[Senate Hearing 115-812] [From the U.S. Government Publishing Office] S. Hrg. 115-812 SIX YEARS OF WAR IN SYRIA: THE HUMAN TOLL ======================================================================= HEARING BEFORE THE COMMITTEE ON FOREIGN RELATIONS UNITED STATES SENATE ONE HUNDRED FIFTEENTH CONGRESS FIRST SESSION __________ MARCH 15, 2017 __________ Printed for the use of the Committee on Foreign Relations [GRAPHIC NOT AVAILABLE IN TIFF FORMAT] Available via the World Wide Web: http://www.govinfo.gov __________ U.S. GOVERNMENT PUBLISHING OFFICE 40-436 PDF WASHINGTON : 2020 -------------------------------------------------------------------------------------- COMMITTEE ON FOREIGN RELATIONS BOB CORKER, Tennessee, Chairman JAMES E. RISCH, Idaho BENJAMIN L. CARDIN, Maryland MARCO RUBIO, Florida ROBERT MENENDEZ, New Jersey RON JOHNSON, Wisconsin JEANNE SHAHEEN, New Hampshire JEFF FLAKE, Arizona CHRISTOPHER A. COONS, Delaware CORY GARDNER, Colorado TOM UDALL, New Mexico TODD YOUNG, Indiana CHRISTOPHER MURPHY, Connecticut JOHN BARRASSO, Wyoming TIM KAINE, Virginia JOHNNY ISAKSON, Georgia EDWARD J. MARKEY, Massachusetts ROB PORTMAN, Ohio JEFF MERKLEY, Oregon RAND PAUL, Kentucky CORY A. BOOKER, New Jersey Todd Womack, Staff Director Jessica Lewis, Democratic Staff Director John Dutton, Chief Clerk (ii) C O N T E N T S ---------- Page Risch, Hon. James E., U.S. Senator From Idaho.................... 1 1Cardin, Hon. Benjamin L., U.S. Senator From Maryland............ 1 Merkley, Hon. Jeff, U.S. Senator From Oregon..................... 4 Farida, Dr., Syrian American Medical Society, Aleppo, Syria...... 5 Prepared statement........................................... 6 Abdulkhalek, Dr., Syrian American Medical Society, Aleppo, Syria. 7 Prepared statement........................................... 9 Rajab, Dr. Mohamed Abu, Syrian American Medical Society, Aleppo, Syria.......................................................... 10 Prepared statement........................................... 11 Keny-Guyer, Neal, Chief Executive Officer, Mercy Corps, Portland, OR............................................................. 12 Prepared statement........................................... 14 Miliband, Rt. Hon. David, President and Chief Executive Officer, International Rescue Committee, New York, NY................... 20 Prepared statement........................................... 22 Additional Material Submitted for the Record The Committee Received No Response From Mr. Neal Keny-Guyer for the Following Questions Submitted by Senator Todd Young........ 48 Responses of The Right Hon. David Miliband to Questions Submitted by Senator Todd Young.......................................... 49 (iii) SIX YEARS OF WAR IN SYRIA: THE HUMAN TOLL ---------- WEDNESDAY, MARCH 15, 2017 U.S. Senate, Committee on Foreign Relations, Washington, DC. The committee met, pursuant to notice, at 11:05 a.m., in room SD-419, Dirksen Senate Office Building, Hon. James E. Risch presiding. Present: Senators Risch [presiding], Rubio, Johnson, Flake, Young, Cardin, Menendez, Coons, Kaine, Markey, and Merkley. OPENING STATEMENT OF HON. JAMES E. RISCH, U.S. SENATOR FROM IDAHO Senator Risch. The meeting will come to order. Good morning, everyone, and thank you for attending. Today marks the sixth anniversary--I use that word guardedly--to the start of the civil war in Syria. We all know that it has caused the largest humanitarian crisis on the planet since World War II. There are many, many issues regarding the conflict, and today we are going to explore some of those. And a few of them that we will talk about are the food shortage in Syria, and the substantial starvation and deprivation that has occurred there, a recent development where Turkey has revoked the permits for certain humanitarian NGOs to distribute food there. Education is a big issue, of course, for everyone in the world. And with 6 years of this war, there is an entire generation that is going to be deprived on the educational front. There are a number of issues regarding that, and we are going to delve into all of those. So with that, I would like to recognize our distinguished ranking member, Senator Cardin, for his comments. STATEMENT OF HON. BENJAMIN L. CARDIN, U.S. SENATOR FROM MARYLAND Senator Cardin. Chairman Risch, first of all, thank you very much for stepping in to chair this hearing. We should point out that Senator Corker has commitments with President Trump today in Tennessee, and that is the reason why he is not able to chair the hearing. I have talked to Senator Corker. I know his personal interests in regards to the humanitarian crisis in Syria. I can assure everyone that this committee will work together to do everything we can to help in regards to the humanitarian crisis that exists in Syria today. As Chairman Risch pointed out, the war has been going on for 6 years, 6 long years. The country and many of its cities have been reduced to rubble. Loved ones have been killed and wounded. Syrians are now destitute, two-thirds in extreme or abject poverty. I heard that it could cost as much as 25 percent of a Syrian family's income to pay for water. Think about that for a moment, spending one-fourth of your income so that you have water for your family. The essential infrastructures have been destroyed in the country. Schools have been destroyed, hospitals, sanitation systems, electrical grids. Five million Syrians have fled their homeland. And it is tragic for all Syrians, but particularly for the innocent children, many of whom have been killed. The mental health of the Syrian children, we just received a report last week from Save the Children, and it is tragic. As that report points out, these children have lost their childhood. They have been absent from school because school does not exist in many parts of Syria today. Their speech has been affected. And they have many issues, including partial amnesia. So this is a tragic situation for all in Syria. The act of war has challenged the humanitarian efforts to get help to the people who have been victimized. We know that. I have grave concern about the Trump policies as to how it is assisting and dealing with the crisis in Syria. And, Mr. Chairman, let me just mention three points that concern me. First, we have heard that President Trump will be submitting a budget that has a 37 percent cut in the State Department's budget. If America is going to be active in dealing with the humanitarian needs, how do we do that with a budget that is already inadequate, cutting it by over one- third? We have also heard reports that the humanitarian budget may be zeroed out in some cases. That is not what America stands for. We, our country, have been the leader globally in pursuing humanitarian needs, recognizing that it is part of what we stand for as a Nation, but it is also in our national security interests to make sure that there is stability in countries. Can we really do that with a budget that cuts development assistance by that size and amount of money? Budgets talk about priorities. Is that what our priority is going to be? Secondly, I have grave concern about Mr. Trump's policies as it relates to Russia in dealing with Syria. Russia has supported and facilitated the atrocities that have taken place in Syria. They have targeted civilians. They have attacked humanitarian convoys. We know about the U.N. convoy that was attacked, killing 14 civilians and wounding and severely injuring another 15 more. Russia has participated in war crimes. They need to be held accountable. I will be reintroducing shortly the Syrian War Crime Accountability Act. I urge my colleagues to help us get that done so we make it clear to all who are participating in atrocities in Syria that they will be held accountable for their activities. Third, let me mention the refugee policy of the Trump administration, the most recent executive order. There have been now over 100 Republican and Democratic national security experts who have sent a letter, saying that the President's executive order is harmful to U.S. national security interests and beneath the dignity of our great Nation. I could not agree more. It is counterproductive. Let me just share with the members of this committee the conversations we had with King Abdullah of Jordan. Jordan has accepted 650,000--650,000--Syrian refugees. King Abdullah has made it clear that that has not presented a security challenge for the country of Jordan. The United States has accepted a few thousand Syrian refugees. There has been no example of any security threat. These individuals are vetted as extremely as we have for anyone coming to America, taking anywhere from 18 to 24 months. I think the members of this committee know that. We talk about that frequently. And, Mr. Chairman, with your permission, I would like to introduce three families who are with us today, because I think it is important to put a face-- these are not numbers. These are people who are escaping terror and persecution that are now making America their home to help build this great country, as many of our parents and grandparents came to this country to build a better life for their children. If I might, let me first introduce Mohammed and his family who arrived in the United States on November 16th of last year. Mohammed was a pastry chef in Damascus prior to fleeing to Jordan. Mohammed and his family remained displaced in Jordan for more than 4 years before resettling by the International Rescue Committee in Maryland. Thank you. Next, let me introduce, if I might, Aouad, who arrived in the United States last June. Aouad was in the farming and wholesale business in Daraa, Syria, before fleeing to Jordan. Aouad was displaced for 3 years before he was referred to the United States for resettlement. The International Rescue Committee also helped resettle Aouad in Maryland. Thank you for being here. I appreciate it. And finally, let me introduce Samir and his wife, who arrived in the U.S. in December. Samir owned a market in Homs, Syria. Samir and his wife fled to Egypt to escape the war where they remained for 5 years before being resettled by the International Rescue Committee in Maryland. Welcome. I am proud that you are here in the United States. I am particularly proud that you are in my State of Maryland. Our State has embraced diversity. Our State, I believe, is stronger because of the diversity that we have. It is very interesting, Mr. Chairman, and I will conclude on these remarks. Thank you all very much. When we look at Maryland counties that surround D.C., we have Prince George's County and Montgomery County, considered to be two of the strongest counties in the United States. Both have embraced diversity for decades, and it is a place in which we welcome immigrants. Mr. Chairman, we need to know Mr. Trump's policies as it relates to Syria and ending the conflict in Syria in the national interests of the United States. We do not have that information today. What we do have is a panel of experts who can help us deal with the humanitarian crisis that exists today and how we can be helpful in dealing with those needs. I welcome our panel. Senator Risch. Thank you, Senator Cardin. And I think all of us are anxious to see a specific policy regarding America moving forward regarding the Syrian situation. And that, I am sure, will be forthcoming. We all have our ideas about it. I think everyone is getting some input into that. Today, though, we are going to be talking about the humanitarian crisis. I suppose there will be some overlap, but today is a focus on the humanitarian crisis. And certainly, over the last 8 years and particularly the last 6 years, our policy in Syria has been drifting, to say the least. And it really needs focus. If we do not focus it, we are going to have the same result that we had over the last 6 years. And it is unacceptable in the world, and it is unacceptable to America. We have five witnesses to testify today. First of all, we have three witnesses who are Syrian doctors who have come here to testify: Dr. Farida, Dr. Abdulkhalek, and Dr. Rajab. Our fourth witness is Mr. Neal Keny-Guyer. Senator Merkley has asked to say a few words about Mr. Keny-Guyer, and I will yield to Senator Merkley. STATEMENT OF HON. JEFF MERKLEY, U.S. SENATOR FROM OREGON Senator Merkley. Thank you very much, Mr. Chairman. I am very pleased to introduce my friend, Neal Keny-Guyer, the CEO of Mercy Corps, a Portland-based humanitarian and development nonprofit. Mercy Corps is a unique organization. It works in over 40 countries, almost all of which are either in conflict, like Syria, or recovering from conflict or natural disaster. Mercy Corps is committed to innovation. Even in complex and fragile states, Mercy Corps works to make markets function better so that poor families can earn a living and lift themselves out of poverty. In places like Ethiopia, Nepal, Uganda, Mercy Corps' commitment to innovation is allowing them to help the poorest of the poor. Their commitment to innovation is impressive, but also their courage, working in some of the most difficult locations to be found on the globe. In considerable danger to their own team, Mercy Corps has assisted millions of Syrians over the course of the war. They are one of the largest U.S. Government partners providing assistance to Syrians affected by the war. And Neal's team continues to do all they can to alleviate the suffering of vulnerable individuals, vulnerable citizens. I look forward to hearing your testimony, Neal. Thank you so much for the work of your organization. Senator Risch. Thank you, Senator Merkley. Our fifth and final witness is the Right Honorable David Miliband, who is president and chief executive officer of International Rescue Committee. So with that, I am going to recognize all five of you to make statements. We are on a short string here, obviously, as we always are in the U.S. Senate. We would ask you to keep your remarks to no more than 5 minutes. However, your full remarks submitted in writing will actually be included in the record of this hearing. So with that, I am going to recognize our three doctors from Syria, and I guess I will let you decide on who is going to go first to present their statement. Doctor. STATEMENT OF DR. FARIDA, SYRIAN AMERICAN MEDICAL SOCIETY, ALEPPO, SYRIA Dr. Farida. Good morning. Chairman Risch, Ranking Member Cardin, distinguished members of the committee, thank you for the opportunity to appear before you today. My name is Dr. Farida. I am an OB/GYN from Aleppo. I am here today not only as a doctor, but as a wife, a mother, and a Syrian. Throughout the past 6 years, I have witnessed unspeakable horrors. I worked in M2 hospital in Aleppo, which was in the opposition-held area of the city. There, together with my fellow health workers, we risked our lives every day to save the lives of the others. We refused to leave until the very last minute. I was one of the many victims of chemical attacks, siege, cluster munitions, bunker-buster bombs, and finally, forced displacement. I left Aleppo on December 12, 2016, along with my husband, Dr. Abdulkhalek, and our 8-year-old daughter. In the months leading up to our displacement, I can only describe the events as hell. In my hospital, M2, my team and I treated many women with severe injuries. One woman came with shrapnel, which penetrated her womb, cutting the 5-month-old fetus into two pieces. It took three doctors at once to stabilize the patient. We saved her life, but her unborn baby lay dead on a nearby table, split in two from the waist down. Many other women died because they could not make it to the hospital due to the lack of ambulances and fuel, or because of the dangerous conditions on the roads. Instead, they bled to death in their homes, along with their newborn children. A hospital was the most dangerous place in Aleppo. My unit in M2 hospital was on the third floor. We were subjected to a daily barrage of rockets, barrel bombs, and cluster munitions. One day, I was performing a cesarean section when a missile struck the fourth floor, causing the ceiling to partially collapse. The surgical staff had to flee the room, but the doctors could not because we were forced to clean the debris out of the patient's abdominal cavity. Thankfully, we were able to save her life. After my hospital, M2, was partially destroyed by airstrikes, we tried to build a new hospital underground, but the siege prevented the materials from entering the city. I then moved to M3 hospital, where I worked until it was targeted by both airstrikes and chemical weapons. Through all of this, I had my daughter at my side. As a mother, how am I supposed to explain all of this to an 8-year- old who has known nothing about violence, killing, and destruction? How am I supposed to protect her? I remember one day back in July when there was a chlorine attack near the hospital. She came running into the operating room, crying, unable to breath. I left the patient, gave my daughter oxygen, and held her close. What else could I have done? This broke my heart. That feeling of powerless to protect my child has broken me to this day. I wish I could say that these atrocities and the plight of so many Syrian families was unique to Aleppo. Sadly, this is not the case. They are happening right now in other parts of Syria. Presently, more than 600,000 Syrians live under siege. This must end. Humanitarian access must be granted to these areas, and the international community must work together to end this practice once and for all. In Idlib, East Ghouta, Daraa, Hama, and Homs, airstrikes have intensified, and the humanitarian aid has been nearly nonexistent. Three hospitals have been targeted by airstrikes in the past 2 weeks, and one of SAMS' nurses was killed by an airstrike last week. It is our duty as human beings to advocate to all involved parties on the ground to allow humanitarian access, and to finally hold those who violate international humanitarian law accountable. Later this month, my family and I will return to Syria to continue our work at a hospital in northern Syria. The reason is simple. It is our duty. As doctors, we have taken an oath to treat any and all patients, regardless of their affiliation. We have a moral obligation to try and save as many lives as possible, even if that means sacrificing our own. The Quran teaches us that ``to save one life is to save all of Humanity.'' Work with us to save lives. If you want to do anything, do it now. There is no time to wait, as Syrians continue to die day after day. Thank you. [The prepared statement of Dr. Farida follows:] Prepared Statement of Dr. Farida Chairman Corker, Ranking Member Cardin, distinguished members of the committee: thank you for the opportunity to appear before you today. I am here today not only as a doctor, but as a wife, a mother, and a Syrian. Throughout the past 6 years, I have witnessed unspeakable horrors. I worked as an obstetrician in M2 hospital in Aleppo, which was in the opposition-held area of the city. There, together with my fellow health workers, I risked my life every day to save the lives of others. I refused to leave until the very last minute. I was one of the many victims of chemical attacks, siege, cluster munitions, bunker buster bombs, and finally, forced displacement. I left Aleppo on December 12, 2016, along with my husband, Dr. Abdulkhalek, and our 8-year old daughter. In the months leading up to our displacement, I can only describe the events as hell. Bodies parts scattered on the streets; blood everywhere; constant bombardment by air attacks; buildings reduced to rubble. In my hospital, M2, my team and I treated many women with severe injuries. One woman came with shrapnel which penetrated her womb, cutting the 5-month-old fetus into two pieces. It took three doctors at once to stabilize the patient. We saved her life, but her unborn baby lay dead on a nearby table, split in two from the waist down. Many other women died because they couldn't make it to the hospital due to the lack of ambulances and fuel, or because of the dangerous conditions on the roads. Instead, they bled to death in their homes, along with their newborn children. The women who were fortunate enough to make it to the hospital often couldn't wait to leave. A hospital was the most dangerous place in Aleppo. My unit in M2 hospital was on the third floor, so we were subjected to a daily barrage of rockets, barrel bombs, and cluster munitions. One day I was performing a cesarean section when a missile struck the fourth floor, causing the ceiling to partially collapse. The surgical staff had to flee the room, but the doctor's couldn't because we were forced to clean debris out of the patient's abdominal cavity. Thankfully we were able to save her life. After my hospital, M2, was partially destroyed by airstrikes, we tried to build a new hospital underground, but the seige prevented the materials from entering the city. I then moved to M3 hospital, where I worked until it was targeted by both airstrikes and chemical weapons. From there I moved to Al Quds hospital, which was the last remaining hospital in the city. Through all of this, I had my daughter at my side. As a mother, how am I supposed to explain all of this to an 8- year-old who has known nothing but violence, killing, and destruction? How am I supposed to protect her? I remember one day back in July when there was a chlorine attack near the hospital. She came running into the operating room, crying and unable to breath. I left the patient, gave her oxygen, and held her close. What else could I have done? This broke my heart. That feeling of powerless to protect my child had shaken me to this day. On December 11, 2016 I was working at M3 hospital when a patient in labor arrived. The few remaining staff were making preparations to deliver her baby when a chlorine bomb hit the hospital. We were unable to deliver the baby there, so I made the decision to travel by ambulance across the city to Al-Quds hospital, the last hospital still in operation. This was the only way to save her life and the life of the baby. I said goodbye to my husband and daughter. When I left, I thought to myself that it would be the last time I would see them. The drive to Al-Quds was extremely dangerous, and the scene we encountered in the streets was pure carnage. Bodies everywhere; burning cars; collapsed buildings. Those images will never escape my head. Thankfully, we made it to the hospital and were able to deliver the baby. But I couldn't leave my family; I needed to go back to them. So the ambulance driver and I embarked on the treacherous drive back to M3, taking heavy fire from helicopters overhead. Thankfully we arrived unharmed. The next day, the doctor was shot while attempting to drive to the hospital to check in on my health. I wish I could say that these atrocities and the plight of so many Syrian families was unique to Aleppo. Sadly, this is not the case. They are happening right now in other parts of Syria. Presently, more than 600,000 Syrians live under siege. This must end. Humanitarian access must be granted to these areas, and the international community must work together to end this practice once and for all. In Idlib, East Ghouta, Daraa, Hama, and Homs, airstrikes have intensified, and humanitarian aid has been nearly nonexistent. Three hospitals have been targeted by airstrikes in the past two weeks, and one of SAMS nurses was killed by an airstrike last week. It is our duty as human beings to advocate to all involved parties on the ground to allow humanitarian access, and to finally hold those who violate international humanitarian law accountable. Later this month, my family and I will return to Syria to continue our work at a hospital in Northern Syria. The reason is simple: it is our duty. As doctors, we have taken an oath to treat any and all patients, regardless of their affiliation. We have a moral obligation to try and save as many lives as possible, even if that means sacrificing our own. The Quran teaches us that: ``to save one life is to save all of humanity.'' Work with us to save lives. If you want to do anything, do it now. There is no time to wait, as Syrians continue to die day after day. Thank you. Senator Risch. Thank you for your testimony. Doctor, you are next. STATEMENT OF DR. ABDULKHALEK, SYRIAN AMERICAN MEDICAL SOCIETY, ALEPPO, SYRIA Dr. Abdulkhalek. Chairman Risch, Ranking Member Cardin, members of the committee, my name is Dr. Abdulkhalek. I am an ophthalmologist from Aleppo and was the director of M3 hospital, one of three hospitals in the Syrian American Medical Society supported and besieged eastern Aleppo. This hospital was built in 2014 and constructed underground to protect the patients and staff from airstrikes. M3 was a small hospital, so we were often overwhelmed by the large number of patients and wounded arriving at our facility. We did our best to save as many lives as we could, but we were forced to make very difficult decisions. With the overwhelming number of wounded civilians and the limited resources that were available to us, we had to face the unimaginable task of deciding who to save and who to leave to die. Can you imagine having to make this decision? Yet, my colleagues all over the city and I faced this every single day. We asked for help from the international community many times. We communicated with U.N. agencies. We risked our safety and that of our families by appearing on international media. We did everything we could, yet help never arrived. The U.N. system is clearly broken, as it has no means to enforce its mandates and hold perpetrators accountable for these crimes. I was one of three doctors from Aleppo assigned to negotiate a plan for medical evacuations with the U.N. and World Health Organization. At first, these negotiations were moving well, with the cooperation of many parties, including Russia. However, as the regime and its allies began to take more territory, the cooperation disappeared and the evacuations never occurred. Instead, the attacks on medical facilities, schools, and markets escalated. Last year, on December 11, as we were trying to save lives and care for victims of barrel-bombing attacks, the hospital was attacked by a chlorine bomb. We immediately ran into the inner room, closed the door, and covered our faces. We then heard a knock on the main door and encountered three men who were suffocating from the gas. We brought them whatever medicine we still had available. Thankfully, we were able to save their lives, but many others who were outside died from the gas. After this attack, many hospital staff had to leave, fearing for their lives. Everyone was afraid that a second bomb would strike again. The previous day, another chlorine attack had hit the hospital. Most of the victims were children, and we only had one unit of oxygen. The medical staff worked tirelessly to try to pass the mask from one child to another, so that they would not suffocate. These chlorine attacks occurred after repeated attempts by the regime and its allies to destroy the hospital using barrel bombs and cluster munitions had failed. Instead, they resorted to chemical attacks to drive us out. I am asking you today to hold the perpetrators of these attacks accountable. It must be made clear that attacks on health care and the use of chemical weapons on civilians and health care workers are unacceptable and that international humanitarian law must be strictly enforced. This cannot be the new norm in Syria. In Homs, the 3-year siege has blocked the delivery of medical supplies, such as blood bags, serum bags, and antibiotics. In the past 6 months, the siege has extended to create a complete lack of movement for all materials and medications. Yet, the world does nothing. In East Ghouta, which is also under siege by the regime, there were more than 30 patients in desperate need of kidney dialysis medication earlier this month, after their medication had run out due to lack of aid deliveries. We pleaded with the U.N. and other international actors to deliver the lifesaving medication, but it was not until after three patients died that the medications were delivered. And even then, it was a SARC convoy, not a U.N. convoy, that entered the area. In 3 weeks, those medications will run out, and the patients' lives will once again be at risk. We need sustained humanitarian access. Constant violations of international humanitarian law, regular use of chemical weapons against civilians, besiegement of civilian areas, manipulation of humanitarian aid, and forced displacement are facts, not claims. I myself witnessed or was a victim of every one of these heinous acts. I am here today to ask the American Government for help. Do not let these acts continue. Do not let more innocent civilians suffer. Do not forget the human toll of this war--the refugees, the education gap, the destruction of the health care system. An entire generation has been lost. The world failed Aleppo. Now is your chance to help protect and save the millions of Syrians still caught in the middle of this conflict. Enforce international law. Hold perpetrators of war crimes accountable. Reform the U.N. aid system. Make the protection of civilians and hospitals a priority. I ask you to be a voice for us. Do not fail us again. Thank you. [The prepared statement of Dr. Abdulkhalek follows:] Prepared Statement of Dr. Abdulkhalek Chairman Corker, Ranking Member Cardin, members of the committee: my name is Dr. Abdulkhalek. I'm an ophthamologist from Aleppo, and was the director of M3 hospital, one of three hospitals the Syrian American Medical Society supported in besieged eastern Aleppo. This hospital was built in 2014, and constructed underground to protect the patients and staff from airstrikes. M3 was a small hospital, so we were often overwhelmed by the large number of patients and wounded arriving at our facility. We did our best to save as many lives as we could, but we were forced to make very difficult decisions. With the overwhelming number of wounded civilians and the limited resources that were available to us, we had to face the unimaginable task of deciding who to save, and who to leave to die. Can you imagine having to make this decision? Yet my colleagues all over the city and I faced this every single day. We asked for help from the international community many times. We communicated with U.N. agencies; we risked our safety and that of our families by appearing on international media. We did everything we could, yet help never arrived. The U.N. system is clearly broken, as it has no means to enforce its mandates and hold perpetrators accountable for these crimes. I was one of three doctors from Aleppo assigned to negotiate a plan for medical evacuations with the U.N. and World Health Organization. At first, these negotiations were moving well, with the cooperation of many parties, including Russia. However, as the regime and its allies began to take more territory, the cooperation disappeared and the evacuations never occurred. Instead, the attacks on medical facilities, schools, and markets escalated. With the destruction of the largest trauma hospital, known as M10, in the eastern part of Aleppo by early December, our small M3 hospital became one of two functioning hospitals in the city, providing care to more than 200,000 civilians, including 85,000 children. Equipped with only one OR we had to expand to three ORs, but that was not enough. We had to use the floor of our operating rooms to accommodate two surgeries in each of them at the same time. Doctors were performing major surgeries on the floor, sometimes without anesthesia. Last year, on December 11, as we were trying to save lives and care for victims of barrel bombing attacks, the hospital was attacked by a chlorine bomb. We immediately ran into the inner room, closed the door, and covered our faces. We then heard a knock on the main door, and encountered three men who were suffocating from the gas. We brought them whatever medicine we still had available. Thankfully, we were able to save their lives, but many others who were outside died from the gas. After this attack, many hospital staff had to leave, fearing for their lives. Everyone was afraid that a second bomb would strike again. The next day, another chlorine attack on the hospital. Most of the victims were children, and we only had one unit of oxygen. The medical staff worked tirelessly to try and pass the mask from one child to another, so that they wouldn't suffocate. These chlorine attacks occurred after repeated attempts by the regime and its allies to destroy the hospital using barrel bombs and cluster munitions had failed. Instead, they resorted to chemical attacks to drive us out. I am asking you today to hold the perpetrators of these attacks accountable. Whether it be ISIS, the Syrian government, or any other actors, it must be made clear that attacks on healthcare and the use of chemical weapons on civilians and healthcare workers are unacceptable, and that international humanitarian law must be strictly enforced. This can't be the new norm in Syria. I am also asking the U.S. government to use its influence to help improve the U.N. aid delivery system. Currently, the aid is not reaching the people most in need, particularly in non-government areas. Instead, the aid system is being used to enrich government officials, as well as to punish civilians in non-government areas by denying them delivery of aid or removing essential items such as medications or baby formula. In Aleppo, aid for the city was disproportionately given to the western portion of the city. It even got to the point where residents of western Aleppo would sell their excess rations to residents of eastern Aleppo, for extremely high prices. This is unacceptable. The U.N. aid delivery system must be fair and equal, and meet the needs of all the beneficiaries. In Homs, the 3-year siege has blocked the delivery of medical supplies, such as blood bags, serum bags, and antibiotics. In the past 6 months, the siege has extended to create a complete lack of movement for all materials and medications. The situation today is dire, as people now lack basic food elements, including bread and meat. There are many reported cases of malnutrition, particularly among children. Yet the world does nothing. In East Ghouta, which is also under siege by the regime, there were more than 30 patients in desperate need of kidney dialysis medication earlier this month, after their medication had run out due to lack of aid deliveries. We pleaded with the U.N. and other international actors to deliver the life-saving medication, but it wasn't until after three patients died that the medications were delivered. And even then, it was a SARC convoy, not a U.N. convoy, that entered the area. Constant violations of international humanitarian law, regular use of chemical weapons against civilians, besiegement of civilian areas, manipulation of humanitarian aid, and forced displacement are facts, not claims. I myself witnessed or was a victim of every one of these heinous acts. I am here today to ask the American government for help. Do not let these acts continue. Do not let more innocent civilians suffer. Do not forget the human toll of this war--the refugees, the education gap, the destruction of the health care system. An entire generation has been lost. The world failed Aleppo. Now is your chance to help protect and save the millions of Syrians still caught in the middle of this conflict. Enforce international law; hold perpetrators of war crimes accountable; reform the U.N. aid system; make the protection of civilians and hospitals a priority. I ask you to be a voice for us. Don't fail us again. Senator Risch. Thank you, Doctor. Dr. Rajab. STATEMENT OF DR. MOHAMED ABU RAJAB, SYRIAN AMERICAN MEDICAL SOCIETY, ALEPPO, SYRIA Dr. Rajab. Good morning. My name is Mohamed Abu Rajab. I was the director of M10 hospital in Aleppo, the largest trauma hospital in the eastern part of the city. The hospital was established by the Syrian American Medical Society, SAMS, in February of 2013. Because of the many attacks on the hospital, SAMS moved it underground, to protect its patients and medical workers. From the opening of the hospital in 2013 until it was bombed out of service on October 14, 2016, M10 was hit by airstrikes 22 times. In October 2016, the hospital was targeted four times in 1 week, removing it from service. I myself was injured by shrapnel in one of the attacks. Some of the shrapnel remains in my body to this day. Do you remember the young boy Omran whose photo became a symbol of the children of Aleppo? We treated him at M10. Thankfully, he survived his injuries. Sadly, his brother, Ali who was 11, died from his injuries. Most of our patients at M10 were children. So much death and suffering. And for what? The people of Syria simply want to be free. The use of bunker-buster bombs changed everything. It was not until the entrance of Russia into the conflict that we started to see these advanced weapons: bunker-buster bombs, parachute bombs, and more. We moved from one hospital to another, as each was targeted and taken out of service. We were convinced that we were going to die. When the final evacuations began, we were scared of what would happen to us. The Iranian militias were looting houses and killing anyone who resisted. We went to a checkpoint and boarded the infamous green buses. We ultimately made our way north to Idlib. We would have been arrested if we had entered a government-controlled area. This kind of forced displacement cannot be allowed to continue. I love Aleppo. I love Syria. It is my home. It is a part of me. I dream of one day returning to my home with my family and living in peace. I call on you to protect hospitals and health workers. This is a simple request. In addition, we must allow civilians to remain in their homes and not be forced to evacuate. When you live in freedom, you must help others to be free. The United States Government must be a voice for the innocent people of Syria and must be a moral compass for the parties involved. Thank you, sir. [The prepared statement of Dr. Rajab follows:] Prepared Statement of Dr. Mohamed Abu Rajab Good morning. My name is Mohamed Abu Rajab. I was the director of M10 hospital in Aleppo, the largest trauma hospital in the eastern part of the city. The hospital was established by the Syrian American Medical Society, SAMS, in February of 2013. It had four operating rooms, which made it the largest surgical center in eastern Aleppo. Because of the many attacks on the the hospital, SAMS moved it to an underground, fortified structure to protect its patients and medical workers in 2014. In March of 2015 we added a CAT scanner, the only one in eastern Aleppo. From the opening of the hospital in 2013 until it was bombed out of service on October 14, 2016, M10 was hit by airstrikes 22 times. In October 2016, the hospital was targeted five times in one week, removing it from service. I myself was injured by shrapnel in one of the attacks. Some of the shrapnel remains in my body to this day. Yet I was one of the lucky ones- I survived; many others did not. Do you remember the young boy, Omran, whose photo became a symbol of the plight of the children of Aleppo? We treated him at M10. Thankfully, he survived his injuries. Sadly, his brother, Ali who was 11, died from his injuries a week later. Most of our patients at M10 were children. So much death and suffering- and for what? The people of Syria simply want to live in peace and to be free. We built the hospital underground in order to protect the doctors and patients from the airstrikes. However, the use of bunker busters made this ineffective. It wasn't until the entrance of Russia into the conflict that we started to see these advanced weapons: bunker buster bombs, parachute bombs, and more. We moved from one hospital to another, as each was targeted and taken out of service. We struggled to eat, to sleep, and to protect our families. We were convinced that we were going to die. We lost many of our friends, colleagues, and family members. When the final evacuations began, we were scared of what would happen to us. The Iranian militias were looting houses and killing anyone who resisted. We went to a checkpoint and boarded the infamous green buses. Many people were locked in the buses for up to 20 hours without food, water, or bathrooms. Some of the militias forced people to remove all their clothes and wait in the buses in nothing more than their underwear. We ultimately made our way north to Idlib. We would have been arrested if we had entered a government-controlled area. This kind of forced displacement cannot be allowed to continue. I love Aleppo. It is my home. It is a part of me. I dream of one day returning to my home with my family and living in peace. But I need your help. I call on you to protect hospitals and health workers. This is a simple request. In addition, we must allow civilians to remain in their homes, and not be forced to evacuate. When you live in freedom, you must help others to be free. Who among us does not like peace? The United States government must be a voice for the innocent people of Syria, and must be a moral compass for the parties involved. Thank you. Senator Risch. Thank you very much, Doctor. We will now move to Mr. Keny-Guyer. STATEMENT OF NEAL KENY-GUYER, CHIEF EXECUTIVE OFFICER, MERCY CORPS, PORTLAND, OREGON Mr. Keny-Guyer. Chairman Risch, Ranking Member Cardin, Senators, I almost feel like I should just stop right now after this human face and the courage of our Syrian friends. And I just want to thank Drs. Farida, Abdulkhalek, and Rajab for their courageous work in upholding humanity. You touch us all. Thank you. I also want to say what a privilege it is to be with my friend David Miliband and his great organization, IRC. We work closely together, and proudly, around the world. And also, I have to thank my friend Jeff Merkley for, first of all, his incredible friendship and for his incredible support to Mercy Corps, to our State, and to our country. And finally, to Tim Kaine for all he has done on behalf of Mercy Corps, and, of course, for his friendship as well. While the politics on the ground in Syria have changed, the one thing that remains constant is the suffering of the Syrian people. And at this point, I really want to thank the U.S. Government, USAID, the State Department, for years of leadership in supporting the Syrian people. I think we need to recognize this. The U.S. has been the largest donor, the largest supporter, a leader in upholding whatever aid there can be for Syria over these years. Now, if I may, and Chairman Risch referred to it, Senator Cardin referred to it, I want to begin with Mercy Corps' situation in Turkey where recent events have diminished our ability to alleviate the suffering inside Syria. We have conducted one of the largest humanitarian operations from Turkey to Syria with the permission and full cooperation of the Turkish Government over the past 5 years. As you all may know, just a few weeks ago, the Turkish Government revoked Mercy Corps' registration to operate in Turkey or to deliver cross-border assistance. That has disrupted lifesaving assistance for 360,000 Syrians that we reach every month inside, and has effectively ended support to 100,000 people in Turkey, Syrian and Turkish citizens. To date, our situation remains unresolved. We continue to seek a dialogue with Turkish officials so that we may resume our operations as soon as possible. We stand ready to correct any technical mistakes we might have made. Meanwhile, we have had no choice but to shut down our presence in Turkey while working closely with our partners and donors, including USAID and the State Department, to quickly fill any gaps in our assistance. Now we all know Turkey has been a generous global leader in humanitarian action. It welcomed more than 3 million Syrian refugees and boosts one of the world's most important policies on refugees: allowing them to earn a living for their families and offering them a path to citizenship. Like the United States, Turkey is a signatory to international humanitarian laws requiring protection of innocent civilians caught in the conflict. As an independent and impartial humanitarian organization, Mercy Corps' mandate is to deliver essential aid to civilians in need on all sides of the conflict. And I can tell you that we are very proud of our principled humanitarian efforts in Syria and around the world today. Of course, we all know the only solution to the suffering of Syrians is a political resolution. Humanitarian aid saves lives and it sustains hope. Only peace saves societies and nations. Strong, smart U.S. engagement remains a critical component. Distinguished Senators, I know this issue is tough, but please remain resolute in your push for a durable peace in Syria. Meanwhile, the scale of suffering is staggering. The dark statistics defy description. Imagine the combined populations of Oregon and Tennessee in need of humanitarian assistance, and that is Syria today. At a recent Helsinki conference on supporting Syrians, Humam, a young Syrian who works for Mercy Corps, told the assembly, he said, ``I'm waiting for the war to stop so I can go back and rebuild Syria. I believe that we can rebuild Syria better than before. I feel I have a lot of power, and I can bring my skills. I can now speak out and lead. I want the same for other youth as well.'' And friends, let us remember Humam. Let us remember the human face of the people involved. And let us never lose hope, regardless of how complex or how dark sometimes the days seem. Thank you very much. [The prepared statement of Mr. Keny-Guyer follows:] Prepared Statement of Neal Keny-Guyer Chairman Corker, Ranking Member Cardin: Thank you for inviting me to testify before the U.S. Senate Foreign Relations Committee today about ``Six Years of War in Syria: The Human Cost.'' I am here in my capacity as Chief Executive Officer of the global organization Mercy Corps. In more than 40 countries around the world, we meet the urgent needs of today through emergency humanitarian assistance and disaster risk reduction, and help build stronger tomorrows by connecting people to the resources they need to strengthen their communities from within. Last year alone, we reached about 30 million people around the world. Mercy Corps' global headquarters are in Portland, Oregon, and I would like to thank Senator Merkley for his outstanding and devoted support of our agency and our mission. Mercy Corps has been working in the Middle East and North Africa for more than three decades. For almost the entire duration of the conflict in Syria, we have conducted one of the largest humanitarian operations to help innocent Syrians trapped in the crossfire. We have worked through Syrian employees and partner organizations who have risked everything, even their own lives, to bring relief to civilians in their war-torn country. I talk to our teams there daily and visit the region often. We stand alongside the people inside Syria and support Syrians who are trying to rebuild their lives in Lebanon, Jordan, Turkey and Greece, in addition to the communities hosting them. While the situation on the ground has changed over the last year, the unacceptable levels of suffering of the Syrian people have remained constant. I would like to express my great appreciation and sincere respect for Drs. Farida, Abdulkhalek, Rajab, and their colleagues, as well as the White Helmets, all of whom have risked their lives and sacrificed greatly for the Syrian people. On behalf of my team and the hundreds of thousands of Syrians we've served over the last 5 years, I would like to express our deep appreciation for your attention to the intense suffering and human toll of this horrific war. Through the generous support of Congress, through robust funding of the International Affairs budget, the United States is helping save the lives of millions of the world's most vulnerable people. Your continued attention is also essential to keeping this war in the headlines in this country, and making sure that finding a political solution to resolving this conflict is the top priority of American diplomats. report on mercy corps' turkey operations I would like to begin by updating you on Mercy Corps' situation in Turkey, from where we have delivered lifesaving aid to Syrians, with the permission and cooperation of the Turkish government, for the past 5 years. As you may be aware, just a few weeks ago, the Turkish government suddenly revoked Mercy Corps' registration allowing us to operate in Turkey. This action disrupts lifesaving assistance to 360,000 Syrians every month inside Syria and effectively ends our support to 100,000 Syrian refugees and Turkish children, women and men in Turkey. To date, our situation is not resolved, and we continue to seek a dialogue with Turkish officials so that we may resume our operations as soon as possible. In the meantime, we are shutting down our presence in Turkey while working closely with our partners and donors, including USAID's Office of Foreign Disaster Assistance and the State Department's Bureau for Population, Refugee and Migration- both of which have been extremely helpful-, to quickly fill any gaps in our assistance to Syrians in Syria and to identify solutions for refugee services in Turkey. As you can imagine, this is a tough time for our team. I just received a note from one of our team members who has worked on the border for 4 years helping deliver almost 1 million food kits in Syria. He said: ``We are sure that these problems will end soon just we ask you not to give up, please don't say we have done our best and it didn't work. We are sure that you will get that registration. We are proud of this work, we are proud of Mercy Corps, we have not done anything wrong, and this is why we all have a clear conscious [sic].'' principled humanitarianism in peril The revocation of our Turkish registration is a deeply disturbing turn of events. Turkey has been a generous global leader in humanitarian action. A country of almost 80 million people, it has welcomed more than 3 million Syrian refugees and boasts one of the world's most progressive policies on refugees, allowing them to earn a living for their families and offering them a clear path to citizenship. Like the United States, Turkey is a signatory to international humanitarian laws and the U.N. refugee convention, requiring it to protect civilians caught in or fleeing conflict. It is an important ally of the United States and NATO and an essential partner in the fight against ISIS. We have not been given any official justification by Turkey for the closure of our program. And we are worried by the many news reports that other international aid groups may also soon be ordered to cease working in Turkey. It is important you know that as an independent and impartial humanitarian organization, Mercy Corps' mandate is to deliver essential aid to civilians in need in Syria on all sides of the conflict. If we were to appear to take sides, our credibility and our ability to reach the people in greatest need, as well as the safety of our staff, would be in grave jeopardy. We have lost count of the occasions when our staff had to cross as many as a dozen armed checkpoints and multiple lines of control when driving just 20 miles to deliver food. We were only able to do this because we had proven to all parties to the conflict that our assistance was going to vulnerable families--widows, children, elderly citizens and others enduring the direst of circumstances. Our situation raises the very real specter that principled humanitarianism is imperiled. I fear that it might no longer be just irregular militias or non-state actors blocking urgent assistance, but also members of the community of nations, even those most concerned about the well-being of the Syrian people. In 2014, despite U.N. Security Council resolutions requiring access to humanitarian aid be granted for all Syrians, we were forced out of working in Damascus because we stuck by our humanitarian principals and refused to stop providing humanitarian assistance to civilians in opposition controlled areas. The reality is Syria is a cauldron of the world's conflicting political and military agendas, and humanitarian aid, with its fundamental principles of impartiality and independence, risks becoming another casualty of this horrifying war. Syria would not be the first time principled humanitarian aid has been threatened. For two decades, we have witnessed an alarming trend in which humanitarian assistance falls victim to political and military calculations. But the degradation of the safeguards has accelerated, and Syria has become a laboratory for how that infringement of this space can lead to devastating consequences for innocent men, women and children. These grave challenges are not in the power of humanitarians like Mercy Corps to solve. They are political, and only member states of the United Nations can resolve them. We ask you, distinguished Senators, and the United States government to resolutely push for a lasting peace in Syria. After 6 years and hundreds of thousands lives lost and millions more ruined, finding a way out of this conflict must be a top priority for politicians and diplomats. Until then, we also urge you to continue America's strong financial support of the lifesaving assistance to the Syrian people and to exercise your political power to ensure that aid is provided to all innocent civilians in need, no matter who they are or where they have found safety. a great human catastrophe The scale of the human toll of the war in Syria defies description--the dark statistics are staggering. More than 400,000 people have been killed; 13.5 million are in desperate need of food, clean water and other humanitarian assistance--half of these are children. According to the United Nations, an estimated 6.3 million Syrians have fled their homes and are trying to survive inside Syria. Every day, another 6,000 or more people are displaced and 5 million people have fled to safety in neighboring countries. Mercy Corps continues to deliver lifesaving food, clean water and other essential supplies to about 470,000 innocent Syrian civilians each month. Our team members do this at great personal risk and with unwavering courage--we have lost five team members to this conflict and family members too. Just last week a Mercy Corps driver lost a son and a nephew to an airstrike. In December, as the Syrian government and Russian forces pounded the city of Aleppo, we received scant reports from our remaining 19 team members in the city, who were delivering the last of our food stocks at night during the short lulls in the bombing. They were too afraid to turn on their lights, and made deliveries door-to-door carrying boxes of food in wheelbarrows. Everyone eventually made it out of the city--six of our team members were on the very the last green evacuation buses. We are so thankful they are now safe. The toll on our team has been great and we thank the many great heroes of this conflict, like the doctors sitting next to me, for their unwavering devotion and courage under these extremely dangerous conditions. Although the shape of the conflict has changed significantly over the past year, Syrians are still suffering enormously and in ways we cannot begin to express. Civilian protection remains the number one challenge with people caught up in the fighting, facing death every day. There have been few tangible advances by the international community to end the misery and deliver a sustainable and inclusive peace that reflects the needs and desires of the Syrian people. These headline descriptions of the human cost of the war are, I'm sure, familiar to everyone here. I find that the scale of the crisis is so massive that it is too much to take in. So I will break it down into four areas of focus: hotspots where the humanitarian crisis is most acute; access to food, clean water and sanitation; the impact of the war on adolescents and youth; and the effect on livelihoods. hotspots and critical issues In central Syria, the government of Syria is using similar tactics in Eastern Ghouta as it did in Aleppo. Eastern Ghouta is facing a tightening siege designed to force the armed opposition groups and the 350,000 plus civilians to surrender and accept some sort of `reconciliation' agreement \1\. In the lead up to such an agreement, already limited humanitarian access will be further restricted, and fighting is expected to displace a large number of people. We expect people to be in desperate need of shelter, water and sanitation, in addition to food and medical supplies. --------------------------------------------------------------------------- \1\ In this context, ``reconciliation'' is the process by which the government of Syria reasserts its control over an area by negotiating an agreement that centralizes local political groups, civil society and humanitarian bodies under its authority, and forcibly evacuates individuals and armed opposition fighters who are not willing to engage with this process. --------------------------------------------------------------------------- In Idleb governorate, many of the people evacuated from communities that have previously ``reconciled'' with the government are now caught in the middle of armed opposition groups vying for control of this area. No-one knows exactly what will happen in Idleb, but the fighting will inevitably catalyze more displacement of people and affect access for both commercial and humanitarian supplies, with severe implications for the well-being of the innocent people trapped there. In Raqqa, various military forces are launching an offensive with the aim of pushing ISIS out of the city and surrounding areas. Current humanitarian projections expect more than 432,000 people to be in need of humanitarian assistance in Raqqa governorate, with upwards of 300,000 people potentially being displaced by the fighting. In southern Syria, the government of Syria and opposition forces are fighting over control of the JordanSyria border crossing. Simultaneously, airstrikes are targeting ISIS and ISIS affiliates. Both of these developments are forcing large numbers of people to flee their homes. They urgently need shelter, food, and other basic supplies, in addition to small amounts of cash assistance so that they can buy what they need from local markets. In short, countless innocent children, women and men across Syria continue to bear the brunt of the war. For years now we, as humanitarians, have delivered these same reports:Indiscriminate attacks are killing civilians and damaging civilian infrastructure such as hospitals and schools. All parties to the conflict are using humanitarian assistance as a pawn, by withholding permission to reach communities under siege and leveraging humanitarian access as a bargaining chip at the negotiating table. Humanitarian access is denied or heavily obstructed even though unfettered access is required under international law. Syrian humanitarian workers, who account for almost the entirety of the humanitarian response inside Syria, are targeted and criminalized for trying to help their communities survive. I wish to be clear: These actions are illegal. They violate the laws of armed conflict and international humanitarian law. This flagrant violation of international law by warring parties in Syria sets the world back by decades, and undermines the moral authority of the international community. We need the international community, including strong U.S. leadership, to exert all possible leverage to ensure that civilians are protected, that humanitarian assistance is allowed without any precondition or obstruction, and that humanitarians are allowed to continue to work legally in support of their communities, with their safety guaranteed. food, water and sanitation: the basics of life War tears down humanity in many different ways. As I share examples, I wish to highlight how Syrians are trying to maintain their humanity and dignity. Food insecurity and the risk of hunger is one of the most serious issues in Syria, with an estimated 7 million people currently food insecure and a further 2 million at risk of food insecurity. A note of hope from our food security experts is that despite the real threat of food insecurity and hunger, levels of malnutrition where food aid has reached people are relatively low in comparison to malnutrition in other conflict zones. This shows that the food assistance provided by the United States and other nations--through partners like Mercy Corps--is working. With no end to the conflict in sight, inaccessibility, besiegement and displacement will continue to cause food insecurity on a massive scale. In response to these needs, since 2012 Mercy Corps has partnered with USAID's Office of Foreign Disaster Assistance and Food for Peace-- funded by the International Affairs budget and specifically the International Disaster Assistance and Food for Peace Accounts. Thanks to authorities and funding Congress has provided--and which Chairman Corker has championed--Mercy Corps has been able to locally procure large quantities of wheat in Turkey to deliver into Syria. Among many interventions, since 2013, Mercy Corps has provided flour to bakeries in order to ensure affordable bread prices for families, keep bakers in business and support a functioning local economy. At one point we were providing 19 bakeries with 50 percent of their monthly flour needs, targeting communities in greatest need. Bread is a staple of the Syrian diet, and one bakery alone--which serves 40-some villages--requires some 14 metric tons of flour per day to keep pace with the needs of their residents. Thanks to our deliveries of flour, the price of bread was kept to 65 Syrian pounds, whereas in other areas the price was more than twice as high, closer to 150 Syrian pounds. Separately, it is worth noting that by purchasing food in the region, American taxpayers achieved more impact for their dollar, and supplies were delivered quickly and at a lower cost, while stimulating local markets. Another basic need of human life is clean water, sanitation and hygiene. Because of disrepair and destruction, water and sewage systems are only functioning at a fraction of their previous capacity, and shortages of electricity limit their operation in many places. As a result, nearly 15 million people in Syria urgently need access to water, sanitation and hygiene services. One of the people we helped through our water and sanitation programming is Mahmoud, a father of five. The family lives in a small camp just outside of Aleppo, where they found relative safety after fleeing attacks by Syrian government forces and ISIS. When they arrived, they found that water was more expensive than they could afford. It had to be trucked in from distant areas and was inconsistent in quality. There were few latrines or washing facilities in the camp, which led to the spread of disease, the inability to wash clothing or cooking utensils, or to practice personal hygiene. As we all would be as parents, Mahmoud was desperately concerned for the safety and health of his children, and he could not afford the water they needed to stay healthy. In response to the needs of people like Mahmoud and his children, Mercy Corps quickly provided toilets and showers, as well as clean water to cover the needs of the camp. After our intervention, Mahmoud said he and his family are less worried about the spread of disease since they now have access to sanitation and hygiene facilities. Mercy Corps continues to work hard to help families like Mahmoud's to strengthen access to clean water and sanitation services. Although Mahmoud's family and others like them continue to face enormous challenges, interventions like ours show it is possible to make their lives a little better and a little safer. a generation we can't afford to lose An entire generation of Syrian children, teenagers and young people are growing up in a war zone. Nearly half the 4.8 million Syrian refugees in the region are children, and more than 8.5 million children and young people in Syria need immediate humanitarian support. Nearly one in four of these young people is a teenager. The impact of the war on them is horrific: a recent report found that 652 children were killed last year, 255 in or near a school. Children's deaths rose 20 percent and injuries rose by 25 percent in 2016. Instead of worrying about their schoolwork, they are terrified they or their families might be killed, and worry about whether they will have food to eat and clean water to drink. They are frustrated and isolated--young women in particular rarely leave their homes. Young men and women both experience a sense of powerlessness and constant humiliation. We fear two related consequences of this situation: a lost generation of youth and social instability. Widespread deprivation and prolonged stress among Syrian youth seriously affects their well-being. Young people are suffering from mental health issues and are more likely to take part in high-risk behavior. Isolation and hopelessness, combined with experiences of violence and injustice, are also pervasive among Syrian adolescents. These make a dangerous recipe for producing violent attitudes and actions. Without positive social connections and prospects for their future, young people affected by conflict and displacement may become a destabilizing force in their communities and in the region. But it is possible to address these issues. In collaboration with UNICEF's No Lost Generation initiative launched in 2013, Mercy Corps has been working hard to empower and address the needs of adolescents impacted by the crisis in Syria. Through years of hands-on experience, we know that the key to supporting this generation is to promote learning and psychosocial resilience, build social understanding and peace and help youth set their own goals for the future. We also know that if you fail to address the effects that years of trauma have had on young people's mental health, other efforts, such as education and vocational training, will not be as effective. Mercy Corps has developed a model for helping young people's psychosocial needs, but these interventions need support. I urge the Committee to increase funding for programming that meets psychosocial and mental health needs of adolescents, including through fully funding humanitarian accounts and Economic Support Funds in the FY 2018 budget process. At the Helsinki Conference in January, Humam, a young Syrian and one of our Mercy Corps team members, told the assembly: ``For me, I'm waiting for the war to stop so I can go back and rebuild Syria. I believe that we can rebuild Syria better than before. I have a lot of power that I bring from my skills. I can now speak out and lead. I want the same for other youth too.'' As Humam expressed, the young Syrians of today will build the Syria of tomorrow. They are at a crossroads in their lives--because of their age and because of the hardship they face every day. Although they are living in the darkest of hours, Mercy Corps sees immense possibility in Syrian youth. We see changemakers full of incredible strength and resilience, and capable of creating peace. They will decide today the fate of our world tomorrow, and have the ability to drive lasting change. helping syrians regain control of their lives A bright spot amid this misery is our success helping Syrians regain a measure of control over their own lives, which they tell us is their deepest desire. It is imperative that we do much better at learning from Syrians who have found positive ways to cope with this disaster and to support themselves. Right now, Mercy Corps is conducting a study to identify positive strategies that Syrians are using, so that we can support their adoption across the country. Already we are using our deep understanding of the local context and the needs of the people we serve to undertake longer-term, sustainable programming. And we have been able to do this even in the midst of siege by working with small-business owners to build ``siege- resistant businesses.'' Abdulaziz, a blacksmith, was forced out of business by a siege on his community; he couldn't continue because of shortages in the electricity and fuel he relied on, as well as increases in the price of the raw materials he needed. Thanks to a grant from one of Mercy Corps' partners, Abdulaziz has been able to open a new grocery store, which he hopes will be less vulnerable to the impacts of siege than the blacksmith business; there is a greater demand for groceries, and the business itself is less reliant on electricity and fuel. Across Syria, there are similar opportunities for longer-term programming. Our experience shows us that it is critical to take a holistic, multi-faceted approach to livelihoods and economic opportunities. We have to work across the individual, business and market levels. Vocational training alone is not enough. For example, providing agricultural supplies to farmers as well as small loans to start new businesses and get businesses back into operation will support market development and provide individuals the means to support themselves and their families. recommendations for congress Although the situation is bleak, there are a number of concrete steps that Congress can take now to help the people of Syria. I would like to leave the Committee with the following five key recommendations that we hope will lessen their suffering: 1. Access. We ask that you continue to raise the primacy of humanitarian access with all actors inside and around Syria. 2. Funding. Provide adequate funding for the U.S. government to lead globally and reject any cuts in the President's FY 2018 International Affairs request. Diplomacy, development and lifesaving humanitarian aid supported through the foreign aid budget are critical to help not only the people of Syria, but also communities around the world that are suffering severely. We ask that you fight in FY 2018 for no less than $60 billion for the International Affairs budget, which would still be only 1 percent of the federal budget. With growing needs, it is more important than ever to shore up funding for the various humanitarian and development accounts in the FY18 budget. We ask that you fight for funding in the FY 2018 appropriations bills for: International Disaster Assistance (IDA), and Food for Peace (FFP) and the Migration and Refugee Account, which are critical to providing lifesaving aid; and Economic Support Funds, which provide development assistance to fragile states and, in the case of Syria, can lay the groundwork for community-level reconciliation and livelihoods. 3. Continue to provide and expand authorities to allow for the appropriate response, including local and regional procurement, cash and vouchers. We would appreciate continued support for letting our field team members, in partnership with USAID, utilize the most effective response possible to incredibly complex crises. We appreciate that the Chair has been a champion of using the most effective interventions possible in foreign aid, which in many cases are through local and regional procurement of commodities or providing cash or vouchers to vulnerable families. The use of vouchers and cash for internally displaced people and Syrian refugees has not only empowered families with the dignity to buy what they most need, but also helps to keep markets functioning, allowing for some degree of normalcy in a completely abnormal environment. 4. Increase support for adolescents. Increase funding for psychosocial, livelihoods and education for adolescents and others to help them recover from years of trauma and harness their energy for building a bright future. 5. Diplomacy. Humanitarians are not the solution to the Syrian crisis. I urge you to work with the Trump administration to urgently seek a political solution to the war in Syria in line with the Geneva Communique and UN Security Council Resolution 2254. Our world leaders must take decisive action and push for a lasting peace. The Syrian people have paid too high of a price for six long years. The human misery must end. our call to action Less than a year ago, I stood with the global humanitarian community in Istanbul at the United Nations' first-ever World Humanitarian Summit. There in Turkey, world leaders from government, civil society and business stood up for our common humanity and action to prevent and reduce human suffering. Then, as now, the government and people of Turkey demonstrated their hospitality, and their indispensable role at the forefront of humanitarian action. At this historic summit, President Erdo?an stated in his closing remarks, ``As the participants of this summit, we all know very well that pain knows no color, ethnicity, language or religion.'' We could not agree more and want to continue to support Turkey in what Mr. Erdo?an rightfully called its ``vital role in the name of humanity.'' Mr. Chairman, Distinguished Members of the Committee, we hope that the spirit of that summit will endure and its promises will be realized. We thank this Committee, the United States government and, most of all, the American people for your lifesaving support for the people of Syria. We know that principled humanitarianism is directly connected to our deeply held American values about what is right and good in the world. Know that Mercy Corps stands firmly committed to alleviating the long, intense suffering of the millions of Syrians trapped in this great human catastrophe. Thank you. Senator Risch. Thank you. And finally, the Right Honourable David Miliband. STATEMENT OF THE RT. HON. DAVID MILIBAND, PRESIDENT AND CHIEF EXECUTIVE OFFICER, INTERNATIONAL RESCUE COMMITTEE, NEW YORK, NY Mr. Miliband. Chairman Risch and Senators, it is a real honor to be back in front of this committee, sitting alongside some extraordinary humanitarian leaders. I want to echo what Neal has said about the really humbling work that is done by the Syrian doctors. We are proud to work alongside of them inside Syria. I also echo the mutual admiration society that we are creating for each other. Mercy Corps is an organization that we are proud to stand alongside and to admire. I will not take long for this opening statement. You have the 10-page version, I think, in your papers, and I know that there will be many questions. I also need to apologize that, given the slightly later start time, I am going to have to leave at about 1 o'clock, and I do apologize for that. The International Rescue Committee is a refugee resettlement agency in 29 U.S. cities, and we are an international humanitarian aid agency. We have over 1,000 staff operating inside Syria today, and 2,000 staff in the four neighboring states. In the south of Syria, we are proud to be the largest supplier of health care, but our efforts are currently impeded by a recent uptick in fighting between Syrian forces and opposition groups; by airstrikes on medical facilities--we lost eight of our hospitals in 2016 to airstrikes; and by a local ISIS affiliate capitalizing on the chaos in the south. In the northeast, I was in Iraq seeing some of the cross- border work last week. In the northeast of Syria, we support Iraqis fleeing violence from Mosul entering Syria as refugees, and Syrians displaced by counter-ISIS operations. The U.N. estimates that 400,000 more people could be affected as Raqqa operations intensify in the next few months. In Idlib Province in the northwest of the country of Syria, IRC provides emergency assistance and safe classrooms to locals and those forced from eastern Aleppo. I have to report to you that increased infighting among opposition groups, and air attacks from the regime and their Russian supporters, are threatening civilians and our ability to serve them. I will not repeat all the statistics that you have heard or that you know. I do want to point to one statistic that still shocks me in the evidence I supplied. Subsequent to three U.N. Security Council resolutions, the head of U.N. operations has reported that less than 1 percent of those Syrian civilians under siege inside Syria have been reached by humanitarian operations, not because of inefficiencies in the U.N. but because of deliberate blockage by the regime and, in some cases, by opposition forces. You will also know that 5 million Syrian refugees have fled to Jordan, Lebanon, Turkey, and Iraq. From my visit to Lebanon last week, the priorities are clear. They are work, protections for women and kids, and education. Chairman and Senators, we point out in our statement that there are three fundamental choices that now face the United States Government and the Senate. The first is about politics and diplomacy, because the truth is the U.S. has been absent from the recent public diplomatic efforts. Russia, Turkey, and Iran have put themselves center stage. There is not just a war without end in Syria. There is also a war without law. And a principled American voice is needed to articulate support for international humanitarian law and accountability for those who violate it. The truth is, if the U.S. does not provide this voice, no one else will. The second is about foreign assistance. We understand that major cuts or proposals for major cuts to foreign assistance will be announced tomorrow. This will be a tragedy for the people of Syria and for the region. They would translate into excruciating choices not just for NGOs but for the people that we serve. It would also set back U.S. strategic leadership. I hope you will allow me to say that, from my own time in the U.K. Government, and now running an NGO, I know that U.S. humanitarian leadership is second to none. Bilaterally and through the United Nations, the U.S. provides 40 percent of support for the United Nations High Commissioner on Refugees. The U.S. genuinely drives the global system. The State Department and USAID have led the global community in humanitarian response for decades. They project American ideals and protect American interests all for less than 1 percent of the Federal budget or for 0.2 percent of national income. The OFDA, the Office of Federal Disaster Assistance, estimated that some 6.9 million Syrians in fiscal year 2015 were helped by the United States. That should be a benchmark for the future. It would be a genuine tragedy for the U.S. administration to lose faith in the value of humanitarian aid just as it is proving it is worth. Finally, the third choice is about refugee resettlement. Last week's executive order suspending the resettlement program and reducing resettlement numbers is a stark message to Syrians and to allies in the region, including, I am sorry to say, Iraqis who have worked with and risked their lives with and for the United States. The pause in the program, the uncertainty about its future, is a gift for those who would argue that the United States will not help refugees in need if they happen to be Muslim. That is not true, but it is a calumny that is put around day by day around the region. In Lebanon and Iraq, I spoke with people affected by the executive order. These are some of the most vulnerable people in the world, and the most vetted entrants into the United States. There already is extreme vetting for refugees who want to get here. The review that is being done is perfectly within the rights of any new administration. What is wrong is a suspension of the whole program that will lead to people going to the back of the queue because of the pause that is under way. I would urge this committee that, if there is to be a review, it does not need to take 4 months. A 20- or 30-day review could get to the bottom of this refugee resettlement issue and the vetting arrangements quickly and allow the program to continue. Just remember this: After 9/11, the pause in the program will was only 2 months. For no reason at all, there is now a 4- month pause in the program despite the 120 leaders of the American national security system who said that the program stands. Mr. Chairman, Senators, there can be no effective foreign policy without effective humanitarian policy. I hope that is a message that this committee can take up with pride and with gusto. Thank you very much, indeed. [The prepared statement of Mr. Miliband follows:] Prepared Statement of Rt. Hon. David Miliband Chairman Corker, Ranking Member Cardin and distinguished Senators: The humanitarian dimension of the Syrian war has lacked for strategic analysis and informed prescription, so I congratulate you for your ongoing commitment to understand and address the humanitarian catastrophe unleashed across the region and beyond. I spent last week in Lebanon and Iraq, and am happy to contribute to your full committee hearing from the perspective of the International Rescue Committee, which is working across the full arc of this crisis, from Syria to the four neighboring states, to the refugee transit routes in Europe, and to refugee resettlement for the lucky few who are admitted to start new lives in the U.S. We are able to do so because the United States government has long been a valued partner. The State Department, through its Bureau of Population, Refugees, and Migration (PRM), and USAID, through its Office of Foreign Disaster Assistance (OFDA) have led the global community in humanitarian response. Likewise, PRM has shepherded the refugee resettlement program for decades with bipartisan support. Rarely has there been greater need for this U.S. leadership. Nearly 18 months ago, I spoke to the committee about the human suffering inside Syria and the impact on its neighbors. During the summer of 2015, attention on Syria and its refugees had skyrocketed, with stunning images in the news of families setting out across the Mediterranean. But we now know that the worst was yet to come. The last 18 months have been the worst yet for civilians inside Syria. Since I last testified to the Committee, the introduction of Russian airpower has ushered in a new phase in the conflict--with devastating and deliberate effects on civilians and civilian infrastructure. At least a hundred thousand more Syrians have been killed; hundreds of medical facilities have been purposely attacked (including those of IRC); the number of Syrians in need of humanitarian assistance has ballooned by over a million and it is harder than ever to reach them; nearly 700,000 people live under siege and millions more, nearly half of them children, live beyond the reach of humanitarian organizations. \1\ Over half of all Syrians--some 12 million people--have now been forced from their homes, either as refugees or internally displaced. --------------------------------------------------------------------------- \1\ Joint Statement on Syria- WFP, UNICEF, OCHA, WHO, UNHCR Jan 16, 2017. --------------------------------------------------------------------------- An additional million Syrian refugees have flowed into the already fragile political and economic systems of Jordan, Lebanon, Turkey, and Iraq--bringing the number of Syrians seeking refuge in these front line states to nearly 5 million. It is vital to recognize the extraordinary openness of these countries to Syrian refugees, while also understanding that it has become harder and harder to be a Syrian living in these countries. After 6 years of war, most refugees--from doctors and dentists to farmers, laborers and taxi drivers--have depleted their savings and are living in poverty, with limited access to legal work, struggling to afford healthcare and rent and in too many cases unable to send their children to school. The education of Syrian refugee children is probably one of the best illustrations of the strain that the influx has placed on surrounding countries and the failure of the humanitarian aid system to keep up. In Lebanon alone, despite advances in enrollment numbers in the last school year, nearly a quarter of a million Syrian children are still out of school, many for 3 years or more. Across neighboring countries, that number rises to 700,000 \2\--threatening significant parts of an entire generation. --------------------------------------------------------------------------- \2\ http://www.un.org/apps/news/ story.asp?NewsID=53145#.WMTG4NLyt0w. --------------------------------------------------------------------------- The last time I spoke to this Committee, what had been a civil intra-state conflict had evolved into a regional humanitarian disaster. But the failures of the international community to respond appropriately--to resolve the conflict, to protect civilians, to provide adequate aid to the displaced and to host countries, and to provide durable solutions, including resettlement for refugees--have now engendered consequences far beyond Syria and the region. This is not just about refugee flows. The conflict has exposed the divisions in the U.N. Security Council, undermined International Humanitarian Law (IHL), and in the assault on Aleppo plumbed new depths for the abuse of civilians, including well sourced claims of renewed use of chemical weapons. \3\ --------------------------------------------------------------------------- \3\ Fourth report of the Organization for the Prohibition of Chemical Weapons-United Nations Joint Investigative Mechanism 19 October 2016. --------------------------------------------------------------------------- The U.S., given its unique place in the global system, now faces three significant choices that will have long term implications both for the humanitarian situation and for regional politics. The first major choice is about military and diplomatic commitments. This is not an area where humanitarian organizations have locus, but our staff and beneficiaries bear the consequences of the decisions that are made, and so have a great interest in the issues on the table and the players at the table. Since the collapse of the Kerry-Lavrov dialogue last fall, the U.S. has been notably absent from the public diplomatic efforts to achieve a political solution in Syria. Russia, Turkey and Iran have put themselves center-stage. The U.S. needs to decide what role it wants to play, and who it wants to ally with, in the debates about the future of those parts of Syria still outside government control, and the future shape of national government. This cannot be considered independent of the commitments to defeat Isis/Daesh in Iraq, where the U.S. again faces the conundrum that Iran has the same declared enemy, but where victory threatens to extend her influence. From the point of view of our staff and beneficiaries, it is vital that there is a strong and principled American voice articulating support for international humanitarian law in the conduct of war(s), and for inclusive and legitimate governance to underpin the peace. If the U.S. does not provide this voice, no one else will. The second choice concerns the contribution of humanitarian aid to the relief of suffering and the promotion of stability in the region. Tomorrow we will learn the Administration's plans for U.S. foreign assistance. Major cuts have been foreshadowed in advance briefing. These are the very resources that are used to throw a lifeline to the families caught up in this crisis in the form of basic food, water and sanitation, medical assistance, protection for women and girls and education. My staff make use of these resources across the region: for example when areas of Fallujah, Sal ah Addin, or Mosul are retaken from Isis/Daesh, humanitarian workers are the next to enter. In Lebanon, one-quarter of the population is now Syrian refugees. Allies such as Jordan are struggling with the same disproportionate responsibility, hosting over 1 million Syrian refugees. The humanitarian and economic assistance provided is not just a moral choice, but a strategic necessity. An insufficient humanitarian and development response sustains and begets further crises. This is evident in the flows of Syrian refugees to Europe, at great risk to refugees' lives and with great political consequences for Europe. These flows began 3 years into the war, when refugees' savings were depleted and sufficient aid, work, and education for their children remained out of reach. It is also demonstrated by the fact that U.S. troops are helping to clear some parts of Iraq of terrorist groups for the third time; in part because insufficient investment in humanitarian response, development progress, and political reform has each time allowed extremists to take hold. In the midst of an unprecedented global displacement crisis, now is no time to be scaling back these efforts. Third, there is the question of the interaction of flagship domestic policy with foreign policy. The future of the Middle East is about hearts and minds. Last week's revised Executive Order--which suspends the refugee resettlement program in the U.S.--together with the reduction in U.S. resettlement numbers from 110,000 to 50,000, is a stark message to allies in the region coping with the humanitarian crisis. It is good that Iraqis are no longer banned from travel to the U.S., but Iraqi refugees remain subject to the 4-month pause on the resettlement program. It is good that Syrian refugees now no longer face an indefinite ban, but they are affected by the 4-month pause too. In all 60,000 refugees approved for entry to the United States, after extensive vetting, now face a life on hold or in reverse. Resettlement is an American success story, and the 4-month halt to the program, with uncertainty about what lies beyond, is a gift for those who would argue that America will not help Muslims in need. inside syria The devastation in Aleppo is to be set out for you by some of the doctors doing heroic work there. In late 2016, the conflict reached a new low for brutality and destruction. In the final assault on Aleppo there was deliberate targeting of civilians, hospitals, schools, and public utilities, with starvation and the denial of medical care used as weapons of war that brought the eastern part of the city and its inhabitants to their knees. Last week, the U.N. Human Rights Council released a report on the conclusion of the Aleppo offensive that affirms what INGOs like the IRC have long asserted--that Syrian civilians fell victim to war crimes from all parties. Air strikes destroyed or otherwise rendered all hospitals in eastern Aleppo out of service--meaning even a minor injury or illness could turn life threatening. As the assault reached its final and deadliest stages, daily Russian and Syrian airstrikes claimed hundreds of lives. The report also alleges use of chlorine bombs, resulting in hundreds of civilian casualties. Rebels also abused civilians, firing shells indiscriminately into western Aleppo. In the final days of the siege, the U.N. reported the killing and ``disappearing'' of civilians as well as forced conscriptions. The IRC has been delivering aid into Syria since 2012, but our experience thus far did not diminish the shock at what has befallen the people of Aleppo. As civilians fled for their lives in the cold and snow toward Idleb--our staff were there to meet them and provide assistance. We are the largest health care provider in Southern and Northeast Syria. Last year, thanks to funding from USAID, over 900,000 Syrians received primary, reproductive, and trauma care from the IRC and our partners. Looking beyond the emergency, the IRC supports schools in conflict-affected parts of Idleb province. Our classrooms provide safety and stability to thousands of children--many have known nothing but war and, according to a new IRC survey, are a full 6 years behind in their studies. \4\ Our livelihoods programs (``cash distribution'', and the like) are a lifeline to Syrians struggling to pay rent and purchase food and other essential items for themselves and their families. --------------------------------------------------------------------------- \4\ IRC Report: Impact of War on Syrian Children's Learning: Testing Shows Gaps in Literacy and Math skills 12 March 2017. --------------------------------------------------------------------------- If violence against civilians has characterized the Syrian conflict, so too has violence against aid workers. IRC programming not only connects us closely with the victims of violence inside Syria, it has made us a target of violence as well. Although the U.N. Security Council passed a resolution (2286) last spring condemning attacks on medical facilities, hospitals and humanitarian operations continue to be targeted at an alarming rate. IRC-supported clinics and hospitals were bombed eight times in 2016, including the destruction of two facilities in a single week in October. Another IRC-supported hospital was hit just last month in southern Syria. These types of attacks on aid workers and health facilities are commonplace and devastating, affecting thousands of Syrians who rely on these facilities for lifesaving aid and care. And they are designed to intimidate and deter humanitarian aid workers. Last week, U.N. investigators confirmed that the 2016 attack on a U.N. convoy carrying humanitarian aid that killed 14 aid workers was both purposeful and premeditated. Six years into this war and 3 years after the adoption of U.N. Security Council Resolution 2139, which demanded an increase in humanitarian access, the neediest Syrians still cannot access the food, water, and health care they need to survive. Capacity is not the issue. The U.N. and its implementing partners stand ready and able to deliver assistance to the hundreds of thousands of Syrians living in besieged areas. Denial of lifesaving aid is explicit in the government's war strategy. In December, the U.N. sought and received Syrian government approval to reach close to one million Syrians. Subsequent delay tactics and barriers put up by national and local authorities kept all but one convoy from reaching its destination. As a result, according to U.N. Humanitarian Chief Stephen O'Brien only 6,000 people--less than 1 percent of those living under siege--received the food, fuel, and water needed to survive the winter and all were denied lifesaving medicines and surgical supplies. Preliminary reports for 2017 show only marginal improvements--leaving many Syrians without assistance for the better part of a year. Civilians in parts of Idleb province, which has seen its population swell with displaced Aleppians, have not received an aid delivery since April of last year. Daily life is desperate and dangerous for the Syrians trapped in these neglected towns and cities. The IRC has heard from ordinary people living in areas near Damascus that are under siege by the Syrian government. They tell us, ``You never saw any malnutrition before the siege. Now you see some people who look like walking skeletons. Children [are] passing out at school because they haven't eaten.'' The siege has pushed up prices for basic necessities tenfold--with a loaf of bread costing a full day's pay. Few jobs remain and children have left school to help their families survive. This is needless suffering. And ``Peace'' achieved by means such as siege cannot, and will not, hold. Beyond the sieges, there is a broad picture of increasingly challenging choices for civilians and NGOs. There are access challenges at various border points. NGOs have been afforded welcome hospitality in neighboring states but we cannot be sure of what the future holds. Shifting frontlines across Syria compound these problems. Syrian forces are advancing toward crossings along the Jordanian border: if they succeed in seizing them, it would deliberately and effectively cut off large swathes of Southern Syria from cross-border assistance. The regime is likely to set its sights on Idleb--where it has forced opposition fighters to relocate as part of truce deals, straining the humanitarian infrastructure. Hundreds of thousands of civilians--many evacuees from Eastern Aleppo--cannot get the assistance they need and wait in fear of the same brutal attacks and siege tactics. Violent in- fighting among disillusioned opposition groups in Idleb is on the rise and is disrupting humanitarian activities. Check points have sprung up around the town of Dana--a center of IRC activity--and elsewhere around the governorate. Clashes in January delayed much needed aid distribution in eastern Idleb to thousands recently displaced from Aleppo. Each uptick in fighting will severely hinder our ability to provide health care and other forms of vital aid to the 700,000 people displaced in Idleb. The conflict is now shaped by Russian and Iranian support for President Assad (exemplified by Moscow's Feb 28 veto of a UNSC resolution to impose sanctions for Damascus' use of chemical weapons), Turkey's focus on Kurdish forces in northern Syria, Saudi Arabia's attention on Yemen. There are no shortage of actors in the region and no shortage of interests, but none have civilian protection primary among them. Keeping borders open and aid flowing is not at the top of any actor's priority list. But humanitarian access is a right not a privilege under the Fourth Geneva Convention and related protocols--not a bargaining chip or confidence-building measure. There is experience from Sudan (Operation Lifeline Sudan) and Afghanistan (Operation Salaam) for negotiating access across conflict lines during a civil war. It requires political leadership, credible interlocutors, willingness to work with all sides, and clear pressure on all sides. Ensuring that humanitarian assistance is available to those whose lives have been shattered by this conflict is the minimum we must do. The new Administration has commissioned a review of options for countering Isis/Daesh. Two preoccupations have dominated the briefing so far: speeding up military action and accelerating the return of refugees (to Syria). We would submit that historical evidences shows the following. 1. The conduct of war affects the prospects for peace. This makes civilian protection a strategic as well as moral priority. 2. Military haste produces humanitarian harm, and in particular military options without political destination risk ruin. The future of Raqqa, for example, is a complex political as well as military question. 3. Discussion of ``safe zones'' needs to be detailed not rhetorical. The Committee has discussed this on various occasions. The context inside Syria has shifted considerably since the idea was first explored in 2013. The shifting frontlines and rearranging constellation of parties on the ground, coupled with the multiple and contradictory policy intentions of those parties, severely complicates the options. At worst it would legitimize land grabs and put civilians or returning refugees in jeopardy. syria's neighbors We know that Syria's civilians have borne and continue to bear overwhelming harm from the country's conflict. The humanitarian, economic, and political impact of the rapid and massive influx of five million refugees on Syria's nearest neighbors is not properly understood. Turkey hosts 2.5 million Syrian refugees, Lebanon 1.5 million, and Jordan 1 million--placing these countries among the world's top refugee-hosting countries. The images of Syrian families on flimsy rafts in the Mediterranean pulls at our heartstrings--and rightfully so. But we can't let that blind us to the fact that most Syrian refugees remain on the dry land of Jordan, Lebanon and Turkey. In Lebanon, the arrival of Syrian refugees has led to a 30% increase in its pre-crisis population of 4 million and made it the highest per capita refugee host in the world. These already fragile countries are shouldering unreasonable and unsustainable responsibilities simply by virtue of their geography. Over a year ago, Jordan's King Abdullah warned that his country was at a ``boiling point'' and that ``the dam is going to burst.'' And the inadequate international assistance has only made it worse. While refugee-hosting governments and populations deserve great credit for their hospitality and their sacrifice, we cannot overstate how hard life is for Syrian refugees in these countries. In exile for years, with their lifesavings now depleted, most Syrian refugees live on the margins--unable to meet their families' basic needs, unable to work, and unable to send their children to school. A 2016 assessment found that 71% of Lebanon's registered refugees live in poverty, while a full 90% of Syrians in Jordan live below the poverty line. \5\ And, while this crisis brings to mind images of endless rows of tents, the majority of Syrians are not living in refugee camps. Across the region, refugees rent often-overcrowded apartments, squat in abandoned buildings, or live in ad hoc shelters and informal settlements that expose them to the elements and insecurity. And, despite advances in enrollment numbers in the 2015/16 school year, nearly 60% of Syrian children are still out of school--creating an entire generation lost to this conflict. --------------------------------------------------------------------------- \5\ 3RP Regional Refugee and Resilience Plan 2017 and 2018 in Response to the Syria Crisis. --------------------------------------------------------------------------- As the crisis intensifies so do the needs and the desperation of vulnerable families. U.N. agencies, NGOs like the IRC, and government service providers are unable to keep up with the demand for assistance, which is increasing as refugees deplete their assets. As such, refugees are coping by pulling children from school and putting them to work, offering daughters for early marriage, and increasing indebtedness to relieve economic pressure on themselves and their families. It should have come as no surprise that in the absence of adequate and appropriate international support, these countries are buckling under the strain of their refugee caseload and taking steps to contain political tensions within their countries. Refugees face restrictions on their ability to stay and work legally, and often encounter barriers to attending school. For instance, due to restrictions introduced in 2015 and only partially remedied last month, over 70% of refugees in Lebanon lack residency permits, significantly increasing protection risks, while simultaneously blocking access to formal justice, civil documentation, and health services--not to mention livelihood and education opportunities. Second, these governments have closed many formal and informal border crossings to limit the inflow of additional refugees. As a result, hundreds of thousands of people are living in makeshift camps on or near borders with little or no access to humanitarian assistance. The most concerning example is the situation along the Berm, a desert no man's land between the borders of Syria and Jordan. Tens of thousands of Syrians have been trapped at the berm for 9 months, first with no and now with limited humanitarian assistance. The situation at the berm is a global responsibility--and it is a stunning snapshot of the international community's failure to adequately address the refugee crisis. Likewise, it should have come as no surprise that in 2014, after 3 years under these increasingly pressing circumstances, refugees began to undertake dangerous passage to Europe in increasing and often staggering numbers. The top reasons refugees cite for moving on are first the obvious and all too elusive search for security, closely followed by a lack of jobs for refugee parents and education for refugee children. \6\ Here is the clue to how to address the humanitarian crisis. There is growing research showing that when refugees are in a safe and decent job, and have access to enabling services like education, they have the dignity of providing for themselves and their families and can become net economic contributors to their host economy. \7\ Like the rest of us, refugees want and deserve opportunities to control their own lives and provide for their children. --------------------------------------------------------------------------- \6\ http://www.unhcr.org/en-us/news/briefing/2015/9/560523f26/ seven-factors-behind-movement-syrian-refugeeseurope.html. \7\ Philippe Legrain. 2016. ``Refugees Work: A Humanitarian Investment That Yields Economic Dividends.'' Tent Foundation and Open Network. T. Alexander Aleneikoff. 2015. ``From Dependence to Self- Reliance: Changing the Paradigm in Protracted Refugee Situations.'' Washington, DC: Migration Policy Institute. Alexander Betts et al. 2014. ``Refugee Economies Rethinking Popular Assumptions.'' Oxford, U.K.: Humanitarian Innovation Project, University of Oxford. www.rsc.ox.ac.uk/files/publications/other/ refugee-economies-2014.pdf. --------------------------------------------------------------------------- More aid is part of the answer, but change in the sector is also important--notably to recognize the increasingly long term nature of displacement (once out of their own country for 5 years, refugees are likely to be away for 26) but also to address other changes in the refugee experience (for example its increasingly urban nature). We advocate strong commitment to evidence-based programming; clearer ``collective outcome'' measures for what we expect to achieve for the health, safety, education, and incomes of displaced populations; greater investment in R&D for the sector; and we also need to move beyond short-term financing of basic needs and camp-based responses to financing structures that respond to current trends in displacement. In this regard, we have promising developments in the entry of the World Bank, with strong U.S. support, to provide sustained financing to refugee-hosting nations to improve their markets, institutions, and health and education systems in exchange for greater access for refugees to jobs and public services. The U.S. must similarly re- evaluate its financing tools for humanitarian response and for refugee- hosting nations. Finally, we must bring the interests of women and girls--those disproportionally impacted by conflict--from the margins to the mainstream. Seventy-five percent of Syrian refugees are women and children. \8\ Conflict disproportionately affects women and girls and they face unique and dangerous circumstances in displacement-- sexual violence, harassment, domestic violence, and economic disenfranchisement. Gender inequalities that precede their displacement are exacerbated by it, with women and girls often being the last to receive the benefits of aid, and the first to bear the consequences of displacement--through child labor or other exploitative work, early marriage, and other desperate and negative ``coping mechanisms''. Donors, host governments, and implementers need systematically to identify and prioritize these gender-based challenges. --------------------------------------------------------------------------- \8\ http://data2.unhcr.org/en/situations. --------------------------------------------------------------------------- NGOs like the IRC are already working toward these goals with strategies that include more employment and self-employment programming to help refugees, and especially women, generate income, as well as supporting host communities struggling with unemployment. With U.S. government support, the IRC's small business program is helping Syrian women in Jordan start new ventures to help keep their families afloat. Likewise, Syrian children need to get back to school, but the region's schools have been unable to absorb the hundreds of thousands of new students. To change this calculus, the IRC provides community-based education programs (flexible and tailored to the needs and circumstances of refugee children) to increase education opportunities and provide socio-emotional support for refugee children. Last year, with U.S. government support, the IRC piloted new non-formal early childhood education and retention programs in Lebanese communities, designed to meet the immediate needs of refugee children while the Lebanese government strengthens its capacity and reach to provide for the hundreds of thousands of Syrian children within its borders. The question is how to bring these efforts to scale and to do so sustainably. The global community came together in 2016 to achieve that very goal. Anchored by U.S. commitments, the global community committed to a 30% increase in humanitarian aid and a doubling of resettlement commitments globally in exchange for greater legal protections and access for refugees to jobs, education, and other essential services in their countries of first refuge. The agreement relies on a grand bargain between wealthy nations and the low and middle income countries that collectively host 88 percent \9\ of the world's 21 million refugees. And while we can, and should, expect other wealthy nations to do more, it is U.S. assistance and U.S. leadership that underpins the global protection regime. --------------------------------------------------------------------------- \9\ Forthcoming: IRC-CGD Study Group Report. --------------------------------------------------------------------------- The U.S. commitment to provide humanitarian, development, economic, and security assistance to support the protection of civilians in countries of first refuge is also a function of enlightened self- interest--the forced and premature return of Syrian refugees to an unstable Syria, or of Afghan refugees to an unstable Afghanistan, foments new currents of conflict and crisis that, given U.S. interests and commitments in the region, draw U.S. funds and U.S. troops into further quagmires. the vital role of american leadership The U.S. has major interests in the next phases of the Syrian crisis. (1) To push back against regional instability that threatens regional security as well as instability in Europe that distracts and diminishes U.S. allies; (2) To fight ISIS and other terrorist groups that capitalized on the lawlessness in Syria and the instability elsewhere in the region to gain territory and resources; and (3) To stand up for International Humanitarian Law that is one of the foundation stones of the post-World War II global political order. Amidst the noisy debate about the future of Syria, America's humanitarian leadership is needed in the following areas: Humanitarian Law and Civilian Protection: The U.S. can use its role at the U.N. Security Council and beyond to increase the diplomatic and economic price for those who support violation of International Humanitarian Law. Ambassador Haley's strong condemnation of Russia on February 28th for vetoing the resolution that would have sanctioned Syria for its use of chemical weapons was important. There are Security Council Resolutions on the books that should afford protection to civilians and aid workers--like 2139 that demands humanitarian access and 2286 that condemns attacks on hospitals. Monitoring and reporting mechanisms that name and shame violating countries and individuals would give these resolutions teeth. In December 2016, the U.N. General Assembly established an investigation mechanism that would create trial-ready evidence for eventual prosecutions of those that committed war crimes and violations of IHL in Syria. The U.S. should support this mechanism and push others to do the same. A strong and vocal U.S. commitment to robustly implement its international commitments towards the minimization of harm to civilians and civilian infrastructure are rallying points for the U.S. to call on other states to respond with comparable measures and to name and shame those that do not. This matters not only for the lives of civilians caught in the midst of conflict, but also for the aftermath of conflict and for future conflicts. A Commitment to Foreign Assistance: Resolving the crisis is a complex political undertaking that requires skilled diplomacy, tenacity, and a willingness to pressure all sides. However, responding adequately to humanitarian needs of those requiring lifesaving assistance is more straightforward; and something that the international community, led by the United States, has no excuse not to do. We can get assistance to the people who need it inside Syria, we can provide adequate support to refugees living in precarious situations in the surrounding countries, and we can support our allies who have provided safe harbor to five million people as this conflict has raged on; if we fund and organize to do so. The United States through OFDA assisted some 6.9 million Syrians in FY 2015, and this should be a benchmark for the future. \10\ Yet the combined U.N. appeal in 2016 was only 57% funded by year's end. This year we're off to a feeble start, with only 14% of the $9 billion appeal committed. These seemingly sterile statistics translate into excruciating choices made by U.N. agencies and aid organizations like the IRC regarding which needs will go unmet and whose pleas for help will go unanswered. As noted earlier in my testimony, it is these gaps in assistance that have inspired so many refugees in the region to take dangerous journeys onward to Europe in the hope of improving their untenable situation. As stated in a recent letter--which I would like to submit to the public record-- signed by 120 three and four star retired generals and admirals urging Senate leadership to support the International Affairs budget, ``now is not the time to retreat.'' I urge this authorizing committee overseeing United States foreign policy and assistance to defend the foreign assistance budget as Congress considers the FY 2018 and future year requests. --------------------------------------------------------------------------- \10\ Office of U.S. Foreign Disaster Assistance Annual Report for Fiscal Year 2015. The Case for Resettlement: When I was in Lebanon and Iraq last week, I spoke with some of the people who are impacted by President Trump's executive order. Over 75% of the refugees we resettle in the United States are women and children. Many are Iraqis who have served U.S. institutions, including the State Department, USAID, or U.S. NGOs. They are the family members of those who served with American troops. They are unaccompanied children, survivors of rape and violence, widows struggling to make a new life, and those in need of urgent medical care. They are those under persecution for their political or religious beliefs. True to a proud tradition, the U.S. takes the most vulnerable refugees. They are also the most vetted population to enter the United States. Far from the experience of Europe, where Syrian refugees arrived on Europe's shores by the tens of thousands per week, every Syrian refugee that enters the U.S. is selected for entry by the Department of Homeland Security, and vetted by U.S. national security and intelligence agencies, undergoing a 21- step, 2-year process that includes biometric and security screenings and multiple forms of identify validation. The President's 4-month pause will have a very significant impact on refugees who have waited years and endured multiple screenings to enter the United States, as each step of the security process has a different validity period. There are 60,000 refugees cleared for entry to the United States who would have arrived to the U.S. before the end of September, who are now indefinitely delayed. It's a population the U.S. should proudly embrace in keeping with its history and values, and in keeping faith with our --------------------------------------------------------------------------- allies shouldering the responsibility of millions of refugees. We urge the committee to ensure a good faith, speedy review; to encourage waivers for those most vulnerable; and to support an increase in the number of refugees admitted upon completion of the review. Every administration should take its opportunity to review security procedures. President Bush did it after 9/11 , but even the `pause' of resettlement arrivals after 9/11--a moment of existential crisis for the nation--lasted just 2 months, after which the Bush administration recommitted itself to the refugee admissions program. President Obama also reviewed security procedures, several times, resulting in continuous improvements and without denying entry to the neediest refugee families. But once the review is complete, there is no reason for an arbitrary cap. The world's greatest superpower should not reject the world's most vulnerable. It is a symbolic show of solidarity with the neighboring countries, and a life-changing, lifesaving intervention for the individuals concerned. I thank you and the members of the United States Senate for the opportunity to provide the IRC's perspective on this defining humanitarian challenge. I look forward to addressing your questions. Senator Risch. Thank you. And we are now going to proceed to a round of 5-minute questions and answers, and I am going to reserve my time to interject. And I will recognize Senator Cardin. Senator Cardin. Thank you, Mr. Chairman. I want to thank all five of you for your testimony, but I want to join my two friends in paying special tribute to the three doctors who are here today. You really are inspirational to all of us. I grew up in a generation watching M*A*S*H on television as I saw American doctors perform during the Korean War and marveled how they performed in combat situations. They were soldiers. You are not soldiers, and you are performing with great personal sacrifice to your own safety in order to save lives in your community, under conditions you should not have to put up with. So I just really wanted to express our deep appreciation for your international humanitarian efforts, which really inspire us and I think the global community to do more. What we do is not at personal sacrifice to our lives. What you do is. So I just really wanted to thank you for being here. It is extremely valuable to the effort. And I want to assure you that I am going to do everything in my power to make sure that those who have committed these atrocities--bombed hospitals, targeting hospitals for their bombs, attacking humanitarian convoys in order to stop you from getting the medicines you need to keep children alive--that every one of those individuals who have committed these war crimes, from the Assad regime to the Russian involvement, are held accountable for their activities. And, of course, the number one thing we need to do is end this war. And that is not today's hearing. And I agree with the chairman, that is not what we are here for today. But the way to stop these atrocities, the way to stop this humanitarian crisis, is to resolve the civil war, to deal with the terrorists who are in the country, and to return stability to the people of Syria by a government that represents all of the communities in Syria. So, Mr. Miliband, first of all, thank you for your extraordinary leadership. We have had a chance to talk about these issues. I could not agree with you more about the impact of President Trump's executive order. I just quote from your testimony that those who are affected are family members of those who served American troops. They are unaccompanied children, survivors of rape and violence, widows struggling to make a new life, and those in need of urgent medical care. They are those under persecution for their political or religious beliefs. A 2-month delay is too long for these people. As you said, there was no need for this 4-month period, and we hope that it is much shorter than that. I just really want to talk a little bit and ask your--the potential impact of the executive order in the region. We have Turkey, we have Jordan, we have Lebanon that have literally millions of Syrian refugees that border Syria. If they decide, ``Well, the present U.S. policy is that they are not taking refugees. Maybe we should send these refugees back to Syria,'' what impact could that have on an already unsustainable humanitarian need that exists in Syria? Mr. Miliband. Thank you, Senator. Look, the truth is that the numbers in small countries in the region are staggering. Lebanon has a population of 4.5 million, and it has 1.5 million refugees. Jordan has a population of 7.5 million; it has 650,000 refugees, and the government says 600,000 unregistered refugees. Turkey, obviously a much bigger country, 2.7 million refugees. I think there are three things to have very clearly in your mind. First of all, the conditions for refugees on the ground are getting tougher by the week. They are running out of savings. They are having to reregister, which sometimes has fees associated with it. Their kids are not in school. And they are becoming more desperate. The second situation is the political backlash against U.S. allies in the region, like Jordan, is very real. The unemployment rate amongst Jordanians is 26 percent, never mind the poverty rate amongst Syrians is 78 percent. So there is a political management difficulty, and the short-termism of the humanitarian aid system compounds the difficulties for the Government of Jordan. We are working with them on an employment program to try to help their companies take advantage of free trade access, special free trade access to European markets, but that requires 15 percent of the employees to be refugees. We are trying to work with them to help square that circle. The third aspect, the third consequence, that I think relates to the first two is that many refugees, giving up the hope of legal resettlement in the U.S., are frankly going to take their lives into their own hands and try to get to Europe. The European refugee crisis is not over, and the push factors that are driving people from Syria and from the neighboring states to get to Europe remain very strong, indeed. And obviously, the greatest danger is that there is a domino effect from a U.S. decision. Historically, the U.S. has been the largest refugee resettlement country. The domino effect goes through the European states, who then rein back, and also leads to a series of actions by hosting states, like Jordan and Lebanon, but also, frankly, Kenya, Uganda, Ethiopia. That means that the global ramifications become very real, and instability is the result. Senator Cardin. Thank you. In regards to Mercy Corps, I want you to know I hope today we are going to hear ways that we can help deliver humanitarian aid effectively to those who are involved. Clearly, what was done in Turkey needs to be reversed, and I am sure that we will try to assist you. I will certainly be working with Senator Merkley and Senator Kaine and others on our committee to see how we can engage the Turkish Government to resolve your issue so that you can get that aid back to the people of Syria. I want you to know that we will be in communication with the Turkish Government. Senator Rubio. [Presiding.] Senator Johnson. Senator Johnson. Thank you, Senator Rubio. I also want to thank the doctors for their testimony, for your courage, for spending some time with me in my office yesterday. Mr. Keny-Guyer said the politics have changed, and I want to ask you, Dr. Abdulkhalek, with the involvement of Russia, you have obviously been witness of chemical attacks. You have been present. Can you talk about the change in tactics, the change in weapons the minute that Russia got involved? Dr. Abdulkhalek. After Russia involved in the conflict, we noticed a new development with weapons, like bunker-buster. The bunker-buster can destroy underground structures. And parachute bomb, we noticed they use progressive use of that bomb in the last 3 months of the siege. And also cluster bombs, we had photos by our own phones to that cluster bombs and the parachute bombs. Senator Johnson. Was there more frequent targeting of your hospitals when Russia became involved? Dr. Abdulkhalek. Yes, yes. Senator Johnson. So they were not attacking ISIS. They were attacking Aleppo. Dr. Abdulkhalek. They are locating the hospital. They are locating the hospital position, and they start targeting it many times until we had to leave that hospital, fearing of our safety and for the injured. Senator Johnson. So, Doctor, you also talked about two attacks---- Dr. Abdulkhalek. Yes. Senator Johnson.--the use of chlorine. But you also said regular use. Dr. Abdulkhalek. Yes. Senator Johnson. Any other chemicals that you are aware of that have been documented that have been used, or is it primarily chlorine? Dr. Abdulkhalek. No, just chlorine attack. Just chlorine attack. Senator Johnson. You said regular use. Do you have any idea how many chlorine attacks there were? Dr. Abdulkhalek. On M3, there were just two chlorine attacks because M3 was not known to the government. So the last month, they discovered its place, so they started targeting it by many weapons until they used the chemical weapon chlorine gas. But they targeted the area of the M2 the hospital with the chlorine attack before, 6 or 7 months. Senator Johnson. So, Doctor, you said the world has failed Syria. Dr. Abdulkhalek. Yes. Senator Johnson. I could not agree more. Dr. Abdulkhalek. Yes. Senator Johnson. It is shameful. Mr. Keny-Guyer, you said the politics changed. Describe that. Describe the reality. It is great that we are going to say that we are going to hold people accountable, but describe the reality on the ground right now. What has changed? Mr. Keny-Guyer. Well, I do not often find myself commenting on the politics of a situation, but what I will say that has changed, we all know, as an organization that had a significant commitment to the city of Aleppo, we had team members who were in Aleppo and actually were on the last evacuation bus out, and we are very proud of them. They were given the opportunity to leave, like many of these doctors, earlier on, and chose to stay out of solidarity. But obviously, the situation in Aleppo has changed. In the north, you have now Idlib is very vulnerable. Many of the citizens of Aleppo are now there. You clearly have the Government of Turkey has come down into the Euphrates Shield area, those areas. And then, obviously, the concern over Raqqa. What has also happened in the southern part of the country I think we should all be aware of, and it is very difficult, and that is there have been efforts that have pacified some areas, but, of course, along the Jordanian border, we have seen an increase in conflict. What has remained the same and I think is critically important is the staggering need of innocent Syrians. And just, if I may, in particular comment on, you know, all lives are really important. But at the same time, we are particularly concerned about young Syrians. Nearly 4.8 million Syrian refugees in the region are children, and there are more than 8.5 million children and young people in Syria who are in need of immediate support, never mind education but just immediate support. Senator Johnson. I appreciate that. I have 35 seconds. Mr. Keny-Guyer. Yes. Senator Johnson. The point being is the world has failed. We have stood by, the world, for 6 years and watched the slaughter of a half million, at least, Syrians. And I am all for a diplomatic solution, but diplomacy follows facts on the ground. The facts on the ground are such that Russia, Iran, and Assad have conquered Aleppo. They are winning the war. Is that not correct? Is that not the politics that have changed? And what kind of diplomatic solution can there be when the facts have changed so dramatically on the ground? Mr. Keny-Guyer. Well, I am not sure I would go as far as you did, Senator, in that situation. You know, I have spent more than 30 years working in and out of the Middle East, and I am always cautious to draw any firm and fast conclusions that relate to the Middle East. But what I will say is that we are no closer to a political solution. I think you are right in that. And in fact, in many ways, the situation is more complicated than ever. The one thing I am sure of is that those who suffer the most are innocent civilians and Syrians, and especially the children. Senator Johnson. I agree. Senator Risch. [Presiding.] Thank you very much. Senator Coons. Senator Coons. Thank you, Senator Risch and Senator Cardin. Thank you, Doctors. Thank you for your incredible testimony. Thank you for your bravery. Thank you for what you continue to do to risk your lives in the service of humanity. It is hard to hear your testimony. It is hard to endure the images and the sounds and the stories of unspeakable suffering and unthinkable human rights violations in Syria that continue, week in and week out, month in and month out, over years. And the hundreds of thousands of innocents who have been killed in a way that just cries out for the world to respond should shock the conscience of every Senator here and everyone who listens. Thank you. Delaware just welcomed its first Syrian refugee family. In a small but important act, I think, a Christian church, a Muslim mosque, and Jewish Family Services in partnership welcomed a refugee family that had fled an area close to where you are from because of a chemical attack years ago. The United States has done a great deal, but nowhere near enough. My first visit to confront some of the reality of this was with Senator McCain and a number of other colleagues to a well- known refugee camp in Jordan where we had memorable meetings with Syrians who said: We do not want sympathy. We do not want tears. We do not want blankets. We want action. We want accountability. And we want engagement. It is encouraging to be reminded that American humanitarian assistance did help 7 million Syrians last year, but it is heartbreaking to realize that a likely dramatic cut in our humanitarian assistance that may be announced tomorrow may significantly affect hundreds of thousands if not millions of Syrians and the whole region. And I am gravely concerned that a pause and a travel ban sends exactly the wrong signal about our values and our willingness to welcome and embrace and support exactly the sort of work you have done. So to Mr. Keny-Guyer, thank you for the bravery and the dedication of Mercy Corps. Along with Senator Cardin, whose statement I think speaks for itself and was powerful, about the importance of welcoming refugees to this country and about the importance of supporting Mercy Corps, I will only say amen and I look forward to trying to work with you to right this situation in Turkey. If I might, Mr. Miliband, I would just be interested in hearing what you would think would be the actual human consequences on the ground of having the United States nearly abandon its humanitarian assistance obligations. Mr. Miliband. Thank you, Senator. I think that U.S. assistance should be seen in three or four key areas. One is obviously the Food for Peace program that is a significant contributor to food security for Syrians. We are working with the U.S. Government cross-border on that program. Secondly, the U.S. has distinguished itself by the flexibility and speed by which the Foreign Disaster Assistance bureau works with NGOs like ours to reach those in grave need. One obvious example is inside Syria, but I just draw your attention to what is happening in Mosul at the moment. I was about 15 kilometers from Mosul at the end of last week. It is thanks to U.S. support that when ISIS is driven out of an area of Mosul, humanitarians are the first to go in after, including from the organizations represented here. We are supported by the U.S. in doing that. And that work is beginning to put together the elements of a functioning city. So in the east of Mosul, there is some reconstruction work that is allowing people to have basic services that they can go back to. Thirdly, U.S. foreign assistance is distinguished by its ability to target the most vulnerable. Often, that is women and girls, and it is often labeled as protection work, ``protection work.'' We are certainly proud to be partnering across the region with the U.S. in protecting women and girls from the unspeakable levels of abuse that are often associated with emergency humanitarian situations, and I think it is very important to flag that. The final thing I would mention is that it is a scandal to me that less than 2 percent of the global humanitarian budget is spent on education. That speaks to the short-termism of the humanitarian assistance. There is a fiction that is convenient for donors that these emergencies are short term. And, tragically, it is a fiction that is embraced often by the host countries for their own political reason. The short-termism leads to a neglect of something like education, but the U.S. is willing to support education. In the Beqaa Valley last week, I was able to see some kids who had been traumatized, traumatized refugees who I met 3 or 4 years ago in the same informal settlement, so-called. They are being helped by a program that is an education program that is giving them the chance of rebuilding their lives. Senator Coons. Thank you, Mr. Miliband. If I might just in conclusion, Doctors, 15 of the last remaining doctors in Aleppo, including you, sent a letter to President Obama detailing atrocities of the sort that we have heard testified to here today and asked for us to take action around accountability. I just want to commend Senator Cardin and Senator Rubio for reintroducing the Syrian War Crimes Accountability Act and all of us who are joining as cosponsors to insist on accountability for the unspeakable war crimes that are being committed in Syria against the Syrian people. Thank you for your testimony today. Senator Risch. Thank you. Senator Young Senator Young. Thank you, Chairman. Thank you to our doctors. Thank you for your constancy of purpose, for your courage, and for bringing light to an otherwise very dark situation in Syria. I agree with Mr. Miliband. We do, indeed, have a fundamental choice to make on this authorizing committee about our level of assistance we will continue to provide you and others. You are on the receiving end of international human rights violations, and I would like to elicit from your testimony here a few things that I just thought were incredibly powerful. I will start with something Mr. Miliband said. He indicated that the introduction of Russian airpower ushered in a new phase of this conflict, devastating and deliberate effects on civilians, civilian infrastructure. The airstrikes destroyed or otherwise rendered all hospitals in eastern Aleppo out of service--that despite U.N. Security Council Resolution 2286 condemning attacks on medical facilities, hospitals, and humanitarian operations. And then the doctors. You each spoke in a very personal way to the tragedies you have seen on the ground. Dr. Farida, you note that, ``A hospital was the most dangerous place in Aleppo.'' Dr. Abdulkhalek, you highlight the repeated attempts by the regime and its allies to destroy the hospital where you worked using barrel bombs, using cluster munitions. Dr. Rajab, you noted that in the hospital where you served as director in Aleppo, the hospital was bombed out of service on account of 22 airstrikes. You were hit five times in 1 week. I cannot imagine operating under these conditions. I cannot imagine being in one of these hospitals. I cannot imagine living in an area of the world where you are constantly under this sort of attack. And who do we blame for this? Well, I mean, there is plenty of blame to go around, but certainly the Russian intervention complicated matters significantly. Mr. Miliband, you note that the U.N. Security Council adopted Resolution 2286 in May 2016. Given Russia's permanent seat on the Security Council and habit of vetoing resolutions aimed at the murderous Assad regime, no matter how egregious and deplorable Assad's actions have been, I was curious so I went back and looked at the comments of the Russian representative in May of last year during the passage of this Security Council resolution. Do you know what the Russian deputy permanent representative emphasized in his comments? It is really duplicitous, breathtaking, what he says. He says that it was unacceptable that medical personnel continued to suffer attacks since people's lives depended on their work. He said, ``Protecting humanitarian personnel, including medical personnel, is one of the most important aspects of the whole issue of protecting civilians.'' He further said members of the U.N. must do more work to protect medical personnel. This, again, coming from the Russian deputy permanent representative. The Russian representative also tried to cast doubt regarding Russia's conduct in Aleppo by emphasizing the need for the Security Council to be guided by reliable information. He said, ``It is unacceptable that unverified reports of attacks against hospitals taken from unreliable sources are fed to the media and then used for political pressure.'' Doctors, do you have any thoughts about the Russian representative's comments at the U.N., his assertion that reports of attacks against hospitals are unreliable? Dr. Abdulkhalek. We noticed the attacks being more aggressive in the last months, after they made the siege on al- Waer, on eastern Aleppo. At that stage, Russia was very involved in the process of attacking the more civilian areas. So Russia started to make a big effort to damage the hospital and to let us flee from that area to another area until we had to evacuate all the city of Aleppo. Senator Risch. Senator Menendez. Senator Menendez. Thank you, Mr. Chairman. It is truly a tragedy that we are holding a hearing today to mark the beginning of what was a peaceful uprising in Syria that has turned into the worst humanitarian crisis in recent memory. And we have all seen the heartbreaking images of children and families suffering under the barbaric attacks of Bashar Assad, his brutal oppression, ISIS, the network of actors including Vladimir Putin in Russia, Iranian terrorist networks, who continue to support his ongoing war crimes and human rights violations. And it is unconscionable and reprehensible that the leader of any country could orchestrate bombing campaigns against innocent civilians and institutions, hospitals, schools, aid convoys whose sole purpose is to provide aid and support the communities. So I have the utmost respect for all of you and all of the work you are doing, particularly the doctors. You truly honor your profession globally. And in the darkest moments of man's inhumanity to man, as we have seen in Syria, you have shown us what humanity truly is all about. And so we honor you. And the mere fact that you have to wear masks to protect your identity just speaks volumes of the challenge that you face. But I have to be honest with you. I am concerned that, in the midst of listening to all of the comments of comfort and solidarity and succor, that the reality is that that means nothing if we are going to have a 37 percent cut in our budget, nothing if we are going to deny refugees to come into the United States, nothing if we are not going to continue U.S. leadership in the world in this regard. So all these statements of solidarity will only mean something to me, and certainly more importantly to those who are fleeing Syria, when we act in ways that actually embrace the cause and actually shows our solidarity in meaningful ways--in meaningful ways. So this is why I have a real concern our humanitarian programs operate out of the State Department, mostly the Bureau of Population, Refugees, and Migration, and a host of programs through USAID. I am deeply alarmed by the administration's proposed budget plan to slash these agencies, which account for just 1 percent of the overall budget. I think it is not only morally reprehensible. These kinds of drastic cuts are squarely against the national security interests of the United States. It abdicates our global leadership. It puts our allies at greater risk. We want to say to other countries in the world, in Europe and elsewhere, when the King of Jordan comes here, thank you for housing the refugees from Syria. And yet we are going to cut the very assistance that ultimately gives that a possibility. So I hope my colleagues, when it comes time to follow up the words of solidarity, will do so with their votes. Now I want to go particularly to Mr. Miliband. I appreciate what your organization does, the IRC. I thought the title of ``Senator'' was pretty significant, but ``The Right Honourable'' is a real heckuva title. But on a serious note---- Mr. Miliband. I promise you it is not a hereditary thing in the U.K. Senator Menendez. New Jersey has welcomed 275 Syrian refugees in the past 12 months, and the IRC has an active network in New Jersey that, in my view, has enriched the State. But what happens when we take a different course? I know that you head an organization, and, of course, you had your own distinguished career in Great Britain, but as one of the greatest allies the United States has had, what would you say to us is the consequences of us cutting in half the number of refugees to come to the United States? What are the consequences of decimating the budget that ultimately helps? Why would it not be in the national interests of the United States and its security to do so? Mr. Miliband. Thank you, Senator. I think the simple answer to that is that America helps create a more stable world, and American retreat leads to more instability that is not just an affront to America's moral values but also to her interests. And both in respect to foreign aid and in respect to refugee resettlement, this country has good claim to be a world leader. Maybe it takes a foreigner to recognize the good things about a country, and one of the areas where America undoubtedly has claimed global leadership is in its refugee resettlement program. It is definitely one of the most successful refugee resettlement programs in the world. We are working in Germany and elsewhere where they want to learn the lessons of your refugee resettlement program. So I think that there is an affront to American moral values, but also the strategic leadership that you offer. This global system that we have, this global order that we have, for all of its faults, is upheld by American leadership. And when that leadership is in retreat, then both international humanitarian law, but also global stability, are threatened. Senator Risch. Thank you. Senator Rubio. Senator Menendez. Thank you, Mr. Chairman. Senator Rubio. Thank you all for being here, for all the work you do, and, in particular, for the doctors, who have risked so much to be a part of this. I want to touch on the narrative that some have put out. Since you are on the ground and you have been here and you have seen this reality up close, you can hope to enlighten us about this reality, and all of you, I think, can comment on it. The narrative that you see in some of these outlets around the world, which I do not know where they are getting their news from, is the following, and that is that: Aleppo was a city divided between areas controlled by rebels and areas controlled by the government; and that these benevolent Russian forces, combined with the regime, went in and liberated this part of the city held by rebels who, by the way, I do not think anyone here is a fan of many of those elements, many of which are radicals and who themselves committed all sorts of atrocities against humanity; and that these very benevolent forces came in and liberated this part of the city and rescued all of these civilians and are doing these phenomenal things. And you saw this in late December, images of churches opening. And people know where I stand on Russia. People know how I feel about Assad. And I see a lot of these emails telling me, what are you talking about? Look at these phenomenal things that are occurring in Aleppo with these ``liberated areas.'' In the context of all of this, what is lost that, apart from the rebel forces, many of whom are criminals themselves, is the reality of the suffering of the people that had nothing to do with either side. They just happened to live in this area. They happened to be families and children that were going about their lives not involved in the internal politics of any Nation, including their own, and somehow were targeted, which is what you have now described. Tell us the reality. If you were someone who happened to live in one of these areas, and I think you have touched upon it, but the reality of this sort of notion of liberation, this notion that somehow these benevolent forces have come in now and liberated and are helping to reconstruct a part of the city, how would you characterize the way this was conducted by Assad, by Russia, and even by some of the rebel elements as they left? Dr. Abdulkhalek. I can tell you that, in the eastern part of Aleppo, now the U.N. maps decided that about a fourth of the buildings are destroyed completely, and the other buildings are damaged. There is no life now in eastern Aleppo after the rebels have gone away and after the civilians had fled to other parts to near Idlib. No electricity, no clean water until now. Not all, most of the rebel soldiers are not rebels in the beginning of the revolution. They were civilians like us, and they had to raise their weapons against the government because the government started killing every one uprising against the government. So they were not a soldier from the beginning of the revolution. And they deal with civilians like their brothers, most of the cases, of course. They are afraid of our lives. They let us evacuate before them. And they do not involve by targeting us or killing us. Senator Rubio. You may have alluded to this earlier. I didn't see it in the written testimony. And I see that two of you are concerned about being identified for your own safety. Dr. Abdulkhalek. Yes. Senator Rubio. Who are you fearful of? Dr. Abdulkhalek. We are fearing? Senator Rubio. Yes. Dr. Abdulkhalek. From the government. From the government because, if they discovered our identity, they may send someone to get rid of us, or they can capture our relatives in their area. Senator Rubio. These medical facilities that you worked in, were these medical facilities being used by anyone to conduct war against the government? Or were these just places---- Dr. Abdulkhalek. No. No, it was just a place for operations and for helping civilians. Sometimes injured soldiers came to us, but we do not know which kind of rebels he belonged to, which one he belonged to, that group or that group. We don't know. Senator Rubio. But the bottom line is these were facilities that were treating people with medical conditions, and you have no doubt in your mind that these buildings, particularly after the Russian engagement, were specifically targeted. Dr. Abdulkhalek. Yes. Yes, because many of these hospitals are well-known to the government. They start targeting it one by one, one time and then repeated it until they destroyed it. Then they stopped targeting it after they destroyed it. They knew that it has been out of service, so they stop targeting it. Senator Risch. Thank you. Senator Markey. Senator Markey. Thank you, Mr. Chairman. Let's just get right to the heart of this. President Trump wants to cut the State Department budget by 37 percent, and then move the money over to the Defense Department in order to build more bombs. So that is going to create a dynamic that is very dangerous inside the country. Right now, Russia, Turkey, and Iran are gathered in Astana to shore up the ceasefire, and the Geneva talks are scheduled to resume this week, but the United States does not appear prepared to have a significant role in any of the upcoming discussions, even though the United States has been a part of this war almost from the very beginning. So, Secretary Miliband, how long can America remain absent from these discussions, if we are going to be able to reinforce the ceasefire, protect civilians, allow medical and other relief to go to victims? Mr. Miliband. Well, thank you, Senator. First of all, I think it is important to recognize what the doctors said earlier. The notion that there is a current ceasefire is an abuse of the term ``ceasefire,'' because---- Senator Markey. I agree. Mr. Miliband.--there are significant activities still taking place. Secondly, without a U.S. voice speaking up for the protection of civilians, there will be no voice doing that. Senator Markey. We need U.S. diplomats at the table. Mr. Miliband. I would argue very strongly for that. And I think there is something that Senator Rubio and Senator Cardin have started, this accountability bill that they have introduced, it could very powerfully be linked to a recent resolution in the U.N. General Assembly for bringing together trial-ready material to hold accountable those who commit war crimes. And while it is true that the U.N. Security Council is deadlocked, the U.N. General Assembly is not deadlocked. There is a massive majority of countries ready to support that kind of initiative. Senator Markey. Mr. Keny-Guyer, child soldiers, it is not just ISIS. It is also the Free Syrian Army that are engaged in conscripting children into their armies. What would you recommend the position of the United States should be, in terms of what we use our influence to try to ensure is the policy in Syria? Mr. Keny-Guyer. Thank you, Senator. Obviously, with respect to child soldiers anywhere-- anywhere--whether that is in Africa, whether that is in the Middle East or other parts of the world, we have to have a firm policy that is unacceptable, and those who engage should be held accountable. And I think Senator Rubio described it very well in his description, is Syria has devolved into a situation now where any fair-minded person looking at it is going to go it is hard to sort out who are the good guys and who are the bad guys. It is not crystal clear who the good guys are. But what is crystal clear is that stability in Syria, stability in the Middle East, is critically important for every interest that this country has in that part of the world, and it is critically important to our national security. And as the doctors reminded us, the only solution--there is not a humanitarian solution. Frankly, there is not a military solution. We know the only solution is one that is diplomatic, going forward. And I would certainly urge and believe that we will end up with a lot better solution, one that is more in the U.S. interests, to the degree that we are engaged and at the table. Senator Markey. So you are, once again, just reinforcing this point that whether it be the ceasefire or it be the conscription of child soldiers, all the way down the line, the longer the war goes on, the more each side begins to engage in activities that are atrocities by any definition. And so that is why the United States cannot abandon the diplomatic pathway. It is only solution, ultimately, to this problem. Can you talk a little bit about the programs that we can put in place in the country to protect women and girls, if you have any suggestion to us that the United States Government should be trying to advance? Mr. Keny-Guyer. Well, the biggest protector of women and girls are the community norms and structures that already exist inside Syria. And to the degree that we can support, and all of us work with this--IRC, Mercy Corps. There are credible, civilian, local councils inside Syria that are not involved in the politics, are not involved in the fighting, and believe one day they are going to have the opportunity to build a better Syria. It is in that context where you support organizations like ourselves who work through local Syrian groups. That is the best way to ensure the protection of girls and women. Senator Markey. Do we need to be talking to the Russians to get this resolved, in your opinion? Mr. Keny-Guyer. I think one needs to talk to anyone who is ---- Senator Markey. Including the Russians. Mr. Keny-Guyer. Yes, sir. Senator Markey. Mr. Miliband, do we have to be talking to the Russians to get this resolved, in your opinion? Mr. Miliband. Definitely. But progress depends on what you say to them. Senator Markey. I appreciate that, but you have to have the discussions with them. If you do not have the discussion, it is just repetition syndrome. We are just going to see this go year after year. Do you agree with that? Mr. Miliband. I do. I think the other thing to say is that Russia and Iran are not natural allies, and we should not take it as a matter of definite course that they are cleaved together in an alliance that is unbreakable. And there are some signs that Russia and Iran are sending different messages into the system. And I think it is in your interests, in American interests, that they do not cleave together. Senator Markey. Thank you. I agree with you. Senator Rubio. [Presiding.] Senator Flake. Senator Flake. Thank you, Mr. Chairman. You know, it seems that absent a diplomatic, political solution, we are not going to see an end. I think that is agreed here. But we have been pursuing that for 6 years now without success. The humanitarian situation has been well-documented, but I would like some indication of where that goes from here, how much worse it can get or what we are likely to see if no political solution is reached in the coming months. Mr. Miliband. Mr. Miliband. Thank you, Senator. I would say two things about that. First of all, I think you are going to see more and more people leaving Syria. I mean, you have 7 million internally displaced already in addition to 5 million refugees. We have not seen the end of the refugee flow. And, frankly, the bombardments that are still taking place will drive further people out. The second point is to pick up something Senator Markey was saying. I remarked to him that Iran and Russia are not natural allies. And neither are Turkey and Russia natural allies. Remember, Turkey is a member of NATO and a significant part of the future of the conflict depends on the relations between Turkey, Russia, the Syrians, and the U.S., in respect to the Raqqa situation. And so if it is correct, as the U.N. says, that 400,000 people could be displaced by the attempt to retake Raqqa, then the way in which the U.S. engages is absolutely critical to that. Senator Flake. Any other thoughts on that? Will it be manifested in just increased refugees outside of the country then? Is that the agreement? Mr. Keny-Guyer. No, as I said earlier, Senator, I worry greatly about a whole generation, now going on two generations, of young people who have not been educated, who have not had a chance to contribute positively to their societies. And particularly in that part of the world where there are competing ideologies, some of them as sinister as they come and should not be allowed to continue to exist in a civilized world, yet those becomes pathways, increasingly, for young people out of that mix. And so the longer this goes on, the more the instability continues, I think the more we need to worry about those kinds of issues. And that is why it is so important to bring this to a close as soon as we can. Senator Flake. The U.S. and the EU and other organizations and countries have been certainly helpful with the humanitarian effort. Can anybody give any idea what Russia has done with regard to humanitarian efforts? Mr. Miliband. That is not their focus. Senator Flake. I know that is not, but is there even an attempt to make it look like they are concerned about the humanitarian situation? Mr. Miliband. I did actually raise this with the now-famous Russian Ambassador some time ago, and the Russians talk about their support for the U.N. system, and that is the way in which they would see their humanitarian aid going forward. Senator Flake. But nothing independently, unilaterally? Mr. Miliband. No. Senator Flake. Okay. All right. Thank you. Thank you, Mr. Chairman. Senator Rubio. Senator Merkley. Senator Merkley. Thank you very much, Mr. Chairman. Today, here we are 6 years from March 15, 2011, the ``Day of Rage,'' where mass popular demonstrations occurred against the Syrian President, triggered by the Syrian secret police torturing young boys who had spray-painted anti-Assad graffiti, 6 years in which we now see a half million people who are dead and a quarter of the 21 million people in the country have fled, destabilizing neighboring countries, certainly having a big impact on Europe. U.N. Secretary General Antonio Guterres, when he was High Commissioner of Refugees, characterized the war in Syria as ``the great tragedy of this century, a disgraceful humanitarian calamity with suffering and displacement unparalleled in recent history.'' Our witnesses today, the doctors and IRC and Mercy Corps, have been there in these horrific circumstances, trying to assist with medical care and nutrition and support, and I commend them all for this tremendous effort individually and with their organizations. I am disappointed that Turkey has revoked the registration of Mercy Corps to provide assistance through Turkey to over 300,000 Syrians. I do appreciate the Government of Turkey has been a leader in the refugee response and a close partner to Mercy Corps over many years before. So, Mr. Keny-Guyer, I would like to ask, what are the immediate steps that would be helpful that you might like to see taken by the Government of Turkey? Mr. Keny-Guyer. Thank you, Senator. And thank you for your efforts as well in this matter. You know, when the revocation came, we were, frankly, stunned and deeply saddened. And I say ``saddened'' because of the hundreds of thousands of Syrians that we help each month inside the country and have been such a critical lifeline of support and hope. And then, secondly, particularly for our Syrian team members who have put their lives on the line through all of these years in the toughest times and darkest days to make a difference. And we have always enjoyed a close working relationship with Turkey. So our approach right now is we presume, and we have not been given an official reason, but we presume that there is some technicality and that our sole aim is to enter into discussions and negotiations that will allow us to restore our ability to operate. The governors in Turkey have been extremely supportive of our work. The local authorities have been supportive. The Turkish Red Crescent has been supportive. And so we thank the Senators here for all your support. And at this stage, we are working night and day to ensure that we can get back to work there as soon as possible. Senator Merkley. And has our State Department been helpful in facilitating a conversation? Mr. Keny-Guyer. Our State Department and our Ambassador have been extremely, extremely helpful. I want to commend them for their efforts, particularly in these difficult times. Senator Merkley. So at this moment, with the supply chain of significant assistance to over 300,000 inside Syria, with that disrupted, can you paint for us a picture of the challenges being faced by those who would have otherwise been assisted by the flour and water and support that you all provide? Mr. Keny-Guyer. Well, a large, substantial portion of our aid going cross-border was wheat flour that went to bakeries. We were trying to use markets to keep the price of bread affordable for ordinary, normal citizens there. And through those bakeries, really vulnerable people got vouchers so they could pay a very little amount for their bread. So that was a critical lifeline. In addition to that, there are a number of internally displaced camps for Syrians along the Turkey-Syrian border. We have been providing clean and fresh water for those camps to more than 100,000 people on a weekly basis. So immediately, those abilities have been cut off. In addition--because, again, we see the resilience of Syrians. We see their desire to help themselves, even at this time. We have been supporting inside Syria the recovery of agricultural land so that Syrians could get back to growing their own food and not be as dependent on the outside. Again, wherever you can restore markets, it is so important for people. It is so important for any chance of recovery. All of those programs are at risk. Senator Merkley. Thank you very much. Thank you. Senator Rubio. Senator Kaine. Senator Kaine. Thank you, Mr. Chair. I want to thank some colleagues. Senators Murphy, Rubio, and McCain joined with me today, introducing a resolution commemorating the challenges of the last 6 years and encouraging all of us, the global community, to do more. I want to thank the organizations here, IRC, Mercy Corps, and SAMS. SAMS does wonderful work. You have been praised as individuals, but I also know this organization. And I met with SAMS physicians in the United States and also in Gaziantep. It is really, really a strong organization. Thank you for what you are doing. A comment, and then maybe a question or two. In November 2015, right before Thanksgiving, the House of Representatives here passed a bill called the security America against foreign enemies act. That was the bill that blocked Syrian refugees from coming into the United States. This is a body that will not have a vote to declare ISIS an enemy, but it will label Syrian refugees an enemy. I was very proud of my Senate colleagues. When that bill came over here, we would not have anything to do with it, because refugees are not the enemies of the United States. And I am extremely discouraged that, after the Senate had the good sense not to do that, this administration came in and perpetrated the same thing. It issued the immigration orders in January with the title, an executive order protecting the nation from foreign terrorism. That was the title. The revised immigration orders are not much better because they hit refugees in three ways: one, by a temporary suspension of the refugee program; two, by a temporary suspension of Syrians being able to come to the United States; and, three, by a dramatic reduction of the number of refugees the United States will take. Refugees are not terrorists. Refugees are not enemies. When the administration issued the initial executive order, I was in Roanoke, Virginia, and Blacksburg, far from an international airport, far from worrying about this issue, doing events about the Affordable Care Act there. And I had somebody come up to me at a reception and said, hey, my family helped a Syrian refugee family resettle in Roanoke, working with Catholic Charities a year ago. Let me tell you how great they are doing. The husband is working on a construction crew, and everybody loves him. And all the construction workers of different political persuasions banded together to buy soccer shoes for all the kids at Christmas. And you can never say anything bad about this guy in front of any of those construction workers. This family has been a credit to our community. But what they were asking me was this, here is what they said, but we have a second Syrian family arriving at the Roanoke airport in 4 days. They have been in a refugee camp in Jordan for 4 years getting vetted and finally approved to come to the United States. What is going to happen to them? And they have not been able to come to the United States. The notion that this administration is perpetrating, that refugees are enemies, is just absolutely contrary to the values of this country. I second comments made that the slashing of the foreign aid budget would be a horrible thing. But even if the foreign aid budget does not get slashed by a penny, perpetrating a stereotype about refugees or Syrians, that they are our enemies, is deeply troubling to me. A question: The U.N. Security Council in February of 2014 passed a Resolution 2139 calling for cross-border delivery of aid, safety for people receiving aid, and safety of medical facilities. I think the enforcement and implementation of that has been a disaster, based on the testimony that has been given. What does it say about the U.N., what does it say about the Security Council, what does it say about the nations that are members of the Security Council, that a resolution that called so clearly for there to be delivery of aid and protection of medical facilities has been so poorly enforced in the 3 years since it passed? Mr. Miliband. If I might, Mr. Chairman, I think that there are two very important things to say about that. First of all, you made a distinction between the U.N. and the U.N. Security Council, and there is often a confusion between the agencies of the U.N., the officials of the U.N., and the countries that stand it up. I know from my own experience that a divided Security Council means a weak U.N. And the truth about these resolutions is that a divided Security Council weaken the hand of all those trying to implement the resolutions. The second point, I do not know which is worse, the fact that the 2014 resolution has not been abided by or that a resolution condemning the use of chemical weapons on the 28th of February this year was vetoed by the Russians. And I think it is important to see the two of them together because it points to the fundamental challenge that now exists, because we have never been in this situation before, where a permanent member of the Security Council was unwilling to uphold fundamental aspects of international humanitarian law. Senator Kaine. Yes? Mr. Keny-Guyer. Senator, if I may just add quickly, I think you point out the U.N., even the best of the operational agencies often reflects the politics of the Security Council, and discourages them sometimes from taking the kind of bold, clear action that they should be taking. We have encouraged them, along with IRC and others, we encouraged them from the day of that resolution to now test it and push, push, push for cross-border humanitarian assistance. Unfortunately, that did not happen. I think that just reinforces why and how important it is, the importance of organizations like Mercy Corps, IRC, and SAMS, in order to reach people in need in some of the toughest places in the world, but particularly those environments that are plagued by these kinds of politics. We are often the only last mile and the only lifeline. Senator Kaine. Mr. Chair, I have one more question, but if you would like to each ask questions before I do, I can---- Senator Rubio. No. Do you have any further questions? Senator Cardin. No, I just will have closing comments. Senator Rubio. Okay. Senator Kaine. If I might, the U.S. is currently engaged in major military action with other nations against Raqqa, and there has been a prediction that that might lead to another 400,000 refugees out of the area. I do not want to ask you about the military side of it, but what would be your prediction? If this military operation is successful, walk down the road with us a bit and tell us what we, A, might see in terms of the humanitarian challenge; and, B, what that might mean in terms of opening up space for either a greater or lesser likelihood of a political resolution in Geneva and some of the talks about finding a ceasefire and then, hopefully, a next chapter in Syria. Mr. Keny-Guyer. Well, very quickly, I do not know any of us who do not hope deeply that groups like Daesh, ISIS, have no place to operate anywhere. They are not in the interest of anyone. They are certainly not in the interest of innocent Syrians. And so I think one would welcome through that kind of action that Raqqa could come back as a normal city. In terms of the humanitarian impact, it really is going to depend on, obviously, how the military action unfolds. There were great predictions that Mosul would produce a million- person humanitarian disaster. It still might. It has not, up to now. I think we all have appreciated some of the great care that has been taken, the real concern for civilians. Again, they are suffering. But some of the harshest predictions did not come true. I think we all hope that for Raqqa as well. And so if there is effective coordination on the ground, if there is upholding humanitarian principles and rights, if there is respect for the actors like ourselves, I think, actually, we could move in very quickly, restore essential services and meet critical humanitarian needs, if there is also the funding available to do that. Mr. Miliband. First of all, I think it is very important to emphasize the degree of trauma that it means to live under ISIS/Daesh for 2 or 3 years. The people I met last week coming out of Mosul have lost sons, brothers, to execution. They have relatives who are in hiding, literally not coming out of their own house for 2 years because they previously worked for the Iraqi Government. There will be a massive degree of trauma. Secondly, I do not see Raqqa being a quick win at all. You are going to be debating this in a year's time, I would guess. And I think it is very important to recognize that. Thirdly, we know from history, and we can see in Iran today, the position of civilians in the definition of military operations is absolutely key to the way in which the peace is then built after the war has been won. And the way in which you win the war defines whether or not you can build the peace. And civilian casualty rates in Mosul are currently running at 47 percent, and that is obviously a dangerous down payment on any attempt to rebuild the city afterward. That is one reason that the humanitarian, the political, and the military all come together. A final point on the political options, the great danger is that the options get worse rather than better, and the options become increasingly extreme opposition groups that Chairman Rubio has referred to versus an Assad regime that in its pomp and its ``claimed victory'' asserts itself in an even more bloody way, and that is a recipe for continued instability inside Syria. Senator Rubio. Senator Cardin. Senator Cardin. Mr. Chairman, I just really wanted to thank the panel. Mr. Miliband, I think, will make his 1 o'clock deadline. I would point out that, in Mosul, we have a government that we can at least work with and communicate with, whereas, in Raqqa, we do not, so there is, I think, a much greater risk in Raqqa. I would also point out that, clearly, we need to deal with the responsibility and accountability to the Assad regime, to Russia's involvement in Syria, to terrorist groups that are operating in Syria, all that is continuing to add to the humanitarian crisis. So we need to engage the international community more effectively in dealing with this. But it starts with taking care with business at home, what we do here in the United States, and many of my colleagues have talked about this. But our refugee program is not only directly important for refugees, but it is a signal to the international community as to America's leadership. And it very much will affect policies in other countries. You mentioned what Europe decides to do, what the neighboring countries of Syria decide to do. We also, in Congress, have our responsibility. We are the ones who pass the budget. President Trump can submit a budget, but we are the ones who pass the budgets. And we have a responsibility. And Republicans and Democrats have been speaking out about the importance of our foreign assistance budget, and I hope we will do the right thing there. We also need to deal with atrocity prevention. We mentioned many bills today. We also have an atrocity prevention bill that is bipartisan that we are working to try to get done. Senator Rubio has been one of the key leaders on that. War crimes accountability, we had that also. Senator Rubio has been instrumental. But it is also U.S. global leadership. Where is America? And we do that by our policies but also by our priorities that we set globally. So we know that displaced families are at risk. We know that it is difficult to get humanitarian aid to those who are at risk. And we all need to do a better job. I thought today's hearing--I want to thank again the doctors, particularly, for being here. But I want to thank all of our witnesses for providing, I think, very helpful information as to what we need to do to help not only Syrian humanitarian needs but their whole region, which is involved. Senator Rubio. Well, I thank the ranking member and all the members who came today, and everyone who is on this panel, including and especially the doctors here who have taken great personal risk not just in their conduct on the ground but even being here today. There was a statement made earlier, and I understand exactly what you meant to say. I believe it was Mr. Keny-Guyer who said we do not know who the good guys are, and I understand exactly what you mean. But I know who three of them are. I know who five of them are, but three in particular who are with us today and the three doctors, in particular, the doctors who are here, and we thank them for the work that they have done. The other part that is striking today, and I say this to my colleagues who remain, and there is a lesson to be learned, we did not have to be here today. This did not have to happen. This began, as has been pointed out repeatedly, by Syrians themselves standing up against the government. And when we talk about some of these horrifying actors on the ground, it is amazing how many of them are not Syrians, how this vacuum in Syria became a magnet for foreign fighters from all over the region to come in and use it as a playground for their broader aims and goals, how the Assad regime has invited non-Syrians to come in and slaughter their fellow countrymen. And it was stunning in this committee about 2 months ago we had a hearing, and I asked a very direct question of the then- nominee for Secretary of State about whether the Russians have been involved in the commission of war crimes, and he said he was not aware. It has been 2 months, so I think hopefully by now he has been made aware of the reality that targeting medical facilities, no matter what is happening in that area, is a war crime, and that that targeting would not have been possible had it not been for the assistance and potentially the direct attacks conducted by the Putin regime. Moving forward, I think that this is an ongoing crisis for the world. And to those who have argued in the past that America has a lot of problems, and we should be focused on our problems, and let other countries take care of their own problems, it does not work that way. That is not how the world works, especially now, as interconnected as it is. We are having debates in this country about refugee programs and the like because we have refugees. If we did not have refugees, if we did not have people who needed to leave, there would not be a refugee issue for us to be debating in this country. And the other is, this is what the absence of American leadership looks like. And sadly, I believe it is a bipartisan absence, in many cases, that has led to this situation. So sometimes in foreign policy, it is not enough to do the right thing. You have to do the right thing at the right time, because if you do not, those options are forestalled and you reach the situation that we face here today. Our obligation is to take this message back to our colleagues and ensure that these ideas are reflected not just in what we do now when it comes to Syria but the role that America decides to play in the world in the years to come. And having this hearing here today, and hearing the testimony of all of you, but in particular those who risk their lives before they came and risk their lives now upon their return, I hope will serve as an inspiration to every member of this committee, every Member of the Senate, and those of us who care deeply about the affairs of the world, about the way forward in the years to come. So I thank you for hosting this hearing, and I want to thank all of you for being here. The record for this hearing is going to remain open until the close of business on Friday, and that includes for members. That is time for members to submit additional questions for the record. We ask the witnesses, if possible, obviously, given the circumstances, to respond promptly, because they are going to be made part of the record, which we can refer back to as we debate some interesting topics in the weeks and months to come. So with that, I want to thank again every member of the committee who came, and this hearing is adjourned. [Whereupon, at 12:50 p.m., the hearing was adjourned.] ---------- Additional Material Submitted for the Record The Committee Received No Response From Mr. Neal Keny-Guyer for the Following Questions Submitted by Senator Todd Young Question. Mr. Miliband and Mr. Keny-Guyer, as the heads of your respective organizations, you both have worked with the Department of State and USAID. This is the authorizing committee and the committee of oversight for State and USAID. Based on your interactions with State and USAID, what do you believe are the areas in most need of oversight attention and reform? [No Response Received] Question. Mr. Miliband and Mr. Keny-Guyer: To what degree do your respective organizations depend on private sources of funding? Please provide statistics. [No Response Received] Question. Mr. Keny-Guyer, you have noted that in the last few weeks the Turkish government revoked Mercy Corps' registration to operate in Turkey. You write in your prepared testimony that this decision disrupts ``lifesaving assistance to 360,000 Syrians every month inside Syria and effectively ends [your] support to 100,000 Syrian refugees and Turkish children, women and men in Turkey.'' Do you believe that many of the Syrians who Mercy Corps will no longer be able to help inside Syria will likely flee to Turkey--increasing the burden on the Turkish government? From that perspective, wouldn't it be in Ankara's self-interest to permit Mercy Corps to resume its lifesaving work? [No Response Received] __________ Responses of The Right Hon. David Miliband to Questions Submitted by Senator Todd Young Question. Mr. Miliband and Mr. Keny-Guyer, as the heads of your respective organizations, you both have worked with the Department of State and USAID. This is the authorizing committee and the committee of oversight for State and USAID. Based on your interactions with State and USAID, what do you believe are the areas in most need of oversight attention and reform? Answer. The Department of State and USAID have long played a critical role in alleviating poverty and responding to disasters, conflicts, and other humanitarian crises around the world; their leadership, partnership, and funding enable us to do our work more effectively as non-governmental organizations. Of course, as the nature of crises have changed over the years and our sector has learned more about best practices, these agencies have needed to modernize their mechanisms of assistance. As noted in the attached brief, USAID and the Department of State have--often in close collaboration with Congress and this committee--taken significant steps to improve their effectiveness. This includes undertaking an internal reform strategy (USAID Forward) that increased funding and requirements for evaluation and evidence generation, local engagement, and public- private partnerships; reporting and publishing foreign aid financing data to ForeignAssistance.gov and the International Accountability and Transparency Initiative (IATI) platform; reforming food aid to increase local and regional procurement; and most recently supporting the passage of the bipartisan Foreign Aid Transparency and Accountability Act through this committee and the House of Representatives. Nonetheless, the crisis in the Syria region--where refugees are living in displaced situations for many years, outside of camps, with pressing needs for education and jobs and not just food and shelter-- has highlighted a problem common to not just USAID and the Department of State, but to the international aid system more broadly. Namely, we have relied too long on an outdated and false construct that humanitarian and development work belongs in separate, often uncoordinated sectors. Funding can be siloed between humanitarian responses and development work, when in reality it is not a linear process with humanitarian aid and economic development intricately linked. Refugee crises place pressure on host countries and communities, which can generate economic pressure on community and government systems; possibly leading to the erosion of development gains. Lack of economic development and opportunity often times provides fertile ground for new humanitarian crises, whether by diminishing the resilience of communities facing shocks like El Nino conditions or in exacerbating tension and conflict between different demographic groups. There have been steps forward to better coordinate the United States' humanitarian and development efforts so that all resources and skill sets are brought to bear in reaching the goals of assisting people and making sure that humanitarian crises do not result in the loss of hard won development progress. These include advancing ``resilience'' efforts and better combined planning in complex refugee emergency environments like the Syria region. However, further opportunities should be explored to link humanitarian and development planning where appropriate. While emergency response is critical it is insufficient for creating long-term safety and stability; therefore financing structures that allow for a longer-term approach to assisting those displaced for years are required. There are several opportunities that would advance U.S. humanitarian agencies toward this continuum and ensure even greater combined impact: First, humanitarian and development agencies should work together to orient planning around collective outcome targets. Agencies could define specific targets that correspond to medium- and long-term outcomes beyond emergency assistance--measuring not just the number of food packets delivered, but proportion of the population that is now not hungry, or not just the number of children enrolled in school, but their learning and skills--to drive greater accountability and focus on the right solutions. These targets should have corresponding common indicators, so results can be compared across projects and agencies. As an example, the IRC has implemented a set of core outcome indicators that is allowing us to standardize our planning and reporting and evaluate our impact across the many different contexts in which we work.\1\ Adopting collective outcomes for crisis-affected populations as measures of success would encourage the Department of State and USAID to work jointly and more comprehensively across their humanitarian and development arms to accomplish these goals. Second, U.S. humanitarian agencies should provide more multi-year funding. Long-term displacement is now the rule, not the exception, with most refugees displaced for a decade or more. As a result, programs should be designed not on 9 month or 1-year time frames, but over longer periods (2 years or more) to allow agencies and their grantees to provide more meaningful assistance to displaced people and the communities hosting them, and have sufficient time to measure and report on the outcome targets defined above. It would also reduce the high administrative costs of having to renew 12-month grants year after year. Third, agencies could more rigorously incorporate evidence on impact and cost-efficiency and effectiveness into program planning and evaluation. As explained in more detail in question 3, the Department of State and USAID have strong policies on evidence and evaluation. Including requirements for all grantees to link interventions to the existing evidence base, and investing even more in generating new research to fill evidence gaps for programs in crisis settings would solidify their role at the forefront of outcome and evidence-driven humanitarian practice globally. Question. Mr. Miliband and Mr. Keny-Guyer: To what degree do your respective organizations depend on private sources of funding? Please provide statistics. Answer. For FY2016, the IRC received $128 million from private contributions, representing 17% of our total income. Question. Mr. Miliband, in your prepared testimony, you ``advocate for a strong commitment to evidence-based programming and clearer `collective outcome' measures for what we expect to achieve for the health, safety, education, and incomes of displaced populations.'' You also call for ``greater investment in R & D for the sector.'' How does the International Rescue Committee employ evidence-based programming? What best practices or lessons learned have you identified that can inform our oversight efforts and benefit other groups? In your experience, to what degree do the Department of State's Bureau of Population, Refugees, and Migration (PRM) and USAID's Office of Foreign Disaster Assistance demand evidence-based programming with clear outcome measures? Answer. evidence at the irc By generating, sharing, and using data and evidence, the IRC aims to improve the effectiveness and efficiency of programs and policies in humanitarian settings, and to significantly and sustainably improve the lives of people affected by crisis. The IRC maintains a dedicated professional Research, Evaluation and Learning team whose job it is to ensure that we rely on evidence to design and operate our programs. The team develops cutting-edge tools and guidelines that enhance IRC's ability to monitor the quality of work and track performance. They build our capacity for sound data collection and methods of analysis, and for demonstrating with precision the impact of our practitioners across the globe and the United States. One of these tools--the Outcomes and Evidence Framework (OEF)--was rolled out across all IRC programs last year to be integrated into program design and reporting. The OEF is a set of tools, including theories of change, outcome indicators, and evidence maps, for IRC staff to use to ensure our programs are outcomes based and driven by the best available evidence that proves what interventions do and do not work to achieve those outcomes. Beyond this commitment to improving how we operate, the IRC is also sharing this approach with other practitioners, donors, and any interested parties, including this committee, through an online interactive Outcomes and Evidence Framework found at www.rescue.org/oef. Although we have worked to compile the best evidence available in this framework, there are still substantial evidence gaps, and the IRC is working to fill them--of ten in partnership with the State Department and USAID. We have been at the frontier of conducting rigorous research in humanitarian settings, and are one of few response organizations conducting impact evaluations in conflict and post- conflict contexts. To date, we have completed or are in the process of conducting 84 research studies, including 38 impact evaluations across 28 conflict-affected countries. We are currently building the evidence base within strategic priority areas, such as preventing family violence or cash relief in emergencies, across various crisis-affected contexts and sharing our learning. With all evidence-based approaches, IRC maintains that there must be a balance of investing in and scaling up what we already know to be effective, and experimenting with new approaches that can yield even better solutions. evidence at prm and ofda In many ways, USAID and State have been leaders in establishing and standardizing evaluation and evidence-based policy and practice. The 2010 USAID Forward strategy focused heavily on building a capacity and culture of evidence at the agency, with demonstrated results: between 2010 and 2015, USAID trained 1,600 staff in evaluation methods, completed more than 1,000 evaluations on its programs, and an independent study showed that as of 2016, 59 percent of approved country strategies referenced at least one of these evaluations.\2\ Specifically within the humanitarian space, both OFDA and PRM have both embraced evidence-based programming and sponsored a number of evidence- generating research initiatives. IRC has partnered with OFDA and PRM on fifteen such initiatives over the last 10 years, including developing a new evidence-driven protocol for treating acute malnutrition,\3\ adapting screening methods for gender-based violence,\4\ strengthening community-based surveillance methods to combat Ebola,\5\ and supporting safe and sustained livelihoods for female refugees and returnees.\6\ PRM and OFDA have worked with the IRC to support evaluations and feasibility studies to make sure the interventions they are funding work. At the same time, they are themselves experts in best practices for achieving meaningful outcomes for vulnerable populations in the complex, conflict-affected contexts where we work. There are certainly remaining challenges in ensuring the range of programs chosen and the metrics used in evaluation are suited for the changing reality of crisis situations. The humanitarian sector, by nature, has been about lifesaving emergency response--meeting basic needs of food, water, shelter, medicine, etc.--and has done it well. However, given the evolving trends of displacement and crisis, where refugees are displaced for an average of 10 years, there is a need to shift from providing inputs for their survival to providing medium and long-term services that help them thrive. Humanitarian and development agencies should work together to define specific targets that correspond to these medium- and long-term outcomes--measuring not just the number of food packets delivered, but proportion of the population that is now not hungry, or not just the number of children enrolled in school, but their learning and skills--to drive greater accountability and focus on the right solutions. Adopting collective outcomes for crisis-affected populations as measures of success would encourage State and USAID to work more jointly and comprehensively across their humanitarian and development arms to accomplish these goals. Both PRM and OFDA have shown leadership in moving towards these kinds of programs and outcome measurements. They have been supportive and rigorous but also flexible partners in responding quickly to emergencies while at the same time requiring the highest standards for outcomes and for evidence generation as resources allow. For example, PRM has been among a small handful of institutions that have funded education for refugees around the world based on clear and compelling evidence that education is critical for, and one of the best predictors, of future stability, health and prosperity. However, PRM's funding is largely short-term and is rarely sufficient to cover the assessment of meaningful education outcomes such as social-emotional learning. While they are supportive of the IRC's application of the evidence underpinning our programs, there is no systematic requirement for grantees to cite evidence in project design or proposals. Expanding multi-year funding to support the achievement medium- and long-term outcomes, incorporating requirements for all grantees to link interventions to existing evidence base, and investing even more in generating new research to fill evidence gaps would help put OFDA and PRM even more at the forefront of outcome and evidence-driven humanitarian practice. Question. Mr. Miliband, in your prepared statement, you discuss the impact of the Syrian crisis on Syria's neighbors--Lebanon, Turkey, and Jordan. You note that Turkey hosts approximately 2.5 million Syrian refugees, Lebanon 1.5 million, and Jordan 1 million--placing these countries among the world's top refugee-hosting countries. I am particularly interested in the case of Jordan. Jordan's government is a close and important ally of the United States. As you state in your prepared testimony, Jordan's King Abdullah has warned that his country was at a ``boiling point'' and that ``the dam is going to burst.'' You note a 2016 assessment that found that 90% of Syrians in Jordan live below the poverty line. You note that inadequate international assistance has only made it worse. What is your assessment of the situation in Jordan? What assistance does the Jordanian government most need to help refugees and cope with the humanitarian crisis that has spilled from Syria into Jordan? Answer. Just a handful of countries bear a disproportionate percentage of the refugee caseload. Jordan is among a group of just seven (which also includes Iran, Lebanon, Pakistan, Palestinian territories, Syria, and Turkey) which together make up just 2.5 percent of global GDP, but host half of the world's refugees. We know that Syria's civilians have borne and continue to bear overwhelming harm from the country's conflict. But, the humanitarian, economic, and political impact of the rapid and massive influx of five million refugees on Syria's nearest neighbors is not properly recognized or understood. Jordan hosts roughly a million (600,000+ UNHCR plus an estimated equal number of unregistered) Syrian refugees, placing tremendous strains on its economy, politics, and social fabric. Jordan's leaders face immeasurable political pressures as economic growth remains low and unemployment remains high. Economic pressures are reaching a head with the budget deficit soaring in recent months. In cooperation with the IMF, Jordan has undertaken a variety of austerity measures that are hitting Jordanians of all economic strata. For instance, earlier this year the Jordanian government instituted deeply unpopular cuts to subsidies that caused the price of consumer goods (including mobile phone use, food, and gasoline) to skyrocket. At the same time, due in part to its commitment to the anti-ISIS coalition as well as its strong ties to the U.S. and relations with Israel, Jordan has found itself in the crosshairs of ISIS and related extremist groups. We have seen an uptick in Islamic State-directed or inspired attacks inside the Kingdom--six in 2016 and another already this year. In addition, southern Syria, heretofore relatively stable, is now the scene of intensified fighting--threatening to bring violence and instability closer to Jordan's northern border. It is a vital for U.S. security interests in the region and beyond that the Jordanian government is able to maintain this balancing act. In the context of economic strain, security threats, overwhelming refugee caseload, it is critical that U.S. economic (ESF, budget support) and military assistance (FMF, EDA, and assistance via DOD- managed accounts) continue. This assistance is substantively important--allowing the Jordanian government to service foreign debt and procure military equipment and training. But, it also has tremendous symbolic value--illustrating an enduring U.S.--Jordanian partnership and affording the strained Jordan Government a domestic political win--a tangible example of its diplomatic skill. Slashes to the State and USAID budget, especially cuts as significant as those in the Administration's proposal, would send a dangerous signal that U.S. is abandoning Jordan as it continues to host a disproportionate and burdensome number of refugees and finds itself more vulnerable than ever to terrorist attacks. These abandonment issues are exacerbated by executive order that would suspend and then limit the U.S. refugee resettlement program. The combination of drastic cuts to assistance, taken with significant cuts to resettlement would be a cruel and counterproductive move. It says to Jordanians, who are shouldering so much of this burden, that the U.S. does not stand with them; that the U.S. will not welcome refugees nor will it help them abroad. Maintaining or even increasing aid is part of the answer, but change in the sector is just as important. The financial mechanisms that have traditionally supported assistance programs for refugees are out of step with the realities of current displacement trends. Humanitarian financing is short-term, with the vast majority of grants provided for less than a year. This fails to recognize the increasingly long term nature of displacement (once out of their own country for 5 years, refugees are likely to be away for 26) but also to address other changes in the refugee experience (for example its increasingly urban nature). Given these realties, the life-saving assistance prioritized by the humanitarian sector, while critical, falls short of what is needed given that people are rarely displaced for only days or months. A significant proportion of the humanitarian budget is allocated to food and other in-kind assistance (24.7 percent to food security, shelter, and non-food items in 2016), but refugees who are displaced for several years--like those in Jordan--need much more.\7\ They need access to quality, safe education, job opportunities, and other public services to rebuild their lives and live in dignity and safety. Currently, humanitarian financing does not reflect these needs: for example, in 2016, just 1.9 percent of humanitarian aid was allocated to education. Yet almost one third--226,000 out of 660,000--of Syrians registered with the UNHCR in Jordan are children between 5-17 years old. Of these, over a third (over 80,000) did not attend school in 2015-16.\8\ Of course, resources should be reserved for unmet emergency needs--but the overall resources to address displacement of the scale we see in Jordan must grow and be better rationalized between short and long-term needs and across humanitarian and development budgets. Key constraints to refugee self-reliance in Jordan relate to freedom of movement, legal residency, access to financing, right to work, and a host of other barriers. Given the political sensitivities, Jordan (and other host countries) need and deserve strong incentives and clearly articulated benefits for integrating refugees more fully into national development strategies. In this regard, compact agreements have emerged as an approach that brings together host countries, donors, and development and humanitarian actors in multiyear agreements to achieve defined outcomes for refugees and host communities. By bringing together diverse actors and financing mechanisms in multi-year agreements focused on measurable results, compacts strengthen incentives for policy reforms. Compacts set mutually-reinforcing and binding commitments, such as financing and policy changes from both host countries and donors, with a plan and accountability mechanism for achieving and tracking results. These developments and opportunities represent some of the most innovative changes in the humanitarian sector in decades and really get to the heart of the challenged facing refugee-hosting nations like Jordan. Such an approach is already in place in Jordan where the World Bank has partnered with host governments and other donors to improve livelihoods and education outcomes. The Jordan Compact, agreed to in February 2016 at the London Donor's Conference, In Jordan, the compact seeks to create 200,000 new job opportunities for refugees primarily by developing and strengthening existing special economic zones, complemented by relaxed rules for exports to the European Union, to attract international and domestic investments and spur job growth. In return, the Jordanian government will receive low-interest loans from foreign creditors (such as the World Bank's Global Concessional Financing Facility) and trade preferences for Jordanian exports to the European Union for goods produced in special economic zones with a designated level of Syrian labor participation. The U.S. could similarly implement a ``compact'' approach for Jordan, providing robust financing with targets for improvements in the lives of both refugees and their host communities. Jordan has already proven itself a willing and strong partner in such an approach, with an award-winning compact with the Millennium Challenge Corporation. The U.S. commitment to provide bilateral and multilateral assistance--including creative thinking like the Compact model--to support refugees and hosts alike is a function of enlightened self- interest--especially for critical ally and partner like Jordan. The forced and premature return of Syrian refugees to an unstable Syria or significant instability or unrest in Jordan would foment new currents of conflict and crisis that, given U.S. interests and commitments in the region, would draw U.S. funds and U.S. troops into further quagmires. Question. Mr. Miliband, in your prepared remarks, you state that the combined U.N. appeal in 2016 was only 57% funded by year's end. You also write that ``this year we're off to a feeble start, with only 14% of the $9 billion appeal committed.'' You note that this failure of donors to honor their commitments results in pleas for help going unmet. You also observe that these gaps in assistance have exacerbated the refugee crisis. How would you further assess international giving with respect to the crisis in Syria? Which G-20 countries in particular do you believe should contribute more to help ensure this year's U.N. appeal is fully funded? Answer. A chart below provides an understanding of how much the various G-20 countries contributed to the Syria Crisis in 2016. The amounts of assistance given are also presented in light of each country's Gross National Income (GNI), a relative measure of their ability to give. The following chart shows contributions made so far in 2017. The 2016 chart shows the United States in one of the top donor positions, greatest in terms of absolute volume and fourth in terms of the donation in GNI relative terms. Clearly, as you look down the chart, you will see several countries that are giving very little in gross and relative terms. Turkey's contribution should be considered in light of the massive contribution it has made by hosting 2.9 million Syrians in their own country. The United States made impressive strides in September of 2016 through President Obama's Leadership Summit on Refugees in pushing other countries to put greater resources to respond to all refugee crises. The U.S. government pursued a ``pay-to-play'' model in which countries were only able to participate if they made concrete and actionable commitments in three core areas critical to ``responsibility sharing'' for refugees, including: increasing refugee assistance (by 30% over their 2015 contributions), doubling the number of resettlement slots offered and, for refugee hosting countries, increasing refugee self-reliance by allowing access to work permits and education opportunities. Several countries, including G-20 countries, committed to the 30% increase in humanitarian assistance. G-20 countries on the bottom half of 2016 Syria donors chart made significant commitments at the Summit, including; Australia, China, France, Italy, Japan, Korea and Mexico. Other G-20 countries among the top donors to the Syria crisis that committed to even greater financing at the Summit included Germany, Canada and Saudi Arabia. The new Administration should pick up on Leaders' Summit efforts to ensure the delivery of these commitments in real terms. A great deal of U.S. diplomatic and political energy was tapped in persuading these countries to take greater responsibility in responding to the global refugee crisis; these wins should not be lost as we transition to a new administration. While we can, and should, expect other wealthy nations to do more, it is U.S. assistance and U.S. diplomatic leadership that drives change and catalyzes allies and partners to take on their share of the burden. Question. Mr. Miliband, in your prepared statement, you write the following: ``U.S. troops are helping to clear some parts of Iraq of terrorist groups for the third time; in part because insufficient investment in humanitarian response, development progress, and political reform has each time allowed extremists to take hold.'' What does that fact tell us about the need for robust U.S. investments in effective development and diplomacy? Do you believe sufficient planning is underway now to address post-conflict governance and humanitarian issues in Raqqa? Answer. Successive military interventions have taught us that military force can and will drive ISIS from Mosul and Raqqa. But, impact of driving out the Islamic State will be short-lived without political progress and governance gains. Translating military victory into political stability requires local governance that all citizens believe is representative of and responsive to their physical, economic, and political security. Building this confidence is not a ``post-conflict'' endeavor. It starts with the conduct of the war-- whether civilians are protected either in their homes or as they flee-- and the quality of the humanitarian response--both the level and quality of services and whether populations are treated with dignity in respect by all governing authorities. Both have a direct and significant impact on the prospects for reconciliation and stabilization. This is the work of humanitarian responders, diplomats, and development professionals in concert with local governing authorities-- to save lives now and create the conditions necessary for stability later. And this work must start on day 1, not approached sequentially and left for ``phase IV.'' The residents of Mosul, Raqqa, and other retaken areas must be protected during conflict, treated with dignity in displacement, and allowed to return home with guarantees for their safety and their future. Otherwise, the cycle of instability and violence will continue. However, the IRC has identified three distressing trends, which if left unchecked, will undermine the prospects for stability and will keep the ground fertile for ISIS or an offshoot to regroup and reemerge. Military haste. A mandate to speed up the pace of military operations has emerged. This acceleration is evidenced by the sooner- than-anticipated launch of operations in Western Mosul and the increase in military activity in/around Raqqa in recent weeks--including a spike in U.S. troop numbers and the ferrying (via U.S. air assets) of Kurdish and Arab SDF fighters behind ISIS front lines. But, military haste can make for humanitarian harm. The quicker pace too often undercuts civilian protection. We were heartened by the premium that Iraqi Security Forces (ISF) put on the protection of civilian life and property during the operations in Eastern Mosul. But, trends in more difficult operating environment of Western Mosul are less encouraging. The ISF and Coalition forces are increasingly turning to airstrikes and artillery to clear densely populated areas to devastating effect. Just a month into the operations, 40% of Western Mosul's infrastructure has already been destroyed and, as of March 30, more than 800 civilians had already been killed or wounded. On, March 17, a U.S. military airstrike targeting Islamic State fighters may have killed as many as 200 people, including civilians. Amidst this violence, civilians are fleeing at rates higher than expected. At least 200,000 people have already fled Western Mosul, and the number could outstrip OCHA's estimate which has been revised to 400,000 from an initial estimate of 250,000 IDPs. Inflicting heavy civilian casualties and destroying homes and businesses will only make the political challenge of stabilizing ethnically diverse Mosul even more difficult, if not impossible, for the Shia-dominated government of Iraq. In Raqqa, a rush to retake ISIS-held territory without a plan for governance or social cohesion is no plan at all. U.S. forces in Syria are deploying into a multi-sided and combustible political conflict. The complex dynamics of the battlefield are made clear by the fact U.S. forces have had to deploy near Manbij to keep Turkish and Kurdish forces from fighting each other rather than ISIS. As such, pursuing military options in and around Raqqa without a political destination risks adding the U.S. to list of actors scrambling for land rather than long-term solutions. In Raqqa, post-conflict planning is not as simple as handing newly retaken areas back to a host country partner. There is no obvious political partner--running the risk of either a governance vacuum or governance structures that are viewed as exclusive or unjust. Either outcome would set the stage for the reemergence of extremist groups. Strong U.S. diplomacy will be critical to strike a deal that ends violence and reconciles the competing interests of the Assad regime, Turks, Kurds, Russians, Iranians, and, most critically, the local population. A strong and principled American voice must articulate support for international humanitarian law in the conduct of war, and promote inclusive and legitimate governance to underpin the peace where ISIS has been drive out. This matters not only for the lives of civilians caught in the midst of the current conflicts, but for the aftermath of conflict and for future conflicts. Military victory that does not translate into political legitimacy--especially for Sunni populations that will need to be integrated into Shia-dominated governing structures--will not keep ISIS at bay for long. Insufficient humanitarian response. An environment of chaos and great suffering allowed ISIS to emerge. Yet the humanitarian response in both Iraq and Syria remains underwhelming with the U.N. appeal for Iraq less than half funded and the Humanitarian Response Plan for Syria funded at less than 10%. At the same time, the IRC has witnessed the shocking lack of protection for Iraqi and Syrian civilians. During last year's operations in Iraq's Anbar Province, those fleeing contended with unprotected and treacherous exit routes; unclear and often inhumane screening procedures, restrictions on movement, in some cases, premature return to areas that lack security and opportunity. The result is not just a humanitarian crisis--but a political one. Displaced Iraqis (mainly Sunni Arab and other minorities) are experiencing trauma and indignities that underscore their historical grievances, deepen their distrust of the Iraqi government, and undercut the stabilization and reconciliation process that Iraq so desperately needs. While the Iraqi and Kurdish authorities and the international community improved the quality of the Mosul response, ``pain points'', where IDPs endure indignities, hardships, or violence/retribution, remain. And, given the rapid rates of displacement, all IDP camps to the east and south of Mosul are full according to OCHA, leaving IDPs with few options. Most are moving to out-of-camp locations where basic services are scarcely available-- leaving those displaced from Mosul physically and economically insecure. The IRC is also responding to populations fleeing Raqqa and its environs and see similar dynamics. Kurdish authorities in Hassakeh often treat displaced (mostly Sunni Arab) families with distrust rather than dignity as they seek stability, protection, and services. Moreover, the SDF and other security authorities in northern Syria are imposing tight restrictions on those who flee the Raqqa area, pointing to the risk of ISIS cells concealing themselves as IDPs to infiltrate and carry out attacks. We expect a significant deterioration of humanitarian conditions and large-scale displacement once the operation to retake Raqqa itself begins. Tens of thousands have fled as the SDF advanced, 30,000 could flee as the operation on Raqqa itself begins. The U.N. estimates that 400,000 could ultimately be forced from their homes as trade routes are cut and access to food, water, fuel and medical aid diminish. Current funding level are insufficient and security and access will also be a challenge--as it has been across Syria. Access for humanitarian actors, like the IRC, that deliver aid into Syria via cross-border hubs in Jordan, Turkey, and Iraq has steadily decreased and shifting frontlines further threaten our access. Those displaced by fighting must be afforded every protection as they seek safety and the U.S. and other donors must prioritize funding a high-quality response as military operations accelerate. Simply put, humanitarian assistance is enlightened self-interest. Insufficient humanitarian response begets instability and foments new currents of conflict and crisis that draw U.S. funds and U.S. troops into further quagmires. Deep proposed cuts to State Department and USAID budgets. Sustaining support to multilateral and USAID initiatives to deliver emergency assistance and help plant the seeds of good governance is a critical companion to military efforts. Senior Pentagon officials, including Chairman of the Joint Chiefs, General Joseph Dunford, and CENTCOM Commander, General Joseph Votel, have stressed that counter- ISIS strategy requires whole-of-government efforts to bring stability to retaken areas. Cuts to the foreign assistance budget--especially at the rates proposed in the President's FY18 budget--would be inconsistent symbolically and substantively with a true effort to counter and destroy ISIS. Symbolically, such drastic reductions are a step back from diplomatic leadership--both within the 68-member Global Counter-ISIS Coalition and with the competing actors, both state and non-state, in Northern Syria. Such cuts would diminish the likelihood of the U.S. playing a meaningful role in ensuring these conflicts are resolved in a way that benefits long-term stability. Substantively, the resource that would be cut are the very ones used to throw a lifeline to the families caught up in crisis in the form of basic food, water and sanitation, medical assistance, protection for women and girls and education. When areas of Fallujah, Sal ah Addin, Raqqa, or Mosul are retaken from ISIS, humanitarian workers are the next to enter to provide immediate lifesaving assistance and lay the ground work for longer-term stabilization and cohesion. These dangerous cuts would decimate the State Department and USAID and deprive the military of the partners it needs to drive ISIS out of these areas and ensure it does not return. Getting aspects of the military operations, measures to protect civilians, and humanitarian response wrong will undermine chances for social cohesion and stability in the ``post-conflict'' phase. Quality humanitarian response, and measures to protect civilians and ensure their rights and dignity, will go a long way to help reconcile this mostly Sunni population with the central government and prove that government is competent and working to meet their needs and to address their feeling of marginalization. Clearing ISIS will just be just the first step--and it must be coordinated with a plan to meet the humanitarian needs of populations traumatized under ISIS and to set the stage for reconciliation and social cohesion. This will require American diplomatic and humanitarian leadership and American resources--there is no short cut. ------------------ Notes \1\ See www.oef.rescue.org for more information. \2\ Hageboeck, M et al. Evaluation Utilization at USAID. Management Systems International. 2016. \3\ Bailey, J. et al. Combined protocol for SAM/MAM treatment: The ComPAS study. Field Exchange 53:44. 2016. \4\ IRC and Johns Hopkins University. Feasibility and Acceptability of Gender-Based Violence Screening: Primary Health Facilities in Humanitarian Settings. 2015. \5\ Stone E, et al. Community Event-Based Surveillance for Ebola Virus Disease in Sierra Leone: Implementation of a National-Level System During a Crisis. PLOS Currents Outbreaks. 2016. Edition 1. \6\ IRC. Women's Protection and livelihoods: assistance to Central African Refugees and Chadian Returnees in southern Chad --Program Evaluation Final Report, November 2016. \7\ Financial Tracking Service (2017b). \8\ Forthcoming: IRC-CGD Study Group Report. [all]