the new american foundation and washington monthly magazine hosts this event. >> thank you all for attending. we really appreciate you all being here today. my name is paul glastris. i'm the editor-in-chief of the washington monthly and a senior fellow here at the new america foundation, so on behalf of the washington monthly and a new america thanks for coming. we are here today to discuss this special report just released in the current issue of the washington monthly called the "the agent orange boomerang" which you can read it washington monthly.com. am ghaffari start ridges monta thanked america come less thank the staff of the washington and the ford foundation for his support. from 1962 to 1971 the u.s. military sprayed close to

20 million gallons of the herbicide agent orange across vietnam to defoliate dense jungle in order to better protect personnel and equipment from north to south and to destroy enemy crops. bats burring we now know left behind a residue of dioxin persisted in highly toxin-- toxic chemical and over the next two decades american soldiers who served in vietnam were forced to fight another war, this one to force their own government to recognize the damage done to their bodies into provide health care and other benefits they deserve. washington did so in 1991, when president george h. w. bush signed the agent orange act into law. and in the year since justice seemingly done, the issue of the agent orange as largely disappeared from the news. but in reality the problem of agent orange never really went away. in fact it is now morphing into a new set of problems for our

nation's leaders. it turns out that dioxin, a long acting toxin is continuing to damaged lives in vietnam that only for those exposed to it during the war but for their children and their grandchildren. the government estimates as many as 400,000 vietnamese have died early from ailments related to the exposure to dioxin and half a million children have birth defects because of exposure to the chemicals leaching into the soil and water. until recently the effects of agent orange or not something the vietnamese government talk much about after normalizing relations with the united states in 1995. hen knoy's overwhelming goal was to win favorable trade deals with the united states and admission to globaled bodies like the world trade organization, bringing up unpleasant subjects like agent orange, worked against that strategy.

but having detained these schools, hanoi has begun to press its demands and is demanding compensation for the suffering of its people and that has put the united states in a tough spot. not wanting to set a precedent but on the other hand recognizing vietnam is an increasingly vital military security allies and trading partner. it also raises a larger issue of what responsibility to the u.s. military has to clean up the environmental messes after the war a run. meanwhile another hidden problem with agent orange is impacting our veterans. with each passing year medical researchers are discovering many illnesses many of them major chronic diseases like parkinson's for which exposure

to the agent orange turns out to be a risk factor. hundreds of thousands have been denied va care for years and is said they avoided for the signs to prove the suffering they have been having is indeed service related so the problem of agent orange which we thought we had put behind this is once again starting to show its face and in this latest issue of the washington monthly we have a special report that looks at these new developments and makes the case that we finally should do something, do what we should've done actually years ago and that is to offer humanitarian aid to the vietnamese for the suffering of those affected by agent orange and to do right by our veterans and offer va care all who served, no questions asked. you can agree or disagree with those arguments but i think there's no doubt and i think we have documented it pretty carefully that this is an issue that is going to be on the radar

screen for the obama administration, for congress and for the vla, so to discuss these issues were brought together a panel of writers and experts who i am honored to introduce now. dr. michael's martin is a specialist in asian affairs and a congressional research service of the library of congress. dr. martin's professional career includes working in china, japan hongkong and is taught at hong kong baptist university, colby college and tots university. clay ricin is managing editor at democracy eternal ideas. he is formally on the staff of the republic and has written on history, politics and culture for a variety of publications including the new york observer, the smithsonian and now the washington monthly. phil longman is a senior research fellow at the new america foundation here and the

author of the next progressive era a blueprint for broad prosperity. also a fine book called "best care anywhere." so, let me begin by asking to the podium dr. michael martin. >> thank you very much for that kind introduction in bringing up this issue that is proving to be very timely and perhaps of increasing concern in the days ahead. before it began with my shortcome a brief presentation, the quick disclaimer. they have uziah reflecting today are my own and my personal views to not necessarily reflect the views of the congressional research service or the library of congress. what i would like to do for the time i have is to focus on this

issue more from livia ne-- vietnamese perspective than looking at the u.s. aspects of it. and with that in mind what i would first like to do is talk about three particular elements of the issue, a little bit of a background on each of those issues and then talk a bit from the vietnamese perspective how this impacts on u.s. vietnam relations. ..

has done a number of studies in vietnam will to try to determine where indeed it in remains and the environment and basically they came up with this concept of hotspots, places where the concentration levels are high. a generally due to basically spillage and loss during the movement, not areas sprayed by and large studies have found that the residuals in this parade areas, even heavily sprayed areas are not of the international threshold for opposing extended danger. whether or not those studies are comprehensive as a whole issue but as a result there is a focus on these hot spots. there appears to be somewhere in the 20 to 30 house lots are on

the country. but three of them have become the prominent focus of the efforts to date on this issue and oddly enough they are all free around what used to be u.s. military bases. excuse my vietnamese pronunciation i've been there but i'm not a very good at vietnamese. [speaking in vietnamese] -- and was a primary base for military operations during the war. if you look at the vietnamese perspective, most recent figure i found is the estimate it will cost from $60 million to pick up the airport. there is a joint effort going on between the united states and the vietnamese government. to date in terms of resources dedicated by the united states on this effort roughly $4 million. just recently announced the

contracting of 1.7 million, 1.69 to be more precise for the construction of a secured landfill. now i've been to the facility, and what has been done to date is effectively a containment effort. a way of trying to limit public access to contaminated soil, water, lakes, ponds as well as the creation of a catchment area to catching water that would be contaminated with dioxin so that does not spread further in the ecosystem. but this has now created a new situation which is say having contained the problem they are moving to clean up, and they're at least the last i heard is the question was do you just try to clean it up right away or basically move the contaminated soil out of the area and find a way of cleaning it up later. appears to have chosen to do the latter. that is to say move it to an area in a secure landfill and

then find a way of trying to remove the dioxin from the environment. one of the ways of doing that is an experimental bile remediation technology which is being utilized. which is hopefully of greater use than just this one application but could be used in other situations around the world. there has been some criticism in the vietnamese press and from the vietnamese government about the speed at which this cleanup program has proceeded however my impressions have been that by and large the relationship between the u.s. entities and vietnamese entities are involved in this containment and clean-up activity has been fairly good and fairly successful. moving than to the health care issue then things start getting a little more problematic and a part of the big issue is the act will scope or scale of the issue is really are known. if you look at vietnamese figures, we have already heard the figure of 400,000 deaths

attributable to exposure to the agent orange by oxen, the vietnamese themselves, but the figure of 4.8 million people in to get mom that have health or medical problems associated with exposure to dioxin and agent orange, and one recent media reports put that in your estimated cost of dealing with health effects of agent orange dioxin at $30 billion. to give you some perspective on the scope of this, the latest figure i could see of the vietnamese government in terms of their annual out we to do with the issue is 44 million. so we are a few scales off from each other, 30 billion on the one side, 44 million on the other. u.s. assistance dealing with the health care aspects of agent orange in vietnam to date, 2 million. which is again to get an idea we are moving orders of magnitude as we go from one to the other.

part of the problem behind it is misuse identifying the victims and people associated with exposure of the sba to dioxin. as you can probably imagine, at the time of war it wasn't exactly clear who was where exactly when. particularly given the nature of the warfare going on in vietnam. since the war, a number of people have moved to relocate around the imam said the actual physical location at this time may not be associated with exposure. the result is it isn't clear who exactly was exposed to the agent orange and dioxin when they were in vietnam. second even if they were exposed it isn't 100% clear how much they themselves have been affected by yet and one of the disease associated with that is the cost of trying to do such a study. agent orange isn't water soluble, it is fat soluble. i'm not a scientist in this regard but what it means is you have to a fat test, that tissue test and the last estimate lysol

was $2,000 per test. needless to say given the money is the resources and the resources available doing comprehensive testing on everybody in the imam would be a prohibitively expensive cost particularly given the alternative would be to utilize it to take care of people they believe are affected by the speed. another element and this is my personal view is there is a little bit of completion in vietnam between victims of speed as it is often put and people with certain medical conditions. there is almost a presumption that if you have a certain type of medical condition is a triple to exposure to agent orange. a case spina bifida would be an excellent one. the va recognizes spina bifida as a birth defect associated with agent orange and the imam is by charnel with spina bifida it is often presumed its related to the speed exposure even though it may not be. so, moving on then quickly the

area of scientific research. if you look back over the time period since the war, there was an effort for joint research between the united states government and vietnamese government to try to identify the extent of this problem. it foundered, it didn't really go out as well as it had hoped. there was a period they pulled away from it. this seems to be emerging as an area of willingness to do research, however as i indicated earlier, the ability to do such research is difficult. identifying people flexible if you want control groups, people not exposed to people who were exposed. inside the imam is very difficult to differentiate the two populations simply because people move around and people were not exactly where they were being sprayed with the agent orange and dioxin. second as i indicated the cost of doing the study the tissue sampling to determine whether or not somebody has a high level of

dioxin in the system is another problem. third, when he get to the -- even if you determine the individual has dioxin in their system doesn't mazzoleni in the health conditions or problems they have is associated with the dioxin that is in their system. there may be other contributing factors. there are a number of new initiatives going on in vietnam. my understanding is a sense this is being done in the auspices and the ministry of natural resources and the environment as well as ministry of health to try to identify with in the vietnamese population individuals who may have been adversely affected by dioxin. in addition there was a recent japanese joint japanese p.m. knees study that looked at 47,000 veterans and side of the imam, the vietnamese nationals trying to differentiate and exposed and not exposed to see whether or not there is indeed a higher incidence of certain health problems among those exposed to the speed and dioxin.

that study confirmed yes, there is a differentiation is a differentiation >> let me finish then aboutws talking about the impact of u.s. and vietnamese relations. as you've already heard for a period of time the vietnamese government seemed to accept that this issue can remain on the back burner. it wasn't that it wasn't raised but they were willing to let it be set aside so that other priorities for the vietnamese government could move forward such as the return of diplomatic recognition to vietnam. membership in the world trade organization. normal trade relations. those seemed to take more of a priority than trying to press this issue. however, on the other side, on the u.s. side, there were issues associated with the war that also took precedent over the the agent orange issue. which is the mia/pow issue. nothing could go on other issues until the united states felt that was adequately addressed.

we have apparently moved into a period where they do see that's been adequately addressed. as these issues fell to the side as normal trade relations were i áq(ju)jy wto membership, all a of these issues set aside, it basically allowed agent orange to perk up higher on the list in vietnam and they were willing to bring the issue up more. there isn't to say there's issues that threaten but could push agent orange off the front burner and into the back burner again. for example, vietnam applied for the membership in the trade preference policy of the united states government. that application is still pending. no decision has come from either the bush administration or the obama administration. so pushing on agent orange may possibly in the eyes in the vietnamese may have adverse gop

application. another issue coming forward is the transpacific partnership, an initiative to form a free trade partnership and they are going to enter into formal trade negotiations entering into what we call the tppp. vietnam has expressed an interest in joining the tppp so you may have a tradeoff in tppp negotiations versus agent orange in the future. my next point is to in some ways contradict myself in that i keep talking about the vietnamese government and the vietnamese perspective. one of the things i came away in my research in vietnam is that there is no unified vietnamese government perspective on this. different ministries, different agencies have a different take on the issue. there's committee 33 or office 33 that has officially been given the authority to deal with this issue. they're trying to coordinate

this issue and have done from what i see a fairly effective job on that. however, different ministries, different agencies may have different perspectives on the issue. ministry of health may be primarily concerned about the health effects in trying to adequately address the health effects. the what's calleld the invalids and social affairs also deed with the agent orange issue. they deal with providing benefits. they're concerned about it. on the other hand, the site at the airport and they are interested in making it available and their priority may be in getting the contaminant out of the area, they can extend on the runway and proceed on that project and let somebody else worry about the cleanup later. so you start seeing the beginning of tensions within the vietnamese government on how to deal with it.gs

even other industries that you may not think of. the ministry of industry and trade, for example. some of the thiwsz that vietna is best known around the world for exporting,wz say, carp, catfish are bottom-feeding fish. dioxin tends to the chemical may central to the bottom so the catfish may be a primary source in getting in the food chain in vietnam or around the world and the ministry of industry and trade would like to downplay problems associated with dioxin possibly being in the fish, ducks, geese, being the types of exports that may have dioxin in it. similarly, the ministry of natural -- of natural resources in the environment may have mixed feelings about the issue, one, they want cleanup but on

the other hand they don't want to imply that agricultural products coming out of vietnam are inherently contaminated. however, having now pointed out that there are some tensions within the vietnamese government, there are certain elements that i found consistently reflected in different agencies in vietnam on the issue. first was time and time again there was -- the vietnamese talked about the contrast between how the u.s. vietnam war veterans were being treated in u.s. policy and the u.s. government's attitude towards vietnamese war veterans and the vietnamese civilian population from the war. in the u.s. policy and i'll let others speak about that is a presumption of exposure and, therefore, given the presumption of exposure medical conditions can be treated and provide benefits due to that exposure. we have not correspondingly

treated the vietnamese population. second, there's some confusion from the apparent priorities in the u.s. funding. for example, as i mapped out earlier, there's about $6 million that have been provided by the united states government to deal directly with the agent orange issue at da nang airport with $32 million that's been provided to vietnam under the pepfar program. pepfar which deals with hiv-aids is $320 million through this fiscal year which in the vietnamese eyes is a more serious issue has received 2 or 6. at this time my sense is the vietnamese government are more concerned about not addressing blame or who's responsible or legal obligations. they really want to work on solving their problems. dealing with the issues at hand.

the last point i'd also make, which is just to throw it out. on several occasions from the vietnamese perspective, i heard statements saying we cannot fully normalize relations with the united states until the agent orange issue has been addressed. so from their perspective we have not normalized relationships yet. it's a process. we're partway there. going a little bit long, my apologies, a couple of quick things. u.s. response to date as i've indicated there's been three -- $6 million appropriated by congress specifically to deal with this issue. 3 million in fy07 and fy09, is there more to come, that's a good question. we shall see. the house foreign affairs committee has held two hearings on the issue. are there more to come. the obama administration has been actively trying to get the disbursement of the funds that have been appropriated. they have personnel in place dedicated to this project.

and they continue to work through the joint advisory committee to facilitate government to government communications. last and just to reiterate, earlier i mentioned gsp and tpp as issues that may impact on how much there's a willingness to work on agent orange issue. i'd add two more. one recently there's been increasing concern about the human rights situation in vietnam, particularly, treatment of the media. and second, the issue of workers rights continues to be an ongoing issue between the united states and the vietnamese government. so do i provide you any answers? no but hopefully i provided you some useful information and i will hand the podium over to the next speakers and i'm ready and willing to answer questions later. thank you. [applause] sfr

>> i appreciate paul including me in this esteemed panel and new you america hosting us. the focus of the article that i wrote for the package was really to -- or the purpose of it was to take a step back and say what is the historical legal international context within which questions about u.s. obligations or the possibilities of u.s. action to remediate agent orange take place? are there bases for obligations either legal, moral, or political or even just possible leverages, points of leverage where the u.s. could be brought to address these questions. and, you know, the answer unfortunately is, no, there aren't very many. but in the article i try to explain a little bit about how if you were nevertheless to -- as a policymaker try to construct a way to push the u.s.

toward greater responsibility or recognition of its need to act, how would you do that? so the first thing to keep in mind is when you talk about the environmental consequences of war, there are really two kind of broad categories. one -- and they're somewhat artificial. but the first one is the consequences of actual war fighting. so you explode a bomb, you shoot a gun and lay out a land mine, these sorts of things. there are very few -- there are very few points of international law or really efforts to control this kind of -- this aspect of military activity. and in very little interest on the part of the global community to do something. the reason for it is obvious. if you are a country that has a military and you want to make sure that your military is effective, you don't want to be creating a corpus of

international law that restricts unnecessarily your ability to act. so there has been activity on certain things, sort of on the edges, like banning weather modification or restricting the deployment of land mines, land mines are actually a horrible thing for the environment. animals step on them, they leech chemicals and they often are not mapped. the control of chemical weapons and the eradication of chemical weapons is a big step in that regard. but the core idea that we should try to reduce the impact of conventional warfare on the environment is something that ultimately hinges on a paradox. all military activity, all war fighting is inherently bad for the environment. so given that, most countries, i would -- i wouldn't hesitate to say pretty much every country wants to stay away from any of those kinds of limitations. the only place where you do see some action is in sort of victor's justice.

the best example being after the iraq -- the first gulf war in which iraq was required to -- or actually some of the money that iraq was required to give to the u.n. was funneled into funds that paid for cleaning up of spilled -- of oil spills, of the environmental damage caused by iraq's scorched earth campaign toward the end of that conflict. the other category of activity is sort of everything else. but it is -- it's the positioning of military troops and assistant personnel of basing of the movement of goods and troops and material around the world, testing weapons and everything -- developing weapons, everything that goes into getting up to the point of war fighting. so this is obviously an enormous category, also one that, you know, every military undertakes even if they never actually go

to war. and yet this is also one where the efforts to control it have been surprisingly limited at the international level. again, for the same reason. you don't -- if you are a country with a military, you don't want to agree to unnecessary limitations on that -- on that activity. it's always question where very few countries actually really have to deal with it in an international context because most countries don't have bases outside of their own territory. the united states does, britain, france, a few others. the soviet union did or russia now did and withdrew from those in the 1990s. but it really becomes a question of -- a question for the larger powers in the world. and so inherently you're going to have already a stacked deck

against anyone who's trying to create equitable international law around basing issues. there's also the issue of the dominance of bilateral law in this regard. every country who agrees to host military forces has signed some sort of status of forces agreement with the country who's military is coming onto their territory unless, of course, they've been conquered. but let's say the majority of countries are in this category. the philippines up until 1991 had -- was home to the naval base and to clark air force base or clark airfield, enormous facilities. when the u.s. pulled out it was discovered that we had over the course of, you know, several decades laid enormous environmental waste to the countryside. there was never a working sewer system at the bases and so the result was just decades and decades of human and animal

waste accumulating in the ground and in the water around there. however, for what it's worth, the philippines, the government, after world war ii, had signed a status of forces agreement that said it would take care of any of the side effects of u.s. action. the u.s. also said, look, you know, we're pulling out in the 1990s and we're cognizant of these problems, these environmental problems, we can't really hold ourselves responsible for actions that were begun at a time when no one in the world really considered the environmental consequences of this kind of activity. so we're not going to put ourselves in a position where we're suddenly responsible for actions that were taken under a different sort of paradigm or different mindset. ultimately, it comes down to a question of cost. if you were to require the united states or any country

really to clean up after its military activity overseas there really would be no end to what can be required of them. the u.s. recently paid 100 million -- or actually about 10 years ago paid about $100 million of canada to clean up two relatively minor facilities that we had up in the northern part of that country. and, you know, that's a -- that's an instance, you know, the impacts and the amount of damage was relatively minor. and, you know, we don't want to get into a situation where we're having to -- where we, i mean, the u.s. military not obviously myself -- where we -- where the military is having to check itself and spend an inordinate amount of time keeping its activities aboveboard environmentally and, therefore, possibly not doing as much as it can to fulfill its mission. that's its perspective and

that's the perspective of people in the government that i spoke with for the article. now, all that being said -- so you have these two categories around which there really is no corpus of international law and no motivation or no momentum toward the development of a corpus of international law. there are -- there is yet another category where there has been some movement. and that is on the sort of political motivations for cleanup. and there's one great example and one that i think -- that i discuss at length in the article and is something that could provide a framework for thinking about u.s. actions vis-a-vis vietnam, and that is japanese cleanup of chemical weapons left behind by the empirical army by northwest china. so when the military forces of japan were withdrawing very hastily at the end of the war, they left behind some 700,000

unexploded munitions, bombs, shells, what have you of all sorts. they had a whole range of chemical agents. and over time, most of them were buried. some were just left in bogs and river sides. not really near cities necessarily but over time as the population grew and people moved into these areas, farmers started turning up, you know, unexploded shells. construction crews would hit a shell and it would go off or it would leak. over time -- or over the last, say, 60 years, some, you know, hundreds of thousands of people have been affected and many of them have sustained, you know, life-impacting injuries or, you know, have died because of this. so china has long pressed for japan to do something about it. now, until relatively recently, japan has had no obligation to do anything. in the 1990s it signed the chemical weapons convention which required it not only -- which required signatories not

only to get rid of their own chemical weapons but also if they had ever left chemical weapons on foreign soil to remediate that impact. so again there were very few countries that actually fell into that country but one of them was japan. now, that being said, japan for a while did try to resist doing anything. they said, well, we really don't have an obligation. they sort of, you know, said well, it's politically very difficult for us to do anything. you see the far right in japan has a lot of power and they don't want to take responsibility for anything we did in china. but one thing changed over the course, you know, the late '80s, moving to the '90s up until today, the relationship between the two countries has changed. suddenly japan is not as powerful as it used to be and china is much more powerful, economically, geopolitically. the two of them now you have -- the two are now each other's perhaps most important neighbor. and so japan now sees a

political need and an economic need to make nice with china. now, there are certain things japan will probably take a long time to do in this regard. they'll probably never apologize for invading china, for example, but there are certain things that the japanese decided in the 1990s what we can do. we left all those chemical weapons behind. we can address that. we obviously owe china something for that. and here's an easy way, a politically palatable way for us to address this question and, therefore, to improve our relationship with china. so japan did really -- not a 180 but, you know, like a 130 and began to move toward an agreement -- a joint effort with china since 1997, japan has piled millions and millions of dollars in this effort. things haven't gone as swimmingly as it was predicted.

it's a very difficult thing to do. there's never been an effort on this scale before. the chinese government is somewhat difficult to deal with when you're moving large machinery into their country. and there's also been corruption on the japanese side. nevertheless, the political will behind this effort has been -- has been quite striking but the point is that the political will came about not because there was a moral obligation or because the legal groundwork changed but simply because the political environment changed. and there's also an interesting parallel, not nearly of the same size regarding the u.s. having said all this about the u.s. never wanting to take account of its environmental transgressions overseas, there's an interesting comparison to the way that we've addressed this

question with regards to canada as i mentioned and panama. now, in panama we had bases in the canal zone for i don't even almost 100 years and we during the world war ii used some of the -- some of those bases, testing areas, mostly islands off the coast, to test chemical weapons. the idea being that the japanese might use chemical weapons against us in the south pacific or we might have to use them against the japanese and there's no understanding what it would be like in a tropical environment. so the u.s. said well, we have control over these islands. we'll test about weapons there. -- some weapons there. they tested them and not all of them went off. there are to this day an unaccounted number of weapons sitting off a few islands off the coast of panama. now, the u.s. has offered in addition to the bare minimum cleanup that it did after it pulled out of the canal zone in

1999, we've offered a minor sum of money. i think a couple of million dollars to help them clean up these facilities but our position has been, look, you know, what are you really asking for. you want to go in and clean up an unpopulated tropical island. you're going to destroy all of the flora and fauna to get to these weapons. you'll clean them up and the result will be the same as -- it will actually be worse as opposed to just leaving them alone. so our response has been sort of just deal with it. and here's, you know, some hush money. compare that with our efforts -- our cleanup efforts in canada. as i mentioned a couple of -- relatively minor small facilities in canada that we pulled out of after a the cold war, canada said, yes, we know we promised to cleaned this up and you promised us $100 million to clean this and we're not going to this on our own and

we're your biggest trading partner so come on. realpolitik came to the floor and after a few years saying no, we don't do that sort of thing, the u.s. completely turned itself around and said -- and this is according to john hamre, who's the deputy secretary of defense at the time, there's no country with the same geography, historical relationship and vital significance to u.s. security, he said, and indicating, yes, we're actually going to take care of this. however, he said this was a special case not duplicated anywhere else in the world. so what's important to note is two things. because we have this relationship with canada we decided to go against what is a pretty clearly stated policy and to go above and beyond the status of forces agreement that we have with canada and take care of the problem. at the same time, what was very important was the ability for the u.s. to say, here's -- this is a very special case.

we're not going to do this for anyone else. so that becomes kind of a very vague but, i think, useful framework for thinking about how do we -- how could the u.s. come around to doing something in vietnam? or what would be the requirements for the u.s. to do something? first of all, there's never going to be a case where the united states recognizes the moral obligation. it's proven time and time again that that is not a criterion. the u.s. has no legal obligation either bilaterally or under international law to do anything. but -- and the u.s. is going charge a very high price -- or there's going to be a very high threshold for the u.s. to do something because of changing political or economic relations. however, if there is a way to frame the assistance that is delimited where the u.s. can say we're doing this for you and

we're not going to do it for anybody else, then you can start to see possibly -- i think if that were possible, you would start to see some action. and then in fact that is what's happening in the case of the very limited cleanup that michael discussed around da nang. the u.s. has said, well, we'll give you this money, but here's the deal. we don't actually -- we're not doing it -- or we're doing it tore for humanitarian reasons, well, we want to make you happy but the conditions are we don't recognize that dioxin is a problem. we don't recognize that there's dioxin in the area. we don't even recognize that you have any need for this money but just in case you do, it's a few million dollars and there you go. so that's that same kind of framing. because the united states is able or at least has the gumption to say, this isn't a recognized problem but we'll do it for you anyway, we're able to go in and do it. so as we start to think about --

or talk about some of these larger issues addressing the actual health consequences, it would be very useful for policymakers to think about how can we frame this assistance that is limited, that tends toward an explanation of uniqueness and allows the united states an out which would prevent it from having to respond to similar claims from other countries down the line. that's an inordinately high bar. i don't think there is -- you'd have to be very creative, let's say, to come up with a really compelling argument in that regard but i do think given the history of u.s. actions in this regard and the legal framework that's out there internationally, that's going to be the only way forward. thank you. [applause] >> i should have introduced, that's clay risen of democracy

journal. and now i'd like to introduce phil longman of the new america foundation. >> so i'm going to speak with the american veteran experience with agent orange and before i do, i just want to say right off that despite my appearance, i'm actually a little too young to have been in the vietnam war. i missed it by a year. so i say that so nobody will confuse me with a draft dodger or with a vietnam veteran who's got attitude. if anything into a rage here, i'm doing it on behalf of veterans, not because i am one. there's a somewhat complicating factor for me today because as i am, as paul mentioned the author of this book "best care anywhere, why va healthcare is better than yours." and i have ownership of that book.

it's coming out in a second edition. i still stand by what it says, which is essentially that the va despite its mixed reputation has undergone a quality revolution that has a lot to teaching us about reforming the rest of the healthcare system. [applause] >> thank you. but the va does have problems. and when it comes to agent orange, many of those problems are very revealed. and it's interesting for even those who are not particularly interested in this subject. they reveal other contradictions that we carry around with us and how we think about healthcare, not just military health. by way of a little background, the united states didn't even have a va or anything like it until after world war i. there was no presumption that if you had any kind of disability or combat-related problem that we would treat you. civil war union veterans got pensions if they could prove a war-related disability.

but we didn't have va hospitals. the va grew after world war ii into what is now the largest integrated healthcare service provider in the country. it's had a checkered history particularly during the vietnam era but has as i say undergone this great quality revolution in the '90s that when you talk to most vets today, the thing they are mad about with the va is they can't get in because we have this kind of crazy legacy that i don't think we've really thought about much because we just inherited it. that to this day we're not going to treat you as a veteran unless you're indigent or you have some service-related disability that you can prove. you got in the service. there were times when there were other exceptions, but that's essentially how the va works.

now, when we got out of vietnam, guys started coming back and they complained about things, and basically we said to those folks, okay, we'll treat your acne but any kind of complications, we won't recognize anything that you got in vietnam.íç and it got real ugly for those old enough to remember. you know, that was moment when carter's va secretary, max cleland surrounded by the vietnam veterans and he's a triple paraplegic and they threw medals saying well, you lost your balls in the war. and they used the call the

veterans giant cry babies and there was lawsuits in the makers of agent orange. it got settled in a way that left veterans feeling jipped. there were conservative think tanks that put out that it was junk science that agent orange had anything to do with anybody's disabilities. and that went on for years. until finally in 1991 it looked like we had gotten to a point where we were going to do the right thing. so we passed a law that year that said if you served in vietnam and you had one of three conditions, they were by then now associated with agent orange, that would be a presumptive service disability and the va would treat you. then over the years, on that same act called on the institute of medicine to every year review what science was out there. and as the years went by, the iom reports would come back and

they would keep finding more and more complications. the big one came in 1999 when they found a strong association with type 2 diabetes. of course, one of the most common diseases in american life. and much more recently we had new science on parkinson's early onset parkinson's disease. now, normally when it comes to public policy you want it based on science. i mean, right? we went through the last administration everybody said they ignored science and now we're all proscience but in this realm, waiting for science is a real bad thing. it's a real unjust thing. because -- two reasons. one is, it simply takes time and an enormous amounts of data to make a generalization about any association. so we've been waiting for an army to die before this definitive science comes in.

the other thing is -- although when you think of a va hospital you may think of wounded warriors coming back from iraq and afghanistan, they are only a small portion of the people being treated in a va hospital. it's 5% of the people, recent combat vets. everybody else middle-aged. and their problems are the problems of aging. they are chronic diseases mostly. some of them brought on and exacerbated by agent orange, exposed to other hazards in vietnam and it's impossible to look at them and say, well, your parkinson's is exposed by agent orange. chronic diseases are always caused by a combination of genetics and environmental factors, behavioral things and

we're asking people to prove a metaphysical point that can't be and we now have this gigantic appeals court system that's hearing 40,000 cases of people coming up saying i got this problem and i think it has something to do with why service and you say it doesn't and my lawyer says it does and they fight it out every single day. a typical case would be guys 54 years old finds his hearing is going. thinks that's probably because of all the artillery shells i was around in vietnam so he makes a claim for a hearing aid and they come back, no, i think it was following around all those rock bands in the '60s and that's what did it and there's a gigantic particular about who's responsible for this guy's hearing loss. fortunately there's a better way. what we need to do as a society is stop trying to condition

people's access to health on the basis of they're being qualified or deserving, right?ój their access to healthcare because it's a right of citizenship and certainly a right of military servicesship. now, as i said, most of our vets today are elderly or late middle age because of the patterns of our war. the va will have excess capacity and soon it will have excess capacity. it's the last of the world war ii generation as the korean guys pass along. it also has been winning for decades as literally offering the best care anywhere on metrics ranging from patient information, the use of information technology, evidence-based medicine. anybody remotely acquainted with

a good quality of literature on healthcare of the last decade would know that the va has the best care anywhere. also, although it's kind of hard to get a hard number, it appears that their cost per patient as compared to medicare is about two-thirds, all right? this is a triple winner. open up the va to vets who can use their medicare entitlement. not only that, open it up to their wives. let them buy into the system. it not only makes clinical sense but but an 80-year-old veterans has got comorbidity and they both will have to learn to take care of each other but it makes financial sense because everybody you get off medicare to the va you saved maybe about a third. and patient satisfaction is incredibly high. so that's my case for what we ought to do, not just abouthxz agent orange situation but

getting our veterans right in general. thank you. [applause] >> well, thank you, everyone for your remarks. i want to open it up to questions in a minute but i want to ask a few myself.g6v and the first is that it seems like both in vietnam and in the united states -- this is sort of the theme that kind of emerged as we were doing our research and editing the package, what you run into is the limits of science when trying to craft public policy either foreign policy or domestic health policy. as phil said, one wants to hard numbers and hard science. condition benefits or base of

promises of benefits on some in the case of both vietnam and the veterans here, you run into problems with that. this is more of an open-ended question to the staff. but also to michael, is this something that congress, the leadership in congress or the administration is going have to deal with and is it something in your -- in your interactions with the vietnamese, they recognize? i'd love you also hear you talk about the point you made that they see a difference in how we treat our veterans, the promises we make and the science and the science we argue shapes our benefits to veterans and the way

science is used in denying responsibility in vietnam?elo >> let me start with -- since it's the most recent one, the last issue, which is the difference in perception between u.s. veterans and how they're treated. versus howw[v the u.s. governme from the vietnamese perspective xposed to ietnamese perspective dioxin. phil made an excellent explanation about the care to the u.s. veterans and there's one category, for example, the blue water vets, for example, under the way that it's been interpreted by the va to date, veterans who served aboard ship off the coast of vietnam are not eligible on agent orange benefits because they did not put foot on soil and that's how vietnam interpreted the law on congress.

there are bills before congress that would extend benefits to the blue water vets as well as, as well as the air force which is sort of interesting because in many cases the pilots were the ones spraying the agent orange but they he may not be beneficiaries of the agent orange program because they did not touch soil in vietnam if they flew off-coast. i don't know the numbers on that category but it's an interesting concept. the way it generally worked if you served during a certain time frame in theater in vietnam and touched soil and you had certain medical conditions as he said was certified by the institute of medicine as having sufficient scientific evidence that the disease may be attributable to exposure to dioxin, i hate when i have to talk like that, but that's really how it kind of frames out, then benefits may be extended to you under the program.

and that's where the science issue over time becomes a problem. inside vietnam, turning to that aspect of it, what my sense of it was, is in many cases you're dealing with health practitioners. they have a patient. they have somebody with a problem. they want to treat the problem. they want to treat the issue. and to a certain extent they're not overly concerned exactly why that person has that medical condition. and so to the medical practitioners that i've met with, the people who provide care in vietnam that i met with really were interested in providing humanitarian assistance. where things can get problematic is when u.s. money is involved, u.s. government money is involved, that money is earmarked through a particular program to be utilized in a particular way for certain types of beneficiaries. and so you can run into a problem where they have to try to attribute the medical condition to a particular cause so that the u.s. funds can flow to those particular patients.

now there are ways that have been presented that can address that. for example, you can deal with the presumption of the population around da nang airport. we'll provide medical services to people who live near the airport regardless of the nature or the cause of the illness. it's just humanitarian assistance we are providing because they are identified as an affected population. there are ways that it's being addressed on both sides. but it at times can be, from what i -- from the conversations i had with people, it can be very frustrating because you have the regulatory restrictions on the one side and the desire to provide assistance on the other. >> let me ask another question and that is -- especially to clay, as we conduct -- as we look to the future, america obviously is involved in two sizeable military endeavors and

little ones around the globe, we're now pulling out of some of the smaller bases in iraq, consolidating in the large ones eventually those too will be handed over, are we going to see some of the same problems in iraq and eventually afghanistan as we saw in vietnam, in canada and so forth? >> beginning in the early '90s, the u.s. actually -- the military actually did begin to recognize the political dangers inherent in the pollution and environmental damage that was becoming evident on bases not only domestically but also abroad as we started to pull down our forces in asia and in europe. and so there were congressional hearings. there were -- but more

importantly there were steps taken within the military to say, okay, well, going forward we're going to try to be a little more careful about these things, if only because that is what is expected of very publicly visible public institutions, particularly, something like the military. and when it comes to our activities overseas, we don't want this to become a reason why, you know, the next country forces us to pull out. so that doesn't do a whole lot for bases that have been around for a long time. that damage is -- so a lot of the existing -- remaining bases in germany, although those bases have always been a little better maintained than some of our asian bases. but say something like diego garciare are enormous benefits that go back and the need to be better stewards in the '90s that's just going to be

there. so when you apply that question to iraq or afghanistan, i think that, you know, you're going to see as we withdraw a better -- better maintained facilities there. that said the reality is always going to be the same. the forces that we deploy in iraq and afghanistan are not there to be environmental stewards first and foremost. i mean, that's very bluntly the military said and we're there to fight the war and it is someone else's responsibility to take care of it. we'll do the best we can but we're not going to sacrifice or cut corners. and they also still have the same kind of status of forces agreement with iraq and with afghanistan that you saw before. so, yes, i think you can expect to see better facilities being turned over or better -- less

polluted areas and there's still going to be problems and i wouldn't be surprised down the road iraq raises those questions and says, you know, we've seen a higher level of morbidity in a certain area. we think that's because of x, y and z that were stored there during u.s. occupation. so i do think this will continue to be an issue despite more attention being paid since the '90s. >> okay. i'd like to open it up for questions but i would like to recognize walter isaacson, walter part of the aspen institute and leader on the effort to marshall support behind recognizing the issue of vietnam and agent orange and a contributor to our -- to our special report so thank you, walter, for being here. so some questions, the gentleman in the back right here, dan. and please wait until you get to the microphone. state your name and also your affiliation, if any.

>> yes, my name is peter carpenter and i'm a vietnam veteran who was heavily exposed to agent orange. as a consequence was subsequently diagnosed with leukemia. i was the first such veteran to be granted benefits by the va. as a consequence knowing both harvey feinberg of the institute of medicine and ken pfizer of the va i was able to get them to go back and review the data and i just wanted to thank the panelists and the organization for the work you're doing. for the last five or six years this has become sort of a forgotten issue, something that we thought we dealt with. and those of us who served are now getting to the age where we are increasingly vulnerable to the long-term effects of the agent orange exposure which we had. and it's only going to be because of the work of people like you that we don't forget about the people who served then. so thank you very much for what you've done. >> thank you. [applause]

>> this gentleman right here. >> my name is david addleson and i would like to congratulate mr. longman and his presentation and his solution. i think it's infinitely reasonable. i'm an attorney that had been involved in these issues for about 25 years. i was the legal director of the vietnam veterans of america and the codirector of the national veterans legal services program. and i think your article needs some background and expansion. the '91 that came as a result of the litigation we brought against the va challenging the va's interpretation of the 1984 agent orange act, they were applying a cause and effect standard which was absolutely not intended by congress. it was overturned by the federal district court of the northern district of california. and the case has been ongoing for the last 21 years. basically, your gentleman that

you mentioned in your article once parkinson's is concluded, he's entitled to retroactive payments from the first day he applied not the day the regulation -- this has never been advertised public as is agent orange outreach is never done publicly. the va is under legal obligation to do both. they've done neither. and i would just again congratulate you on your analysis. i would correct one thing. congressman montgomery did everything he could to not pass the agent orange act. because of the litigation and because of the lobbying efforts of the vietnam veterans of america, mostly, at that time -- but he fought it tooth and nail. that was the only correction i would add to your article. i'd be happy to talk to you about it more anytime. >> there's a gentleman right here.

>> i have a question for mr. martin. $2,000 to test for dioxin, is that the real barrier or what if we were to have a $2 test and it turns out that people thought they had it didn't and other people -- what's the political implication for that? >> as i indicated in my statement, the $2,000 figure was the one cited to me by the authorities. i do know there's efforts in afoot and charles bailey and the ford foundation were part of that to make available to the vietnamese government test facilities that would lower the costs significantly. so there we can see another cooperative effort that's going on to try to address the issue. now, speculating about what would happen if in a particular case you would find out that the tissue level is below what would

be sufficient to indicate evidence that particularly an illness, malady, birth defect is attributable to agent orange is a speculative type question that's difficult to answer. and in some ways the question may not be whether or not on a case-by-case basis you can demonstrate that the illness is attributable to exposure to agent orange. in some ways as we're discussing in the case of the u.s. veterans and to a certain extent from the vietnamese perspective from the people in vietnam who have been exposed, the issue may be more about trying to address the health problems of the population at this time. >> in the back, right here. >> rick whiteman, david addleson didn't make clear his role, which was seminal not only in court cases but also in helping lead to the '91 act.

and tom daschle and lane evans through. david is correct sonny montgomery tried to stop it but it was ted weiss who stood in front of the train and didn't let the act go through. and ted is a teenager and survived the holocaust so there wasn't much that the gentleman from mississippi could do to ted weiss to scare him. and for that reason vva made him the legislator of the year in '91 but i do want to correct something. the perception that creeps into the talk that american veterans, in fact, the problems have been addressed of american veterans and their families. and particularly the families of birth defects, the biggest concern right now of vietnam veterans is not our kids. it's grandkids. there's not a week that goes by that we don't have a young woman

call the office and talk about her anomalies in her child -- wanting to know is it due to exposures to vietnam. the institute of medicine process that we have in place with the biannual review is a passive process so that they can only review original science done by somebody else. and currently there is not a single scientific study of agent orange of veterans funded by nih, by cdc, by arc, by va or by dod. so if you don't have science to review, you're not going to make progress. 95% of the articles reviewed in 2006 and 2008 by the institute of medicine were done overseas either by norwegian countries or

other countries in europe or the far east. so the real question is, not just justice for the vietnamese, although we certainly would like to see that but it's justice for american families that are still suffering and so the real key is not just raising awareness that agent orange is still a problem having to do with vietnam but that agent orange is still a significant problem having to do with american veterans and their children and their grandchildren. thank you. and thank you all for your efforts. [applause] >> the gentleman in the far back there. >> i want to thank you for all your good work on this issue. and you mentioned earlier max cleland was va director in the late '70s and mentioned things

started to change in the 90s and it was due to jesse brown who was clinton's administration, the va secondary. and you talked about the history of the va i think it's only been 20 years since it's been a cabinet level agency. and today, i was very encouraged by the selection of retired general eric shinseki and when president obama announced his new policy in afghanistan he was included in the speech at west point. and i guess i question feedback on how encouraged you are in general for the future of this administration keeping attention to the issue? >> more questions. this lady right here, please. the microphone is coming. >> my name is alice day.

i'm a filmmaker. in 2008 we finished a film -- a documentary film on the environmental consequences of war. we certainly looked at the vietnam situation. but right now i'd like to think about the implications of this for what's going on now and in the future. you touched on this briefly. but we were interested in depleted uranium. we wanted to have something on that in the film and we were told by people we talked with that there was absolutely no empirical evidence available to put a case for looking at this into the film. but in terms of the science we gathered, the tests for this were not really being conducted in a way that would give science a chance to say something about this.

and i think just from a point of view of the future and preventing some of these things that this needs to be considered. >> so i think clay probably could best address that. >> sure. yes. depleted uranium is an issue that comes up a lot. is also an incredibly popular munition or element in munitions mostly tank shells and artillery. so there's a decided interest against pursuing that very tough question. the issue is that there's a lot of incidental information, a lot of rises in -- increases in morbidity and disease rates in areas where it was used. a lot of suspicion. but not a lot of, as you said science. and there are some studies that show no connection.

but most people, even those who are skeptical of a connection will say well, you know, when they're being honest it's -- the jury is still out. and so we could see in the future -- i could see some day down the line there becoming a body of evidence that shows a connection in which case this will become an incredibly important issue because not only did we use -- did we at the united states use depleted uranium in the first gulf war but we and other nato countries used it extensively in the balkans and we use it in our conflicts in iraq and afghanistan. it's simply -- let's say a question -- a question for the future. i hope that 20 years from now we're not having a very similar panel but focuses on d.u. it could -- it could be the case. >> i'm thinking you may not have

answered one of the gentleman's questions and i think it was whether -- it's probably best for phil the obama administration's appointments to the va suggest a change in policy on these issues. ... but the veterans health administration took a licking but kept on ticking during the bush years in

toward the end they did everything they could to reinvent the the a of 1979 by taking it away from people on the field. >> i think their signs the obama administration gets that, but they also need desperately to get their vaunted information technology to work on claims processing. because that's something that's just totally broken, and stays broken. so there was a big fire in saint louis in 1973, just destroyed a lot of service records. so there's a lot of folks -- there's a whole industry that goes around just trying to help people establish that they were actually in vietnam, or even in the military. and the handoff from the military to the va has been a problem also. they are getting better at integrating their records, but

they are still not there. i think, you know, the threshold from what people categorize as mental illness changes from generation to generation. i don't think the va is entirely at fault, but one of the things it's confronted with is just record numbers of recent vets coming back and wanting and needing mental health services. and there's just -- again, they are hiring every psychiatrist they can find, and in dramatic head injury also. it's partly like, not the signs there, no what to do about it much, so there's a deficit. but in the last budget, they raised the va by 8%, which is pretty good. >> i want to get a quick fire just sort of asked maybe three questions all at once and will

try to get the panel to respond in kind. there was a young lady right here we could start with, and please keep your questions brig and will try to get as many as we can. >> thank you very much. i am very going. i'm a very proud member of the dialogue group and i'm also with the national organization on disability. debriefed. one thing that has not come up today has been complemented back up for a second that i had the opportunity to work on a paper funded by the ford foundation on agent orange issues and its impact on u.s.-vietnam veterans, and received assistance from david allison and rick weidman who just stepped out. i was floored by what i researched with the range and studies and cdc studies, and the squashing, if you will, it's a hard word, harsh word to say, but the squashing of the

science. the challenges that were placed on the methodologies. curious about, comments from the team up there on that. how there have been statements about how that science was done wrong and not just wrong like oops, what purposefully wrong. and how do you think that that might provide another avenue, another vehicle for coming to terms with this situation here, for our veterans and their families, but also as it relates back to the folks into it not? >> another question. >> i am alan oates, the v.v.a. and chairman for the agent orange can be. i've got a couple of comments, and first for dr. martin. any presumptive issues when you say may be caused by the

institute of medicine uses different levels of association, and they don't establish if it may be caused or not. they just show the different levels of association and the secretary makes its determination as the issue becomes presumptive or not. so i just want to point that out. most of the issues are limited or suggested associations or adequate associations or limited association, no association but there may be cause. i want to point that out. the other issue i have, just speak on and maybe the panel could reflect that they have knowledge of it. the agent orange act of 91. the proof in the pudding is always the implication of the act that any act or some requirements on the va to conduct clinical studies, collect clinical data, and use that clinical data to determine if there's issues with vietnam veterans. as of today, if you go to the va and ask them for how many

vietnam veterans who served in vietnam, how parkinson's disease, they cannot break that out. because they only collect data on vietnam and their entrance, whether the person was in service during the vietnam period and there in germany or somewhere else or in the states and never went to vietnam. so they can't break out that clinical data. so they never complied with that part of the law. the other part -- >> we have to wrap it up. is there a question? >> yes, the question i have, as the panel looked at any of the information on the implementation of the agent orange act? >> okay. then very quickly. >> let me comment on sort of the category of scientific research. addressing the issue of scientific research, comments. one is if you noted in my

presentation, i did highlight the need for continuing to do that research as something the vietnamese government sees necessary and to a certain extent, you are seeing some interest in it in the united states government. and what i think is interesting is, in some ways, the vietnamese populations of cells present an opportunity for doing some of that research that would establish causality or reason to believe causality of links between agent orange and certain medical conditions. so i think there's a potential wedding between the two of dealing with the population here in united states and the population in the it not. there's also a third group, and i feel remiss we didn't discuss about that, which is vietnamese nationals will be located inside the united states. often a group that is missed in this issue. i'm number of them lived in vietnam during the time and may have been exposed to agent orange antitoxin. they are not viewed as veterans of the war and may not be eligible under that condition.

the vietnamese government would recognize their medical conditions because they are no longer vietnamese nationals if they have naturalized to the message that there is a subpopulation and deny states that may be running into health problems, that as of now, we don't have a program that addresses their needs. >> again, on the subject of science, alan oates here knows most of what i know, i know from him. but i think one of the things that just astounds me is that the d.a. does have this wonderful electronic medical record system that is held up around the world. and yet, apparently, it lacks a field in the program where you could just enter, served in vietnam between 1963 and 1972. right? now, it would take effort to go back and do that, but this is an

organization that convert from a pure paper record system to this integrated digital system. surely we can put that little record in. you might not be able to do it for every single vietnam vet, but do it. put it up to a size that you could make reasonable generations from. the va does this and all kinds of other realms. take that drug that killed more americans that died in vietnam, vioxx, right? the va was very early lobbing onto that because they could see these clusters of heart attacks, as with these people had in common, and realized it was a vioxx. it seems to me you could do a lot of population health size, not worry about randomized testing and ethical issues and all the other stuff. you do it fast and you could do a g. and i don't know why we don't do it. >> thank you. i think we'll probably go with

-- we didn't do with your question, and that is the issue of operation ranch hand. michael, i don't know -- you ar on top of it or not, i know very, we read your paper and putting together of this and whether you have any inside into her question. >> i'm not a health care professional. let me stay put that to begin with. my understanding of doing studies of that sort is basically predicated on the methodology used there, and a lot of statistical techniques are very similar. for those of you who've looked over my report, there were indications that methodology may not have been followed in a very rigorous fashion. on earlier studies. having said that, i can't establish that. and to a certain extent, my view

is, rather than focusing on a study that were done a number of years ago, the issue as i was trying to indicate earlier is more on looking ahead to studies that could be done, that should be done, to try to make determinations with medical conditions. and with that in mind, as i said, i can see three readily identify populations in which the studies can be done. the population of vietnam, the vietnamese american population that have relocated to the united states, and u.s.-vietnam war vets. >> just in terms of wrapping up, i think one of the questions that we took away from putting this together is what we have in vietnam now is a situation where a lot of these geostrategic interests are aligned in a sense with our moral interests, that there is a very good argument that, for u.s. national security interests, we ought to do right

and deal with this legacy that we still have, that like canada, like panama, we have vietnam is a country of increasing importance that this is an issue that they care about. we have a moral obligation, even if it's not something we would act on as simple as a moral obligation that and so i think the great question is, is a vietnam important enough, that it could likely spur us to take a very difficult steps i think politically it would take to begin to deal with this issue of humanitarian aid to vietnam. and so i want to thank everyone for coming. i want to thank our panel. i want to thank my partner in all things at the "washington monthly" for helping me put this together, the staff at washington monthly, and also,

dan and all the folks here at new america foundation and all you folks for coming. so thank you very much. [applause] [inaudible conversations] [inaudible conversations]

>> you on c-span >> next richard holbrooke, special representative for afghanistan and pakistan, on his upcoming trip to the middle east. he's introduced by proteins institution president strobe talbott. this is an hour. >> good afternoon, everybody. we are very honored, appreciative that ambassador holbrooke takes time off from his duties on the other side of town and indeed, on the other side of the world, to spend

about an hour with us this afternoon talking about policy in afghanistan and pakistan. there are never boring moment in his last. there certainly haven't been in, of course, in the period he has had. [inaudible] >> there you go. that was a favor i was doing you, right? and of course, this is a particularly busy week and a particularly difficult week. ambassador holbrooke has got a number of members of his terrific interagency team with him here, and one of, very promising and productive aspects of the way he's gone about his job, the way in which he got in the interagency process and the u.s. government to work together, and i know a number of teams have lost a number of colleagues due to this suicide bombing in afghanistan. that's one of several notes in a

minor key that we have to take account of. and i thought maybe richard, if he was okay, we would start what we hope would be an open and lively discussion here, just by giving you a chance to tell the group what you think i'm on all of the issues that are out there are the most important ones, and what are the two or three subjects on which you think that we and therefore you are going to be most concentrating on, particularly over the period most had. >> thank you for inviting me. full confession, the match when right is one of my closest friends and most severe critics. so if you says a report between us, we have been best friends since 1978. >> the same can be said any other direction. >> 1978, and it's just a great pleasure to be interviewed by strobe. but knowing stroke, you all know

it will not diminish in one iota, his intense interrogatory style. i see any audience so many friends of mine for so many years, and i'm grateful to see you all. i always want to acknowledge stand, who i first met in the johnson administration when he was secretary of the army, and who is a great figure in america's national security history. and i won't acknowledge anybody else in room, but i just see tons of people i worked with. my own team, i would run a few people today, but since you mentioned them, i should mention them. on the wall there in the show without a jacket is roman ferrell, who is our ngo outreach person. and i want to start with road and they. i think we're the only office in the building with its own ngo person. there are literally well over 1000 ngos working in afghanistan and pakistan, not counting local

ngos are there was no road map. there was nothing to tell us what they did. ronin is doing a crosshatch computerization. we are systematically reaching out to ngos. for zappa, orders is a huge industry under issue in both country. you'll be able to tell us which ngos immunizes worked, which work in afghanistan and pakistan. so next to him, actually bomber who has been with me now for a decade, and has been in her current capacity as specializing on the all important issue of communications and counterpropaganda. this war is a war of information. and it has always been most extraordinaire to me, but that area is where the world's most, the world leading communications station, the united states, has been at least until recently out communicated by mass murderers living in the most remote areas

of afghanistan and pakistan. and they have to take the public information space back from the enemy in order to succeed, and ashley has pioneered such creative ideas as using cellphone technology and such obvious ideas as countering their abuse of low-water is, low fm stations to disseminate most terrible lies. and next to ashley is valet, whom i'm sure no most of you have known. he came from moderate and the council of foreign relations. he has just written another one of his wonderful books. and although many of you associate him with iran, he is working on pakistan with us and not on iran. since that always appears in the blogs and actually, i want to correct it. and i think we're missing someone. kim mcclure is somewhere. kim came to us from afghanistan, a good sso, and representing the

future of the foreign service. we have a whole lot of other people in the back there, including in the department from nine other agencies, plus the state department. stroh, what i would like to say, and i will do this very quickly, is that in dealing with the sophistication of this audience, the most common question i get when i walk down the street, or run into people, is the most valid, why are we in afghanistan? it's a fair question to ask any situation as complicated and difficult as this. this is not an easy situation. a year ago barack obama inherited the situation, and he faces several choices. and so we went to a complicated policy, which some of you in this room contributed. and one person in this room let, bruce riedel turkey was the

chair and i was the cochair of the strategic review committee. and i think bruseghin, here in the front row, i thank bruce for his response to president obama's call, which came on the third day of the administration, if i'm not mistaken. bruce gave us a 60 days and i think strobe for minicam to us. and we concluded quite simply that america's basic national security interests were at stake. in these two countries. this was not vietnam where the vietcong posed no direct threat to the american homeland. it was not iraq where saddam hussein similarly did not oppose a direct threat. this was an area where attacks on our soil and other countries, including pakistan itself, and the people out there've had said very clearly they would do it again as the new mass on christmas day demonstrates so

fully. in fact, this particular person was not trained in pakistan does not change the fact that the aspiration for all of this comes from al qaeda, and al qaeda's leadership is based in the remotest areas on the afghanistan-pakistan border. so we concluded without any dissent that this was a national security issue, and we could not walk away from it. the second question was, therefore, what do we do about it? the answer has been laid out in a series of speeches and public statements by president obama. march 27 and the simmer first of last year were his two major statements, but there have been many others. i've been out there saying the military has hillary clinton, bob gates, vice president biden. the press reported in colonel discussions in which people put forward a variety of views, both in february and march and began an extraordinarily intense policy review process, which i

participated in in august, which came to a culmination under december 1 speech. to let me be very clear on this. having served every democratic president from johnson on, either in the white house or senior state department, position, it is when you don't have discussions of a range of options in the room that you should ask questions. and it was to the enormous credit of these administrations and president obama, that every you that you all in this room are likely to hold, was put forward inside the windowless room and the basement of the white house. so the president have the full range of views as he stepped forward first in march and february, two sandpoint 1000, including training troops, and then again in the summer when he announced 30000 more troops. and that is only a small part of what we did. it is the part the press is focused on, but it's not the

part on directly responsible for. i made inputs into that discussion, but our job at the state department is the civilian side of the war. from communications to agriculture, from rule of law to subnational governance. to education and health. and that's what we do, plus the diplomatic side of things. so i want to underscore that. so we are there to test our national interests are at stake. we know how difficult it is. and our allies in the region know how difficult it is. i have to work now every single country in the region and outside the region that might be affected except your three favorite dance, which i haven't gotten to yet. which will be in the next month even my wri will go to. and without exception, every country in the region agrees that what's happening in afghanistan and on the border regions is a direct final strategic interest to them as

well. and i need to underscore that. from beijing to moscow, and from riyadh and abu dhabi, to our european allies, countries which have their own internal challenges, including all of the states in the gcc, all agree that stability in afghanistan, pakistan is critical in a strategic sense. so we conclude as well that what happens there is not just vital to our own homeland security, it's also vital to an extraordinary large range of countries come which include the two most populous countries in the world, it includes russia, includes the world's largest oil areas, and it includes a whole range of other issues and there are obviously implications for other problems we face to the east. in iran and in regard to the arab-israeli issues.

so 30000 troops started to deploy. on the civilian side, we build up rapidly laster, and i want to underscorunderscore again on behalf of the department of state and the secretary of state, that when we came into office there were 300 civilians in afghanistan. not a lot considering the importance of the country. when i was in germany, there were 2500 people in the nation that i was responsible for. we have a 300 civilians in afghanistan. we tripled that last year. and that growth will continue as the troops build up a. we are working out the details now. of course, working closer with secretary of state jack lew. but there will be a big buildup as we speak here, the new administrator is being sworn in, and he and i are being ready, collaborating on these issues. and he and i will have a press conference right after this at the state department, joined by

tom vilsack, the secretary of agriculture. why the secretary of agriculture? because agriculture is our most important nonsecurity program. tom vilsack will be leaving shortly. exact time is held for security reasons but i hope you will protect that. so we have a vast array of civilian programs. we have expanding dialogue on the international diplomacy. i got back late last live from london, where we spent the whole day at ten downing street, state and essie, pentagon interagency team working out the details of a forthcoming conference at the end of january on the international components. now i don't know, strobe, if i fully address your question. but since time is limited i would like to go where your audience would like to take a

pic but i do want to stress that we really are committed to a successful outcome here because our national security is good at stake. thank you. >> thank you, richard. i think what i would do is put two questions to you and then open it up to the group. one has to do with the made 2011 deadline. how we should understand that, what it means in practical terms. the second is about pakistan. you alluded to it here and you certain he in the past, the importance of the pakistan peace of your assignment. like several of his colleagues, the latest other indices in "the new york times," over the weekend, which the bottom line of which on pakistan is the situation is worse off there, both in terms of the welfare of the pakistani people and also in terms of our interest. and maybe you would give us your own assessment on that.

>> in the december speech, the president announced that we were added 30000 troops began the also said that he would begin a withdrawal of some of the combat troops in july of 2011. and later on in the speech, a phrase that did not get adequate attention, he used the word of responsible transition of security to the afghan police and army. and that is the key to the speech, and that's the key to the policy. the domestic considerations are no secret to any of you, but i'm not going to comment on those. i'm here to represent our foreign policy interest, not on domestic political issues. you're all aware of the controversies that surround his policy. the president believes that -- and by the way, there will be a review of all of this indie

simmer of this year, which he also mentioned in the speech. the president believes that we need to put more emphasis on afghan self-reliance, and that in 18 months we need to show tangible, visible progress towards a transition for afghans taking over responsibility for themselves. not across the country. i left for europe while the president was speaking on december 1 and landed in brussels just after he had spoken. and the europeans have been, of course, with the time difference, they had not heard the speech. the headlines this portray the speech right at the beginning. and said, you know, withdrawal and 2011. and that misunderstanding may have been perpetuated here to some extent by people, either in innocence or deliberately misconstrued in the speech.

some public figures questioned but they misrepresented them. the president made clear in the speech that we are not abandoning afghanistan. that this is a strategy to work with the afghans and create the time and space during which they can improve their own ability for governments. this was discussed at length to present karzai, and with his cabinet on numerous occasions, notably in putting the trip that hillary clinton and i made an afghanistan in october 18 and 19th in conjunction with president karzai's inauguration. the afghans understood this. they are very comfortable with it. . . to underscore that's what july 2011 means. not a withdraw, but the start of a responsibility transition in which american combat troops will begin to draw down. on the second question and in

regard to pakistan, i'm not sure quite how you phrase it. strobe, you made a generic comment? >> mike hamlin and his colleagues have put together a set of bench marks on sort of how things are going. and the trend that they feel they have identified in pakistan is ominous, negative by comparison with a year ago. >> yeah. i read mike's monthly, it's quarterly, actually, isn't it? i read mike's quarterly table with great interest. and it helped -- influenced me a lot as we tried to develop our own benchmarks. but i think we have to be very careful about two things. maybe three things. one, let's not confuse input and output. it's a very common problem that i've seen in most of the -- in every war that i've been involved in. let's not confuse the number of

cell phones to take one of michael's criteria with how the war is going. let's not minimize the importance of it. cell phone penetration is a hugely important issue and a very positive indicator for social and economic development in afghanistan. but it does not -- and pakistan. but it does not tell you how the war is going. i live through this in a distant war in another century and i'm very hard over on the fact that we often confuse input and output. i know you don't disagree with this. now back to strobe's question. how are we going in pakistan? it's a very come preindicated issue. i want to start by saying it's not how we are doing at all. this is their country. not our country. and the question is how is pakistan doing? and i've now been to pakistan six times, i think, last year.

and at least, and i'm going back next week. all i can say that we knew from the beginning that what happened was important to the region. and we approaches pakistan with great respect for its sovereignty and territorial integrity and the enormous complexities of what it faces. economically, socially, politically, and strategyically on both of the major borders. and if you look at pakistan during the last year, you can construct two different models. but from our point of view, we saw the pakistani military go into swat, do great damage to the insurgence, collaborate and cooperate with the american

military and some -- in some information sharing activities which produced beneficial results. but i want to underscore no american troops in pakistan. we do not do fighting in pakistan. and we -- and then they went into south wariristan. there was an enormous refugee problem. they led the response with hundreds of millions of dollars. we were the first out of the box. there was then a controversy of some of the requirements in pakistan. i think that was explained very

well by secretary clinton during her trip. and the country went through some political dramas which were internal to pakistan, but which we watched with concern and sympathy. at the of end of the year, pakistan is in the position today with the united states looking for any way to support their government and their people. very heavy influence on the trip on supporting pakistan, on where the needs are greatest which are energy and water and other major economic issues. the largest muslim city had about 4 hours of the electricity of the day during the worst of the summer months. we want to do things to help address that problem. we've sent some of our very

finest members of the administration out there, notably david lip pton to help work. on water, we're looking for more ways to help. water is not only a big problem, but you know it's going to be become and more and more serious problem. pakistan has a long and complicated history with the united states. which people like this, riedel have lived through. and we will continue to work with pakistan as a friend and an ally and with great understanding and support for the utter complexity of what they are going through. but i to in -- but i do not expect the core peoples of the question that the situation is worst today. the situation is what it is today, and not worse. pakistan is working it's way

through a series of issues which are for them to decide on their own. >> thank you. we'll open it up. martin? and wait for the mic and identify yourself for the very few who don't know who you are. >> martin from the foreign policy program and brookings. ambassador holbrooke, india. some would say that unless you bring india into the picture and find a way to resolve the indian/pakistani differences as deep adds they are, it's going to be impossible to make progress in pakistan or afghanistan. i wonder how you would react to that. >> well, first of all, martin, i think everybody who knows the history knew certainly among them knows than india and pakistan have a unique interrelationship that goes back

to the independence of the two countries. and we have to respect that. we can write books about it. but in the end, it is a fact of history. and we -- and my job does not include india. i'm a special representative for afghanistan and pakistan.@@@@ @b our almost a year in new delhi

does that. having said that, i keep the indians fully informed of my activities on a regular basis through the ambassador her >> see each other tweakly and through recurring trips to india. and everyone understands that india has a legitimate concern for what happens in the region, but i am not negotiating issues between india and pakistan. that's not my job, nor is it something that would be productive if i were to undertake it. but i cannot stress the highly enough that the indian relationship is important to the u.s., the pakistan the relationship is important to the u.s., and there is, in my view, the argument that we favor one country over the other is a legacy of the past. i do not believe it is justified by the policies we are taking right now. >> lady in the pack.

raidty in the back. >> thank you very much. we -- [inaudible] my question is two quick questions really. yesterday the u.n. ambassador for afghanistan said reconciliation efforts is one area that needs attention the. the united states to the government of afghanistan in talks or negotiation, and the second question is the pakistan military -- [inaudible] are fundamental in afghanistan, but recently there have been media reports that pakistan military is, i mean, selectively targeting the militant thes on their own end but not the ones which are operate anything afghanistan, thank you very much. >> on your first question concerning you said the remarks of the u.n. ambassador, did you say? i think you're referring to the senior u.n. representative, is that correct? >> yes, sir. >> yeah.

actually kai was in this morning to see secretary clinton and me, and we had a very good talk. you know, his tour's coming to an end, and he came in for some formal talks, and we discussed this issue. i don't know exactly what remarks you're referring to, but there isn't any question that the, that a policy has to include an opportunity for those people fighting with the taliban who are not members of al-qaeda to rejoin the political process. i would estimate -- bruce and i spent a lot of time talking about this the at the beginning of last year -- i would estimate 60 or 70% of those people fighting with the taliban are not ideologically supportive of al-qaeda and are not necessarily supportive of the taliban's supreme leadership.

but they fight for various reasons. they're misled about the nature of our presence there through the propaganda that i mentioned earlier. they have sense of injustice or personal grievances, or they fight because it's part of the afghan tradition that you fight outsiders, and they may have the isaf/nato/u.s. presence conflated with earlier historical events, some of which are not too far in the past. so it is absolutely imperative that we deal with this issue. if we don't deal with it, success will elude us. hillary clinton addressed this in her speech at the council on foreign relations in washington last summer, and i won't repeat what she said, but she was very clear on the open door for taliban who renounce al-qaeda

to rejoin. many members of the political society in kabul today are former taliban, they're in the national assembly, they're in the government. they are outspoken. one of them wrote a best-selling book about his experiences with the taliban. the -- so this is critically important. this program used to exist on paper, and it was not very successful. but three weeks ago "the washington post" wrote a spew potential front -- superb front page piece on five taliban who decided to come in from the cold and got no support. now they feel like they're trapped in a no man's land. we cannot allow this to happen. when ashley and i visited a year and a half ago as private citizens, we met with five young people who told us the same story, ex-taliban. so president karzai in his

inaugural speech on november 19th laid out a policy proposal, and we are focused very much on this. and i think david petraeus, stan mcchrystal and i would all say that this is one of the most important areas that needs to be addressed because nobody believes that the outcome of this war will end with a complete demolishment or killing everybody who fights with the taliban. that's neither possible nor necessary. nor is it in the nature of this sort of war it's not how this war ends. it won't end on the deck of a battleship, and it won't end on a military base in dayton, ohio. this issue -- i'm spending a lot of time on this question because it's so high on our personal priority list -- this issue is one of the big things that has

to emerge. why didn't it emerge last year? because the election process was so complicate canned and so -- complicated and so intense and involved the same participants that we were not able to get this program resurrected and straightened out and funded right away. but we identified this in the report that bruce and i and our colleagues did. i thank you for raising that. >> the election, though, of course -- >> oh. sorry, go ahead. >> was accompanied by massive fraud and produced a president and a presidency that are highly discredited and tarnished both domestically and around the world. how do you deal with that as yet another albatross around or the neck of the policy? >> this election was, in the words of president obama, messy. it was well in advance of the

election and every interview that i gave i said this is going to be an imperfect election. very few countries would have even attempted an election under these conditions. with the enemy in the middle of a war, with the taliban saying that they would cut off the finger of anyone who had purple ink on it, that pg the mark of a -- being the mark of a person who had voted, and so the fact that it was messy is not surprising. having said that, hamid karzai is the legitimately-elected president of the country, and we will deal with him and his government which has plenty of good people in it -- i should be careful about that because not all his cabinet members have been confirmed yet, but there's some excellent ministers who were -- we're very comfortable

working with. and we are well aware of the fact that this election wasn't perfect, and we work closely with ndi and iri and the european union observers, and i hope future elections will be, will be better. but this was the first really contested election in the country. there had been one five years ago, but not like this. and under most difficult circumstances. secretary clinton said publicly during her trip that it was astonishing that they attempted it at all. but we will work with the karzai government as legitimate government, and we look forward to continuing that, and we look forward to improvements in the relationship. >> yes, sir. >> thank you. mr. ambassador, happy new year. i know you have very difficult

job, you cannot make everybody happy in this job you are doing. my question is as there is a problem in afghanistan, it has been going for over 20 years. and we don't know how long it will continue. but in a report by general secretary of the united statessed nations, ban ki-moon, you cannot win this war unless you enroll afghan people. now, what he's saying i don't know whether you're listening to him or not, other think tank people that the afghan people are important in this war. and another just to follow up is as far as the future of afghanistan is concerned also, i think neighbors are important like india. like you said your job is not to get involved in india. but india can can play, i think, a major role in reconstruction

for the people of afghanistan. so where do we go from here as far as -- >> well, i'm glad you mentioned the 30 years of war because i don't want to tell you something you all know, but it needs to be underscored. very few countries in the world have undergone such a trauma as afghanistan has since december of 1978, and this really is extraordinary. i can think of few countries being hit like this, maybe cambodia. but this is extraordinary, and the society was really damaged. i mentioned agriculture at the beginning. afghanistan was a big agricultural exporting country with india as a prime, as a prime market. a month ago the afghans with great fanfare shipped by airplane 12 tons of apples --

they're famous for their apples -- to india. as a way of resurrecting their once-vibrant export markets, and that's why we're putting so much attention on agriculture. so in answer to your question, my friend, we really are listening to the afghans. not just on agriculture although that is our primary nonsecurity issue, but on everything. one of the things we found when we took office a year ago was that only 10% of american aid to afghanistan, pakistan went through the governments. 10%. so we were undermining the very governments that it was our profezzed goal to strengthen. -- professed goal to strengthen. and most of the rest of the aid went through these contractors. those of you who saw what hillary clinton said yesterday in her development speech, you saw the hard shot she took at contractors.

well, one of my instructions from the president and the secretary of state is to reduce the contractors. but be aid ain't what it was when you were there. as she said yesterday, there are four engineers left in the water area. so we need to do two the things simultaneously. we need to force more of our aid through the governments, and we need to reduce the contractors. this is not easy for many reasons. one is oversight. the congress wants to be sure the money isn't wasted or disappears into people's pockets. the second is the infrastructure of aid, and i mentioned re squeeze shaw earlier. it's going to be one of his main missions. i have no doubt this is being discussed right now at the swearing-in at the ronald reagan building. and number three problem is just moving this thing around with

congressional oversight. so -- but we understand what you're saying. i don't know the exact quotes. on the other issue you raised, the neighbors, i'm not sure exactly what you have in mind, but every one of the neighbors has a role to play here in the stabilization and demilitarization ultimately of afghanistan, and when i say everyone, i mean every one of the neighbors. if you look at a map of afghanistan, there's a lot of neighbors. i mean, bordering neighbors. you mentioned india. india doesn't have a common border with afghanistan. but i'm talking about just the countries who have direct borders next to them. >> trudy. >> trudy reuben, the "philadelphia inquirer". mr. ambassador, when the s.w.a.t. fighting was going on,

initially there was some talk of chinook diplomacy, western diplomacy as with the earthquake in 2005 which was so successful in changing pakistani ideas. the pakistani early rejected that. d army rejected that. i was recently in s.w.a.t., and although the pakistani army -- swat, the civilian government is doing nothing so far. the army is hard-pressed and doesn't know how to cooperate with the public. so my question is how do we effectively use the aid we put into swat was mainly humanitarian where we took the lead. how do we take all of this new civilian aid and make it effective, especially when there is such paranoia can in pakistan that the idea of new a id officials come anything to oversee this new aid has been

billed as an invasion of blackwater in the papers? >> gee, thanks, trudy. that was really helpful. [laughter] that's, you know, let's start with the what you call chinook diplomacy and can -- and the 2005 earthquake. it is true poll numbers went up, but they went right back down again. so let's not get gooey-eyed about what happened. what the bush administration did with the earthquake was a terrific thing in and of its own right, and it was one of the things they should be given vast credit for. when it came to swat, we had a different situation. it wasn't a manmade disaster, excuse me, it wasn't a natural disaster, it was a military operation in a very sensitive area. we worked very closely with

general naim and his colleagues. i met with them. i went out to the area myself several times. we have a refugee person on our staff who's working on these issues. we share your concern that not enough has been done in the reinstruction. i'll be returning to the issue next week. and we contributed, as i said earlier, the overwhelmingly the largest single contributions to work on this. and you mentioned helicopters, the pakistanis asked us for helicopters. they weren't chinooks. they asked us for a different sort of helicopter that wasn't on our inventory. president obama himself got involved in this. we joked that he'd become the chief helicopter procurement officer of the united states because he was so concerned about this. we located the types of helicopters that they wanted which was not easy. we had to find them in countries all over central and eastern europe. and we got them out there. and general petraeus and admiral

mullen and i were all personally involved in this. so we're not doing this simply to raise america's poll numbers. we're doing it because it's a necessity, and this is what a great nation does for a country which is under so much pressure. and we will continue to help them in any way we can. and as far as america's position in pakistan goes, i think it's in terms of attitudes towards the u.s., i believe it's better today than it was a year ago. and i believe a lot of the data, most of the data supports that. at the same time the, it'll take time to rebuild the relationship. the last decade was a complicated one for u.s./pakistan relations. matter of fact, every decade has been. >> in the back.

>> good aaron, am bass daughter -- afternoon, ambassador. i'm bob dreyfuss with the nation magazine. isn't it true that you didn't answer the gentleman's question earlier, but isn't it true that the pakistani military and isi is still to this day giving significant support to the very enemies that we're fighting, the taliban, hakani, and that if we squeeze them too hard on this, that they could cut off our ability to supply our forces lo logistically, so we're kind of hostage to the taliban's main supporter which we depend on in order to supply our forces in afghanistan? isn't that the central paradox you're facing? >> i apologize to not responding to the question earlier. it was the inadvertent.

this is, of course, a much-debated question, bob, and all i can say is you're welcome to your interpretations of what happens. but i do not believe we are hostage, as you put it. it is true that well over 50% of our supplies into afghanistan come in over the kuiper pass, and that's the longest logistical resupply in the history of the united states military. and it is -- and i've sat down with the logistics officers in the field and talked to them about the immense difficulties of bringing things in although we are diversifying. but i don't see the hostage issue. as for the question of