, we can secure much cheaper vaccines, which means more coverage and value for money. But the GAVI program is not a giveaway: all eligible countries need to cofinance these vaccines. GAVI makes sure that these countries can maintain the cost of these programs. U.S. support represents 14% of total support to GAVI. We welcome the continued support of this committee which contributes to saving lives. Ashley Bennett The Global Health Technologies Coalition work to promote new research for health and investment today is critical for our future. U.S. government leadership must not falter. Many tools for global health have become ineffective or nonexistent. Development of new tools is as important as providing access to existing tools.

We request sustained support of the Global Health account in USAID budget, and each subaccount. This should not come at expense of other global health or humanitarian programs. In next five years, researchers anticipate new technologies that could enhance health. New, shortened treatment for TB, which could prevent 8 million infections and 2 million deaths by 2050 in Southeast Asia. We encourage cross department collaboration between Department of Defense, CDC, FDA and USAID to coordinate research and programs for new vaccines. This is a smart U.S. investment: for every dollar, 64 cents goes to U.S. researchers. Extend gratitude to this committee and welcome the opportunity to work with you.

Chairwoman Kay Granger (R-TX) 1. You mentioned a five-year plan to coordinate between departments like FDA, CDC and USAID. Would it not be better to streamline the plan so that it comes from one source? Bennett: o USAID report on health related research and development is a tool to show how global health research and development funding is used. While all those agencies have a role to play, it is important to take elements from all and contribute to one streamlined objective. Dr. Neeraj Mistry We urge continued funding for NTD programs at least FY2012 levels ($89 million) and support our partners request to increase this budget. Since FY2006, the NTD program has: o Helped over 251 million people; o Delivered over 587 million treatments; o Trained over 500,000 health workers in 25 countries. In 2012, partners came together to announce the London Declaration to eliminate 10 NTDs by 2020. Progress includes: o Over 1 billion treatments provided by pharmaceutical partners; o 40 governments launched national multiyear programs on NTD control; o Scorecard created to promote accountability. However, funding gaps remain. Inclusion of other NTD control measures in USAID programs should be considered. If funding for USAIDs NTD program does not at least match FY2012 levels, we will see a resurgence of these diseases and dropping levels of school attendance. David Glassman U.S. funding allows HKI to deliver vital services, including education on farming. We work with local people to build knowledge in the community. Urge continued support of food security programs that prioritize smallholders. We request for FY2014, funding of $3 million for blind children, $100 million for NTDs, $23 million for vitamin A, and $750 million for child survival and maternal health. One child goes blind every minute. This committee has consistently supported programs for blind children in developing countries, saving the sight of thousands. Vitamin A deficiency kills 670,000 children annually. HKI has become a leader in distributing supplements. NTDs can stigmatize, kill and trap millions in persistent poverty. USAIDs NTD program has helped treat over 160 million people worldwide. 7

HKI has saved the sight and lives of millions. Thank you for your consideration.

Samuel A. Worthington Here to advocate for poverty-focused development and humanitarian programs. It is time for strong U.S. leadership in global development, particularly in view of developments in the Arab world and ongoing crises in Mali, Somalia and Syria. Funding for development includes: o Global Health account; o Millennium Challenge account; o Multilateral accounts; o Development Assistance account. For humanitarian assistance includes: o International Disaster Assistance; o Refugee accounts; o Peacekeeping efforts. Through these investments, we do well by doing good. Global humanitarian needs have increased, especially in Syria, where one-fifth of the population has been displaced and a serious infusion of funds is required. If funds are not adequate, we will have to choose between lifesaving programs in one country and not another. We need to strengthen cooperation with private actors, like InterAction member NGOs, who collectively raised $14 million in private contributions in 2010. InterAction continues to hold dialogue with USAID to ensure NGOs are seen as partners as well as implementers. U.S. government can play a unique role in uniting the international and NGO community to solve problems together. Chairwoman Kay Granger (R-TX) 1. The reaching out we do multiplies our contributions, we not only reach out in terms of money but also in research. Bill Gates recent letter brought up good news. We are in a difficult fiscal situation, but we know that the cuts we make will keep U.S. from saving lives. Do you reach out to other members outside of these subcommittees? Worthington: o Yes, we do. 2. And are you convincing? Worthington: o I try to be. I think the bottom line is the fact that the American people give so much in contributions. They want our government to be a good partner. We have an American movement that cares about these issues. But we know that the U.S. government cannot do it alone. We need to partner. The new face of development is partnership with others, with NGOs, the private sector, local actors and universities. The reforms within USAID are heading in that direction. Ranking Member Nita Lowey (D-NY) 1. Thank you for your work and continued commitment. Because of bipartisan support, your priorities are our priorities. And hopefully, we can come out of this hole. So thank you. Rep. Barbara Lee (D-CA) 1. What concerns me is the lack or withdrawal of federal government support i.e., sequestration. I know that fellow funding and support of the U.S. government leverages 8

private and corporate contributions throughout the world. I would ask all our witnesses to consider that and how our withdrawal, given our fiscal constraints, can diminish the partnerships we have with other actors. Worthington: o There is a direct correlation between the U.S. government taking a lead and our ability to generate private resources. Weve seen this at the G8 and other places. We would not have come up with the billion dollar food security pledge had the U.S. government not stood up. Your leadership is essential.

Margaret McGlynn The International AIDS Vaccine Initiative is here to advocate for support of global health. An AIDS vaccine is within reach. A trial in Thailand showed modest protection was possible. We have seen existence of neutralizing antibodies that shows the way forward. But HIV remains a great challenge, and the reality of developing a vaccine is difficult. We have brought four important new vaccines to the market. Investment in HIV research will accelerate delivery of services to those who need it the most. Any break in funding will have a devastating effect on our momentum. We have had advances in treatment that we applaud: o PEPFAR programs that work to achieve an AIDS-free generation; o But we know that prevention is better than treatment; o For every five people newly infected, only three are receiving treatment. We recommend funding at current levels $28.7 million for USAIDs HIV vaccine research account. With your continued support, we are getting ever closer to solving this great challenge. Jeffrey Wolff The Eliminate Project works to eliminate tetanus, a preventable disease that kills one baby every nine minutes. We encourage USAID to provide continued funding for maternal neonatal tetanus (MNT) programs, through the child and maternal health accounts. You are both champions for maternal and child health. In Cambodia, UNICEF is training outreach health workers to provide care to mothers and families otherwise out of reach. Thank you for supporting our first global campaign ending iodine deficiency, and we urge you to support out current campaign to end MNT. Cost of MNT vaccine includes syringes, safe storage and transportation. Kiwanis International aims to raise $110 million to immunize 69 million women globally. We have raised almost $27 million since launching the campaign; we urge you to join U.S. in this final push to eliminate this disease. Andrea Koppel Mercy Corps is a partner of USAID and other agencies. Thanks to this subcommittee for your continued support of lifesaving accounts, including IDA and MRA. Community Development Funds (CDF) offers flexible funding and a resilient approach: o Obama administration developed CDF to promote innovation and effectiveness; o Provides cash for food security programs; o Expand reach to more beneficiaries and allows creativity; o We encourage the FY2014 bill to provide more of this kind of programming. Humanitarian aid is modernizing by addressing more of the needs and drivers, rather than just the effects, of crises. 9

Resilient aid helps communities facing recurrent crises, like in the Horn of Africa and the Sahel. USAIDs resilience strategy brings together elements traditionally housed in silos, such as economic development and livelihoods, natural resource management and water. We want to break down these silos. Syria: if neighboring countries in the region were hit by a natural disaster, there would no doubt be a huge response. But this conflict is a man-made crisis yet the numbers are the same. UN appeal for the Syria crisis is less than one-quarter funded. Please keep this in mind when making funding decisions.

Loyce Pace Bass Non-communicable diseases (NCDs) will cost the world $47 trillion in less than 20 years if we dont act. U.S. has extensive experience with diseases like cancer, diabetes and strokes, so we have a unique opportunity to offer assistance to the world. We can drive a new normal, one that leverages partnership and continued support. Platforms of assistance already exist: o PEPFAR has expanded existing programs in some countries to address cancer; o Community health workers can detect cervical cancer in remote villages. No new money is needed to make a difference, we can use current funds. We will pay for NCDs, one way or another, but we can do things now to lessen our costs. Rachel Wilson PATH is grateful to this subcommittee for continued support of global health. We work in over 70 countries and see the direct impact of U.S. assistance. It is vital we support programs that work, which is why we recommend funding for: o $750 million for USAIDs child and maternal health accounts; o $175 million for GAVI; o $680 million for the presidents malaria initiative; o $1.65 billion for the Global Fund. U.S. investment saves the lives of 6 million children annually. Maternal mortality has declined by 30% in countries with most U.S. involvement. Through public-private partnerships we developed a vaccine vial label to show health workers when a vaccine was spoiled, saving an estimated $5 million. U.S. investment in GAVI Alliance has enabled vaccination of 370 million children. By supporting these initiatives, the U.S. is making a strategic investment. Dr. Joanne Carter There are three areas that can maximize impact and leverage U.S. resources: o The Global Fund; o Child health and nutrition; o The Global Partnership for Education (GPE). The Global Fund: o Programs within the Global Fund are moving U.S. towards the end of AIDS, malaria and TB; o The decisions you make will literally determine the trajectory of these diseases in the next decades;

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U.S. funding allows millions of people to get treatment and invest in their own education and development; o Contribution of $1.65 billion to the Global Fund will continue progress. We have huge opportunity to invest in programs to tackle child malnutrition. o June summit to support Scaling Up Nutrition (SUN) countries will leverage donor and country funding; o If the U.S. scaled up pledge of $200 million in FY2014 budget, this will send an important message. Basic education: o GPE can help U.S. leverage resources and promote cooperation; o New leader Alice Albright is focusing particularly on work in fragile states; o Scaling up the initial U.S. pledge of $20 million to $125 million for the GPE will be another important signal to other donors and countries. o

Lynn Stratford The U.S. Fund for UNICEF requests funding of $135 million in FY2014 to UNICEF under the international organizations programs account. We recommend $750 million for child health programs. In 1990, 12 million children under 5 died of preventable diseases; in 2012, this number dropped to 6.9 million. This needs to be zero. With sustained investment, we can eliminate these deaths in the next 20 years. UNICEF is largest provider of vaccines, delivering 2.5 billion vaccines in 2011, ensuring these reach the poorest children in the most vulnerable communities. We have joined with Rotary International in the fight against polio. In 2011, UNICEF provided 27,000 ready-to-eat therapeutic foods. Not one of U.S. can claim sole responsibility because we are partners together. There are many programs that focus on protecting girls, keeping them in schools and ensuring access to sanitation. Thank you for your continued leadership. Chairwoman Kay Granger (R-TX) I went to Ghana and saw the difference being made by malaria programs. Due to sequestration, we can no longer make these trips. When Congress sees the effects of these programs, it makes all the difference. It is in our national interest for people to be healthy and communities to be safe. It is who we are. You know that the American people are generous. As we look at our priorities, we should remember who we are as the United States and that as a leader, we do make a difference. Syrias Humanitarian Crisis Senate Committee on Foreign Relations Subcommittee on Near Eastern and South and Central Asian Affairs Mar. 19, 2013 Witnesses: Anne C. Richard, assistant secretary of Bureau of Population, Refugees, and Migration, Department of State Nancy E. Lindborg, assistant administrator for democracy, conflict and humanitarian assistance, USAID Antnio Guterres, United Nations high commissioner for refugees, United Nations 11

Tom Malinowski, Washington director, Human Rights Watch Michael Singh, managing director, Washington Institute for Near East Policy

Testimony and Questioning: Chairman Robert Casey (D-PA) Two years ago, the people of Syria began peacefully demonstrating in protest to the authoritarian government of the Assad regime, inspired by the Arab Spring. o Since the peaceful protests of the Syrian people were met with violence by the government security forces, the conflict in Syria has only escalated. o There are now more than 1 million refugees, approximately 2.5 million people still in Syria who have been displaced, and more than 70,000 people have been killed. Statics tend to obscure the human face of the conflict, the men, women, and children who are suffering as a result of the violence. The response by the United Nations thus far has only been in government-held territories because of international law. Laudable humanitarian efforts have been made to provide relief without prejudice food aid and medical supplies. Humanitarian relief is constrained by severe limitations to access, which is raising concerns that assistance is not reaching those who are suffering. There are encouraging signs that Syria can transition into a stable and democratic country in the wake of the current conflict. Congress will be considering new legislation proposed by Sen. Robert Casey (D-PA) and Sen. Marco Rubio (R-FL) to authorize additional funding for reconstruction efforts in Syria. This hearing is intended to address several questions regarding the Syrian crisis and the tremendous humanitarian need in and around the country. o What is the U.S. doing to respond to the crisis in Syria? o What more should be done by the United States? o How can the U.S. and UN improve coordination of the humanitarian response in Syria? o What should the international communitys priorities be after Assads regime is out of power? o What must be done to lay the foundation for a peaceful and democratic transition after the conflict? Ranking Member James Risch (R-ID) Focusing on the Middle East and North Africa region is in the interests of the United States, particularly with the refugee problem and the humanitarian crisis. As the finances of the United States deteriorate, the support the United States is able to give for humanitarian assistance to the Syrian crisis is stretched to its limits. The United States has an interest in Syria, and the situation in that country is increasing in complexity. Humanitarian assistance in the region is made possible only with the assistance of the U.S. government. Dozens of groups are vying for power, and it will be very difficult to predict what a postAssad Syria will look like. What can we look forward to in the days, months and years ahead? Anne Richard

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In the two years since the beginning of the Syrian protests to the Assad regime, 1 million people have fled the country, half of whom have crossed the borders in the last two months. o Jordan is now host to approximately 30% of the refugees (350,000); most of the refugees in Jordan are in the Zaatari camp in the north. o Lebanon now hosts approximately 300,000 refugees, increasing the population in Lebanon by 10%. o Iraq has all but closed its borders, only allowing refugees to cross for medical emergencies or if they are elderly. o Turkey is working to address the humanitarian need and bearing most of the cost without international assistance. The United States is working to encourage all those providing assistance to uphold the humanitarian principles and urging all of Syrias neighbors to keep their borders open for those fleeing the conflict. The Bureau of Population, Refugees, and Migration are helping to lead the response of the United States. Humanitarian relief is by definition neutral and impartial. The humanitarian community is facing a resource crisis.

Nancy Lindborg U.S. fully is committed to supporting the Syrian people and is working to communicate this message in a variety of ways to Syrians. o Aid has been provided to 2.4 million people inside Syria. o Of the $385 million in assistance, $215 million has gone in to Syria. Aid has reached all 14 governances. Approximately 16% of U.S. aid has reached opposition/contested areas. The humanitarian need resulting from the Syrian conflict is growing. It is important for donors to work through as many mechanisms as possible to reach all those who are suffering as a result of this conflict: UN agencies, NGOs, international organizations, local Syrian groups. U.S. humanitarian assistance has been prioritized because of the limitation on resources for providing humanitarian aid: food, basic medical supplies, plastic sheeting for shelters. o With growing crisis, there will need to be improvements made to sanitation services and capacity of refugee camps. o Looking forward, assistance will need to be provided to address the psychosocial impact of this conflict, particularly focusing on children. There are several challenges that must be addressed as the United States continues to provide humanitarian assistance. o Access to those in need is limited, inhibiting access of humanitarian workers to those left most vulnerable by the conflict. o Security of humanitarian aid workers is constantly at risk, which is why there is limited branding of humanitarian aid provided by the United States. o Resources for continuing humanitarian aid are becoming strained. Chairman Robert Casey (D-PA) 1. On the issue of branding, where do you see that issue progressing? Lindborg o U.S. assistance is branded when and where it can be without further endangering aid workers.

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o U.S. agencies are implementing a broader communications strategy to communicate that the American people are standing with the people of Syria, including outreach to the Syrian diaspora in the United States, visits to the region and social media outreach. o The United States participates in weekly coordination meetings to share updates and reports on the situation in and around Syria. 2. What efforts are being made to encourage other (new) donors to participate in the joint efforts of the United States and the United Nations coordination and reporting? Lindborg o The United States is reaching out actively to new donors to engage them in coordinated efforts and encourage them to turn their pledges of support into programs on the ground. o The United States is working to encourage new donors to also participate in the coordination mechanisms of Office for the Coordination of Humanitarian Affairs (OCHA) and the assistance coordination unit run out of Turkey. o Memorandum of understanding signed with the Organization for Islamic Cooperation on the Syrian crisis to ensure that the impact of limited resources can be maximized. 3. What efforts has the State Department made to encourage the countries that border Syria to keep their borders open? Richard o In every diplomatic conversation with the countries that border Syria, the State Department is reiterating its request for the borders with Syria to remain open for refugees. Sen. Ron Johnson (R-WI) 1. Of the 70,000 casualties, how many were members of the opposition vs. supporters of the government? Richard o Demographic information of casualties is not known. o The primary concern is that civilians that were not fighting were massacred by the government; civilians are caught in the midst of this war. 2. Can either of you imagine a scenario in which the Assad regime stays in power? Lindborg o Looking forward, the humanitarian crisis will be protracted. o The United States right now is hoping that he will leave power. 3. Assad must be removed from power in order to establish a peaceful solution. Richard o It is difficult to imagine a peaceful outcome where Assad is still involved. 4. So U.S. policy must focus on his departure? Will peace talks, negotiated settlement continue to protract the humanitarian disaster? Richard o Initially there was hope that this conflict could be resolved quickly; as the conflict is protracted, the humanitarian need and reconstruction need grows. 5. With resources stretched, of the $36 billion allocated for foreign aid, is all of that already allocated? Is there a way for money to move from other places to supplement the need here? Richard o Budgets are set far in advance of situations like the one in Syria. 14

o Humanitarian aid coordinators in the U.S. government are grateful for the flexibility to use contingency funds to respond to this crisis, and at this point efforts are focused on careful spending of the resources already allocated. o Foreign aid funding is promised to other global responsibilities. 6. How high of a priority is Syria? Lindborg o Syria is a top priority. o In resource management, USAID is evaluating trade-offs globally to ensure the U.S. is able to provide an adequate response to the humanitarian crisis in Syria. Sen. Barbara Boxer (D-CA) 1. Can you speak to the situation of female refugees and what are we doing to ensure that services are available for women who may have been victims of sexual assault? Richard o Both USAID and the State Department are working closely to increase protection, especially the protection of victims of sexual violence, and to educate communities. 2. What are you doing specifically to ensure services are available to victims of sexual assault? Richard o The United States is providing support for UN agencies that are working on these programs. 3. Can you speak to the impact of this crisis on children and what targeted services are being made available to them? Lindborg o Rape kits and counseling training have been provided to 144 hospitals. o In Syria, at this point programs are better able to treat victims. 4. Would you be willing, with the groups testifying and others, to bring this shameful situation to light? Will you use your positions to tell the truth about whats going on there? Richard o All media interviews on this issue are being granted. o The State Department is using all available communication avenues to publicize this information and voice concern for the situation of women and children. Lindborg o This is an issue being addressed by communications teams and in speeches, but it is hard to truly capture the horror of what is happening. o USAID is funding programming globally to change norms and attitudes. Sen. Bob Corker (R-TN) 1. Do you think we are doing enough to plan for the days after Assad, to make sure the elements are in place to prevent regional instability? Richard o The administration is doing a good job of planning for a post-Assad Syria, but the protraction of this conflict is concerning. o There needs to be a greater global response and greater coordination among the international community. Lindborg

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o In addition to the planning, there are activities currently underway to begin setting up transitional government infrastructures and to improve the infrastructure that will be necessary to provide basic services. 2. Are there things we can do directly, right now, to ensure the new prime minister and his staff are successful on the ground? Lindborg o The United States is introducing a new package designed to support Syrias transition from this conflict. The United States is enabling the coalition government to ensure essential service delivery to build trust with the people and establish a sense of accountability. o The people in Aleppo have held successful local elections, which is encouraging. 3. What is your take on how well the civilian/political opposition and the armed/military opposition groups will meld? Since the United States has not been overtly providing arms assistance, has the U.S. presence on the ground been adequately felt so that the United States involvement will impact how Syria moves forward toward transition? Richard o The Syrian diaspora in the United States has strong ties with the people of Syria. o The United States has very good communications with the top representatives of the opposition coalition. 4. Is our presence on the ground being felt by the people who will determine the future of Syria? Do they know we are providing this aid? Do they know we are involved? Do they think we are involved enough to help shape the future of Syria once Assad falls? Lindborg o The opposition leadership, on every level, knows that humanitarian assistance is coming from the United States. Sen. Benjamin L. Cardin (D-MD) 1. What assurances can be given that funds from American taxpayers are furthering U.S. interest? That is primarily humanitarian, so is it getting to the right people? How much confidence do we have that the international assistance that the United States contributes to is being distributed in the most efficient way to further U.S. objectives? Richard o U.S. partners in the field are only granted access to funding if they can prove their effectiveness in providing the aid being funded. o The United States is working to best communicate the U.S. role in supporting the Syrian people, but there are challenges with the availability of information and frustrations that the United States is not providing arms assistance. Lindborg o The United States is using all communication channels to publicize its role in providing assistance in this crisis. Antnio Guterres The Syrian crisis is most complex and dangerous, and the humanitarian need as a result is staggering and only escalating. o There are 1.15 million refugees from Syria who have fled to surrounding countries, and there are reports of an estimated 3.6 million people displaced inside Syria. 16

Last April, there were 33,000 refugees registered; in December, there were 500,000 registered refugees. o In December, 3,000 people were crossing the border each day; in January 5,000; in February 8,000; in the last few weeks, there have been reports of 14,000 people fleeing Syria every day. UNHCR is focusing advocacy on keeping borders open for those fleeing. UNHCR is working to provide psychosocial support for refugees. Most refugees are women and children. o There are reports of rape and sexual abuse of women and children. o Families are pushing girls into early marriage or prostitution. o UNHCR is working to provide protection and support for victims of sexual violence. UNHCR has 200,000 staff in the region, operating out of 16 offices. UNHCR is working with other UN agencies, NGOs and governments to coordinate assistance. UNHCR is working to support IDPs. Conditions inside Syria are worse than they are outside Syria. UNHCR and other UN agencies are working with a lack of resources. There are very serious concerns that the conflict in Syria will cause long-lasting regional instability. o

Chairman Robert P. Casey (D-PA) 1. Can you identify more specifically what the gap is in resources? Guterres o UNHCR has called for additional funding, as original funding requests were based on original projections of 1.1 million refugees in June, which has been funded to less than 30%. o UNHCR needs an additional $700 million. o UNHCR estimates that there will be 1 million refugees per host country by the end of 2013. Sen. Ron Johnson (R-WI) 1. Is it inevitable that Assad will fall? Guterres o The Syrian crisis could be protracted; the deterioration of Syria could go on for months or years. o Preparations must be made for this crisis to evolve. 2. Are we falling in Syrians opinion because we are not doing more from a military standpoint? Guterres o People believe that the international community as a whole should come together to find a solution. o People in crisis do not make the distinction between interventions of a military nature or what is strictly humanitarian assistance. 3. Do you get the sense that U.S. involvement is known? Guterres o U.S. efforts are known, but that is not necessarily an indication of peoples attitudes. o This refugee community is well-informed, politicized and engaged. 4. How do we get out information about programs for women and children? How do we get this information out to galvanize the international community? 17

Guterres o The International Refugee Committee, UNICEF and Save the Children have all published reports about what is happening in and around Syria. o Arab media are all reporting on the Syrian crisis through standing broadcasts and debates.

Chairman Robert P. Casey (D-PA) 1. What is the most difficult challenge you have dealing with a humanitarian crisis on this scale? What mechanisms and on the ground challenges are there? Guterres o This refugee population is highly informed and politicized. o The greatest risk with this crisis is the potential for spillover, for this crisis to destabilize the region. o Effective humanitarian aid is a moral obligation, a factor for events to move in the right direction, a factor in ensuring that Syria can become a normal country with normal democratic institutions. Tom Malinowski There is extreme suffering in Syria and a striking absence of the international community. o Though some aid is reaching those suffering inside Syria, there is no awareness of U.S. involvement in providing aid. o Though there has been an increase in humanitarian aid provided, people are not aware that humanitarian aid is coming from the United States. People in Syria are angry at the United States. o The United States is recognized as a powerful country with the capacity to resolve this crisis. o People in Syria believe that action and inaction are planned decisions, so they assume that help is being withheld. More can be done. o Turkey could open more border crossings; o Turkey could register more NGO staff; o A resolution could be passed in the General Assembly authorizing cross-border operations; o Development aid can be provided directly to the opposition, to local councils, to begin providing basic services and infrastructure reconstruction; o Humanitarian aid should be left to the agencies with the logistical capacity to provide it. More branding of humanitarian aid would be great, but branding decisions, in security issues, should be deferred to the humanitarian aid workers who are at the most risk. Michael Singh Cannot address the humanitarian crisis without considering the policy regarding the conflict that is the cause. This crisis is a confluence of both moral imperative and the strategic interests of the United States. Current foreign policy is not effective in advancing U.S. interests, either in addressing the humanitarian crisis or hastening the fall of the Assad regime. There must be a reassessment of U.S. objectives on this issue; U.S. policy should focus on a resolution of the conflict to avoid further regional spillover and strengthening of the moderate opposition. 18

U.S. policy should be based on three pillars: people, funding and military support. o People: The U.S. should work to ensure the protection of minorities There need to be incentives for members of the regime, especially in the military, to defect. There must be support for an interim government o Funding: Sanctions against international trade with the Syrian regime need to be strengthened. Greater funding should be given to the opposition, which has received relatively little direct funding from the United States. o Military support: The opposition needs an advantage to break the current stalemate. Assads regime controls the airspace, so authorization for NATO airstrikes may be in order. The moderate opposition needs a strong security force to combat extremism in the wake of this conflict. Inaction poses the greatest risk to U.S. interest in the region.

Chairman Robert P. Casey (D-PA) 1. What is the extent and influence of extremists among the opposition? Malinowski o People inside Syria are aware of the extremists in their country. o Because of the perceived lack of response from the international community, extremists are filling a void. o Moving forward, there needs to be greater support to strengthen the capacity of the moderate opposition and civilian councils that have greater authority than extremists. 2. What% of the opposition is composed of extremists? Malinowski o There is limited support for extremists; they are tolerated because they are the only group fulfilling certain needs. 3. Is there one group that is predominant? Malinowski o Unconfirmed rumors indicate that Al-Nusra is the predominant extremist group in Syria. Singh o The question must be asked, particularly of the administration, why dont we know more about the composition of the opposition? Sen. Ron Johnson (R-WI) 1. Is enough being done to bring this conflict to an end? Can the U.S. get by with not standing in the way of other countries providing military assistance? Will that be enough? Does that stand any chance of success? Singh o Inaction is not a policy; it is the policy equivalent of no comment. o There is an urgent national security threat posed by the protraction of this conflict. o U.S. allies look to the United States for leadership, and doing nothing is not leadership. 19

2. Can either of you explain why the administration has not been more forward in addressing this conflict? What has been the underlying reluctance? What is the danger of greater U.S. involvement? Malinowski o The United States should become more involved. Humanitarian aid is not enough; there needs to be a political solution. Humanitarian aid will not convince Syrians that the United States is on their side. o There must be greater consideration of the risks of inaction. o The rapid escalation of the refugee crisis will have serious consequences. A safe area in Syria should be considered as a way to mitigate the regional impact of the displacement of Syrians. 3. Can this conflict be brought to an end by providing opposition forces with arms? Will this require greater military intervention by other countries? Singh o The United States should work toward ending this conflict quickly. o Protraction of this conflict will make reconstruction in Syria more difficult. 4. So the risk is not just more deaths, but also spilling over into the greater Middle East and having a far larger problem than we have now? Singh o Yes. There are concerns about the spillover of violence to other regions, as demonstrated by the missiles being fired into Lebanon. Chairman Robert P. Casey (D-PA) 1. Can either of you comment on the use of sanctions as a tool to create even more pressure on the regime? Singh o There are many sanctions in place against the regime, and they should be strengthened to the extent that they can be. Malinowski o The main supplier of the Assad regime is Iran, which will likely not be receptive to further sanctions. o There is a concern that as long as the means exist for Assad to fight, he will continue to fight.

Note: The House Foreign Affairs Committee had a hearing on Syria on Wednesday of this week, too, but that summary will be included in next weeks Update, along with a summary of the joint subcommittee hearing on Afghanistan and Pakistan. ARTICLES AND REPORTS Due to the length of the Update, weve included no articles this week. For recommended headlines, visit www.twitter.com/interactionorg.

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