or @c-span. next, medical and military experts discuss current health and security issues from around the world. topics include the sprefd ebola, ferksicts of biological and chemical warfare and humanitarian and refugee crises. this is hosted by the interuniversity center for terrorism studies. it's just under two hours. >> okay. i guess we're ready to start. i want to welcome everyone again to a very timely seminar. i want to thank all of the people who put this together with a great deal of haste really, considering the topic. the health challenges we have. the security responses from ebola to terrorism. of course, i think it's extraordinarily timely event.

we have a super panel here. i'm going to let yonah do the introductions at the right time. our panel -- we're blessed really by having a panel that has a lot of military experience, a lot of government experience, medical experience, a lot of all kinds of experience, if you will, that you need to talk about this topic, along with don and his international legal advice and all of that kind of thing. somebody told me one time when i was a young guy, if you want a good idea, read an old book. and i think that is very timely. for example, here's a book written by yonah 13 years ago. and the title is "terrorism and medical responses -- u.s. lessons and policy implications." i think that says it all. with that, yonah, it's yours.

>> thank you for your kind words. and since he mentioned the book, i would like to call your attention to the extraordinary book that general reyes and we have the information in the package that we provided to you with -- if you read this book, you know what it's all about. and we learned the lessons, what worked, what didn't work and the general made many contributions as we know from many, many, many years. now before we move on to our speakers, i have to deal as an academic, with some of my -- first of all, again, to thank the co-sponsors of this event.

of course, the potomac institute for policy studies and the chairman is unfortunately not here today. but we do have some of the colleagues. kathryn, where are you? in the back. and i think we do have a few other members here. and my colleague right there for many years from the international law institute. and i do have to mention alsoor colleagues who are not here but they work with us for a long time. the center for national security law, the university of virginia school of law. particular particularly john moore and professor turner. i have to mention also my

colleague, professor edgar brenner who died several years ago. we worked together for many years at the center for legal studies at international law institute. now let me first introduce our panel and then i have to make some remarks before they speak. one dr. robert right here and you will see a bio, very, very impressive bio, as the general mentioned. we do have some former senior officials, the white house, the pentagon, u.s. senate and so on. so you can read the bios of the speakers. next one is dr. rashid chotani. medical also doctor who is a --

at the potomac institute. also has a very rich background, and you can see that. who is now with the near southeast asia center for strategic studies. and he also participated in the government -- the u.n. and so forth. now you do have the program in front of you, and i would like to make a few remarks, both as an academic, and it's my obligation to try to put some context and rationalization to

our discussion. before that, i would like to mention that in general wln we discuss the issue of security and terrorism, we dedicate the seminar or the session or discussion, first all, in the memory of the victims of violence, both manmade and mother nature which i will come back to it. now because of the ebola disease and those who were victimized by terrorism throughout the world. as we speak, we have to keep in mind that we're living with a challenge which is very serious with implications regionally and globally and all of that. and we certainly have to think

about the victims. also some specific of segments of the society that are targeted by terrorism, for example, some of the journalists. those who cover the events and try to bring us the information all the way from -- who was assassinated in pakistan in 2010. and so the islamic state, a video of the execution of james foley. so, one, it's a dedication to the victims and secondly, also we have to celebrate the work of those who served to protect our societies. in this, of course, the medical community, the first responders, the law enforcement people, the

military governments and the civic society in general. secondly, i think, if i may, we try to pull together a seminar that would have two major challenges. in other words, one is the initial disasters -- okay. so i -- very quickly, a few slide slides. humanity faced two major challenges, natural disasters and man-made disasters all the way from earthquakes to the deadly diseases and now ebola. and secondly, of course, man-made all the way from the economic collapse, technological

disasters, crime, piracy, radicalization and terrorism and war. obviously, we have to deal with both of them in order to understand what are some of the major challenges that we have to deal with. now, if i may, i think we have to make the connection between the historical experiences, as well as contemporary times. trying to deal with technology. as we say, nothing is new under the sun except technology, right? i'm using the wrong thing. right. after all, i'm an academic, but, at any rate, we just had the

publication here on the challenges in africa that was published yesterday and we're releasing it and we'll provide you with copies dealing with both ebola as well as the terrorism challenges. so if, for example, we look all the way back, even the bible and the holy books and all of that and it's very clear what happened to societies at that time and the victimization, but it is interesting to look during history what were the reactions and almost to blame for some of these disasters. natural as well as manmade. and we can look what shakespeare said and became clear to point

the fingers. guilty of the disasters. but i think the best answer was provided by noah when he built the ark because he basically sent a message that i think should be critical in terms of developing policy. he said, look, there is no room. there is no room for delays or indecision. so governments have to move, and the society have to move in order to deal with the challenges. so if we look back, obviously, we can look back at history. the time of the pharaohs, if you will and the ten plagues. the middle ages, and the thing is that the middle ages and the -- is not just a chapter in history. even today we find in

contemporary struggle that some extremists, they try to push an idea that one can call blood -- for example, in the gaza recent, i think crisis and war, there were communications that the jews are poisoning some of the waters in gaza in order to kill more and more people. now if we look back at the responses, this is one picture of a physician in the middle ages protecting themselves from the black plague. and basically, you can see that he's really wearing a cloth which is oil cloth covering his face with a mask and a sponge with vinegar.

so issues of mass mortality. so we have to learn in the past, and i found in fact, i think professor wallace and i, i remember we were together at the conference in turkey. and we saw the monument of kamal ataturk, the father of the turkish republic which just celebrate the 91st anniversary of the turkish republic. and i think kamal ataturk in this particular statement trying to equate the -- was really on the mark. it seemed to me he set it for us to follow and humanity that we cannot be detached from reality,

and we have to look at the situation as it is. we have to deal with the virus and the threat of ebola and what we learn from history that there are two emotions that drive people. one is fear and one is hope. with fear, obviously, we see what that man, even if there were very few cases in the united states in the west and it did generate a great deal of fear, we're going to discuss the whole issue of ebola and we do have -- i will say experts to deal with that. each time we're surprised about the surprise because we did not anticipate that kind of activity while in africa. we know that there were many,

many cases of infectious diseases all the way from malaria and so on. so number one, we're going to discuss the ebola specifically. the roots. what are some of the challenges we're going to face in the coming months and years. finally, we're going to discuss also the security issue cl hwhi has to do with what happened with isis. now i suggest we look at some of the other groups as well. for example, hezbollah. and, obviously, we also marked this month in october, the 31st anniversary of the attack on the marine base and the french forces in lebanon. and i think we have to look at hezbollah as well because we

find that hezbollah is very much engaged as we know in syria and, according to all kinds of reports, hezbollah, frankly, was able to upgrade his capacity. and according to different reports, there are probably about 100,000 records of hezbollah as in any case of a third lebanon war between hezbollah and israel, we are going to see, obviously, that kind of capability. now, in addition to that, i think we echo a look at other groups in the region and the next one, of course, is the al qaeda group. but not only al qaeda central. we have to look at the affiliate

groups and we're going to discuss it with one of our panelists as well. the maghreb and so on. and this is an older map in the beginning of the year. obviously we're going to have an upgraded map to indicate what's happening now in the region and elsewhere with the americans. the groups in the region and the extended groups. we also have to deal with the hamas issue and particularly now we find the most recent attack in the sinai that we witnessed, the attack on the egyptian army in sinai and apparently some connections with the hamas and

other external groups in the region, and clearly, i think egypt in order to develop security, they must construct a buffer zone in the region between sinai and gaza and israel. and there is no doubt that we have to pay very close attention to the question of stability in egypt, which is the most important country in the middle east. finally the islamic state that we're going to discuss in some details and what is really interesting about the islamic state that they are able to somehow recruit thousands of volunteers from all over the world as we know the foreign

fighters. for example, from tunisia today, according to reports, there are about 3,000, i think, volunteers. despite the fact that tunisia approved that it can somehow develop democracy. the recent elections that we know. but nevertheless, we find those who fight for the islamic state. and the brutality of the islamic state is very well known, but i like to mention that only the journalist but also women and children and so forth. so we know the islamic state controls territories as well and, of course, the concern is that the islamic state has a grand plan strategy in five years or ten years and i would say we have to be concerned

about this. finally, in regard to the role of terrorism linked with security, we're going to discuss the humanitarian crisis in the middle east and in africa. we'll go into some details. the countries that we know if you take, for example, syria, the total number of refugees or displaced person in syria is around 10 million if you take into account the refugees, over 3 million left from various countries in the middle east. i think the same thing is in the maghreb, and we're going to discuss it. so the question is basically, what are we facing in terms of

security? and i submit to you that we must discuss not only the ebola, but the biological and chemical and nuclear challenges that society is facing and then, of course, in order to deal with the issue, we have to strike a balance between the security considerations and civil liberties. with that i'm going to -- come and speak. >> thank you, sir. appreciate it. >> sure. >> professor alexander, general grai gray, ladies and gentlemen. it's a great pleasure and privilege to be here. i'm reminded of a plato quote that only the dead have seen the

end of war. only the dead have seen the end of war, terrorism and disease. and so on the topic of ebola, it really represented, i think, a very interesting point in time, and i think the historical reference to the black playing is an interesting one because it will highlight some points i'll ma make later about the risks we face for future plagues like not only ebola but other things that are going to be enabled by things like climate change, things like globalization and megaurbanization. but i'll talk about that a little bit later. i think the issues i'd like to highlight for you is give you a sense of, we enter into this circumstance with great humanitarian crisis and quite frankly initial security crisis in western africa. after a fair bit of work that has been done over the last decade to improver game in terms

of health preparedness and health security. so it will be my intent to give you some sense of what has been done and from a policy perspective exist for the current administration, whoever is president next, he or she, whoever that is and certainly the new congress that will begin in january. i think the current ebola crisis from a u.s. perspective highlights the great vulnerability of our health care system to a single case of ebola that basically walked through the emergency room door in dallas and was immediately sent out after all the warnings and messages the centers for disease control had sent saying it was possible, more than possible, that an ebola victim could walk into your emergency room or hospital. what's worse about this is the effect and you can argue this has been largely media hype. but i would argue something very

different. there's a very core fear in the american public that predates the events that happened here in october that go well back, and i have an historical example of it. back to 1946. so many of you may not realize that during world war ii, we had two manhattan projects. one was developing a nuclear bomb and we know who the oppenheimer was there. but there was also a bilomgical oppenheimer. george merck. his name may sound familiar because there's a billion-dollar multinational pharmaceutical company named after him. but he was the american oppenheimer for the offensive bw program. quite frankly during the several years it was existent in world war ii, they were never able to create a functional biological weapon that they intended to use

at either japan or germany used those weapons against us. i make that point because there's an historical point about the role of intelligence. in 1943, when president fdr was warned about the possibility of biological warfare, the u.s. intelligence community, basically informed him germany had a biological weapons program and germany didn't. we found out after the war the exact opposite was true. you can relate to more recent examples where the intelligence community hasn't been 100% right on these sets of issues but it's just worthy to note it was certainly the case then and now if we rely on intelligence we may be very disappointed. particularly about not only terrorism and the use of these kinds of weapons but also about disease itself. the point i'm trying to make, in 1946, george merck released a report to the american public about the efforts to develop

biological weapons. it's one of the few cases that i know of where a report was unclassified, released to the public and later reclassified as secret and pulled from all the shelves. why was that? because it scared the bejeezus out of the american public. you can recount that if you go into the archives of newsweek magazine and time magazine when they were printed on paper and evaluate what was not only the scientific debate but the fear that was invoked by the consepts that you could create agents that would be invisible, total ly alien to our senses that could kill you in a rapid fashion. everybody has been sick in their life so there's some element of what i'd say personal reference to the idea of illness as there is. few people have had ebola in

america. if you recall robert preston's book "the hot zone," he makes a compelling case why you should fear such an organism, the ebola virus. there's an innate fear and a created fear by public press. there have been popular movies of the subject. and, obviously, the media has certainly not missed their chance to sell print or advertising in today's world. but the point is this represents an interesting nexus for the potential for terrorism. that's kind of what we experienced around 9/11 with the anthrax letter attacks. so i would just argue for the purposes of this panel, that in some ways, while we view the ebola crisis as it is today, it could certainly migrate into a different space, should someone take advantage of the availability of a virus like

ebola and use means to deliberately infect people. but this is not new news to you but i do think in some ways you need to understand the health care system that we have to date. it's a $2.8 trillion activity. and the u.s. government currently spends about, for hospital preparedness, about $225 million. that represents 1/100 of 1% of what we annually spend on health care. so you can imagine that what we gain out of that federal investment around health preparedness is evident when a single case of ebola walks through a door or could be any other disease of significance like smallpox or pandemic influenz is that, the affordable health care act, and i'm not here to throw stones at it, but does not have a thread of preparedness weaved through it to ensure the health care system

that we will develop over time, where every american has not only access to the right health care is a system that is prepared to meet the challenges of the 21st century. and ebola represents if you will, the poster child for the challenges we face ahead of us. the other thing you need to understand and i'll throw out this quick anecdote. we spend -- the amount of money we spend an health preparedness is about 3% of what the american people spend on potato chips. as a society, we don't put a lot of investment or priority or sig novemb significance on this. i need to convey to you there's a wealth of things that have been done beginning back in the mid'90s during the clinton administration that really have, if you will, evolved policy and legislative action to the point where we are today that in some ways, i would say we have enough

policy, we have enough legislation to do what we need to do, but we failed on execution and commitment and priority to do the things that have already been established by presidential policy and legislative statute. and i'll give you some examples of that. first of all, president clinton basically recognized the concern about bioterrorism. even though conventional press says it was around the book cobra event, another book about a synthetic virus and toxin that someone comes up with. but the point is that much like the einstein letter of the 1940s, that was sent to president fdr, president clinton got a letter from a distinguished nobel laureate who earlier in that decade in 1992 did a study for the institute of medicine that indicated that

emerging diseases were going to be a significant consideration in the future. again, 1992, before the issues, if you will, of global climate change, before the issues of globalization were realized. dr. letterberg and his colleague from yale university basically recognized that we were on a converging path, potentially with disaster with the possibility of emerging diseases in bioterrorism. and it was their work and dr. letterberg's warning to clinton that basically if you will initiate things. i'm a great believer in our system at government at best we can hope for imperfect incrementalism. you can look at any issue in the united states history, whether civil rights, defense policy or i would argue in this case public and medical preparedness

that we demonstrate imperfect incrementalism. we make a few steps forward, one step back. realign and move forward again. and so it is with that, there have been a series of, if you will, legislative initiatives that basically happened after 9/11 that are worth noting. one is the pandemic all hazard preparedness act. i'd like to tack credit for it because i was a staff director for the senate subcommittee that drafted it. but it was actually senator richard burr from north carolina and senator ted kennedy who championed that bill. and the significance of that bill was it basically used the lexicon of national security to define and, if you will, redefine the u.s. government's role in preparing for these events. interesting enough, and i'll make reference to a project that general rey was involved in in his career. but we used the

goldwater/nichols act as the template for this bill. not because we think public health or medical capability should be aligned along the dod axis, but it did identify in the goldwater/nichols act the idea of having joint operations, putting somebody in charge and creating a kind of command structure overall. so with that, a position was created at the health and human services department for the assistant secretary of preparedness and response. regrettable in the crisis at hand you don't hear much about that office but it was their function to do the necessary things to align not only the u.s. government's efforts in this space, realizing that in some ways it's not only hhs, dod and va that have significant assets to bring to the fight but also this idea that to basically align the state and local authorities who are, if you wishlgs the front line soldiers in this kind of activity. we can argue that was effective

or not. i think the story will be written. but i do hope that as a result of this ebola event, somebody will have the wisdom that they had in the 1980s to commission a holloway report that general gray was part of. we talked about it before these proceedings. that really did assess why did things fail? in that case, desert one, because what they identified in the blueprint they laid and the vision they left was one that over two decades went from the point in time when we had a tremendous failure in the iranian hostage rescue to the point in time we could all celebrate the demise of osama bin laden. that didn't come overnight. that didn't happen because somebody just said let's do it. it literally took decades of commitment by the special operations committee to do four

essential things. four essential things that i would argue today are the essential elements of the kind of public health preparedness we need to address the current ebola crisis and any future public health crisis we may encounter. one is recruit the best people. if you look at the record right now, we have a tremendous brain drain. and graying of the public health commune hit. the people operating at state and local level who basically eninsure people abide by their quarantine, that people do do the things that lower the risk to the public to disease. we also acknowledge in the medical community that in many ways we don't necessarily train or equip them to manage these events. i think the events in dallas prove, as they did prove in the case of desert one there is no such thing as just in time preparedness. the idea you need a force at the ready, they need to be trained,

equipped and exercised. yesterday i spent the entire day, i co-chair a channel of the institute of medicine and we spent a day looking at what's already transpired with the ebola virus. we heard from local public health and medical leaders from atlanta, from nebraska, from new york and from dallas, or at least indirectly from dallas, on their experience so far. and what they said is, you know, what we really needed to do was make sure we had the equipment on hand and that we were well trained. not just in time training but continual training to ensure that we could meet the mission. so these are essential elements of the challenge we face right now in terms of preparing. now you'll hear of ad hoc teams from cdc, department of defense. those are truly ad hoc gap

fillers. but as we look forward to the events before us, i think it does raise the question, how much are we going to invest in this space? how much of a priority are we going to put in this space? after this ebola crisis is over, realizing the next one may be on the near horizon. now there 24 majare two major p issues that are outstanding that need to be addressed and then i'll probably be at the end of my time but i'll leave you with some final thoughts. one of the lessons that we learned in the early 2000 period from the standpoint of the anthrax letter events, it could have been a lot worse. we know from the wmd commission report by senator graham and talent, they recognized had that perpetrator taken a single envelope of that anthrax and put

it into a ventilation shaft in the metro, it would have killed several people. it could have infected several hundred or several thousand people. and this points out a very important issue of inversion that i think has happened in the policy toward these events. we talk about inversion about companies moving overseas. let me give you policy aversion over health security. number one is in considering these events, it was always believed in some ways bioterrorism, biowarfare, a state actor conducting this or a group, conducting these kind of attacks using infectious disease agents could create a situation not seen in nature. you could basically infect millions of people nearly simultaneous simultaneously. the belief is in some ways if we

prepare for natural events like ebola, which don't have the same epidemiology, that somehow we'll get the benefit of improving our public health and medical infrastructure, maybe at a lower cost, but in some ways, that's the more likely scenario. it's like telling an army or to say -- or basically better yet, let me use a football analogy, taking the washington redskins and telling them they'll play one of the local high school teams as their way to practice when they're going to play the dallas cowboys or the seattle seahawks. the whole thing is that if you define the problem in a certain way, and i think we're an the wrong track at the current time, that we will basically not prepare ourselves to address -- i won't say the worst case scenario but certainly a reasonable case scenario where terrorism tries to use these

kinds of agents as weapons. and as i think you can see in the events of the ebola case, we have not proved ourselves necessarily competent to deal with a single case of a naturally occurring disease that's reported in the united states. the second issue is, another policy issue is, in all the efforts and even the efforts i was a participant of, that preparedness, particularly health and security preparedness, was somehow outside the domain of regular health care. kind of an add on. an adjunct. it has to be integral with. that's another major policy issue that i think is outstanding. i think in the construct of my comments today, alluding back to the points the professor alexander made around black death, we have to look at the

events that are going to make our life challenging no matter what. whether it's disease that is natural in origin or deliberate in origin. and that is three essential factors. talk about climate change a little bit. globalization. the opportunity that someone can get on a plane today and be in the united states about the same day but the next day carrying a disease that either he acquired or she acquired. that could represent a public health threat or by basically having ten people purposely inoculated by a particular disease being if you will, infiltrating the united states by commercial airliners. and i think the other element here is this idea of urbanization. ebola wasn't a problem in the past because it happened in a remote village. people would get sick. people would die and because there was no access to modern

transportation, the outbreak was naturally contained into those settings. now there are better roads in africa. people living in large urban environment s like monrovia. a million people living in a dense urban environment. somebody gets sick in that environment, particularly when sanitation and other conveniences of life we take for granted are not available, it basically creates a circumstance where these things can rapidly propagate. i think i've probably, if anything, went over my time, but i hope i left you with a sense of the landscape that we've done which, again, first is imperfect incrementalism. we're two decades into a dedicated effort to improve the preparedness of our health and medical infrastructure. we have many more miles before we sleep, before we get it right. this is not rocket science. i think the experiences or

analogies we've done in other areas and i was the socom experience as being one employe fix this problem. it's not entirely expensive. but it takes priority. it takes leadership. and resources to do so. and the last thing is, we need to define the problem correctly. that in some ways the challenges before us are likely to be more frequent. they may represent a deliberate component that represents something entirely different than we are dealing with now. and we should have the wisdom and fortitude to develop what we need before it happens because there is no just in time preparedness. with that, i will completely remarks. >> general gray, professor

yonah, and distinguished guests. it is always difficult to go after someone you respect tremendously, a friend, mentor and adviser for many years, dr. kadlec. you what i will do is specifically focus on some of the facts and ethical issues related to this particular disease. in africa, ebola primarily occurred in remote villages, tropical forests in central and west africa. democratic republic of congo, formerly known as sighier -- we have seen cases in new guinea and sierra leone. between 2006 and 2012 it,388 cases and 1,590 deaths are recorded. now when you look at this and

look at numbers today we are amazed. that is something we want to keep in perspective. how does ebola spread? now recent studies have clearly indicated that fruit bats are a reservoir for ebola and that nonhuman primates such as the ape and monkeys are carriers that transmit it to humans. now let's move to human to human transmission. the way in which it appears in human, humans at the start of the outbreak is so far unknown. we know how it comes but really don't know what exactly happened. the first patient becomes infected through contact with infected animals, such as fruit bats, as i mentioned, aep primates. which is called a spill over event. person to person transmission can lead to a large number of people getting infected. and small past ebola outbreaks,

primates were also effected and a lot of primates died during these outbreaks. and humans when they consume those primates or touch those primates got infected. humans can spread in several ways, through direct contact, broken skin, mucus membrane. eyes, nose, mouth and body fluids of a sick person. and it is not limited just urine, saliva, sweat, vomit, but also the breast milk and semen. objects like needles can also contaminate and transmit and from infected as we have also mentioned, you know, the fruit bats and primates. past research as we know have established now, and we are still working on it and there are still some questions. but past research has clearly suggested that the spread does not -- that the disease does not

spread through air or by water or in general by food. in africa, ebola may spread at the result of, as we mentioned earlier, handling of the bush weed which is very critical to understand and appreciate. there's no evidence that mosquitos or other insects can transmit ebola. once someone recoveres from ebola, they can no longer spread to others. however, ebola is found in semen for up to three months. so that is something also to consider. as of october 29, the current epidemic in west africa called by the zieier stream has resulted in infecting over 13,000 people and close to 5,000 deaths which brings the current case fatality, mortality rate to about 36%. the three main countries are liberia, sierra leone and guinea. nigeria had 20 cases and eight

deaths and was declared ebowl why free on october 18th. synagogue was declared ebola free on the 19th. all districts of sierra leone have reported one case of ebola. and the next potential country that could get the disease. or 500 health care workers have contracted the disease out of which 50% died. which is a very high number. because the case fatality rate right now in the general population is about 36%. interestingly, the first outbreak that happened in 1976, the case fatality race was about 80%. that was a zieier strain. the last outbreak in 2000, 2001, had a case of about 32%. so we are getting close to the percentages that we anticipate

that are going to be for this particular stream. we all know in spain, there is a case on october 6th, and a nurse is taking care of two missionaries contracted the disease on october 20th. no trace was found in her blood and spain will be declared after 21 days ebowl why free of actually 42 days ebola free. we all know about the cases in the united states, the united states and dr. kadlec talked about it in detail. and the problems and issues with our preparedness and recognition of disease is big. something we need to look at very carefully and appreciate. there are a couple other cases, there is one case that is in new york right now. that was diagnosed on october 23rd. and a physician worked with doctors without borders and it is currently being treated. and all of the tracking in terms of people that he was in contact with is being done in new york.

there was another potential case in new york of a little child, 5-year-old child, taken to the hospital who tested negative. there was a case in maryland, taken to the university of maryland medical system on october 27th. and it turned out that was not a positive case of ebola. there are two interesting things that happened on october 27th. cdc outlined plans to monitor travel. most health care workers returning from west africa or ebola hard zone would be considered to be at some risk for infection. while health care workers tending to ebola patients in the united states facilities would be seen as low but no zero risk threat to the population. these guidelines were short of the controversial mandatory quarantine imposed by some united states states such as new york and new jersey. same day united states department of defense came up

with its own policy well beyond previous established military protocols. isolating about a dozen soldiers as far as at the base in italy, including mayor general williams who oversaw the initial response of the oebola outbreak if afric. the military had been building infrastructure to help authorities to treaty bowla victims. we have about 3,000 boots on ground in rotation in africa, helping with this particular problem. one of the critical problems of ebola is house to diagnose this particular disease. we did not have an effect of way of doiagnosing it. there was eua for the defense department for realtime for chain reaction for ebola.

on october 25th, fda issued another emergency operation for two new diagnostic tests, called the biochoir test which can be done on student and give you your result if about an hour. france also has the ebola z screen which has been developed by the french atomic energy position. they can diagnose ebola in about 15 minutes. there is no approved treatment available for the disease. clinical management is in supportive care of complications. however multiple therapeutic drugs are in the process of being developed, that would help this -- help work on this disease. there are two particular vac evens that are of interest over here. one developed by glaxosmithkline. another one by new link, which

is a canadian vaccine, being produced in iowa. both of these vaccines can, if the test of all of the safety in humans that is being done right now comes out okay, then this should be a descent amount of supplies in the middle of the first quarter of 2015 before populations within the united states are to be given to health care workers and the first responders in africa. one of the most -- one of the other important factors to consider is what is going on in terms of the beds in africa. there are just not enough beds for patients. the latest data from the case, it 2% of the planned ebowl why treatment center beds and 4% of planned community care center beds are now operation.2% of th treatment center beds and 4% of planned community care center beds are now operation. which leaves a huge void in terms of helping the population.

the largest and most complex on record with an unprecedent number of effected countries. thousands of cases and death. and in general population and hundreds of health care workers infected. the escalating outbreak forces an urgent need for large scale and the need for effective medical intervention. subject to the outcome of safety of studies and trials, we expect that, as i mentioned earlier, that they there will be therapeutic and vaccines available to work on this disease. now all of you have heard the experts predicted that if the appropriate measures are not taken, we can expect approximately 10,000 cases per week starting in december in africa. well, let me say that in two of the countries that outbreak is going on, we are seeing a little bit of decline in terms of the cases. so there is some hope that this

potential outbreak can be nipped by january if appropriate measures are taken. as dr. kadlec had suggested be with the world is making this up as we go, and we have to be more comfortable with solidarity. it is a huge problem. the current epidemic which africa struggles with, is something that we should have thought about. they do not have a health care structure that can deal with the regular issues that go on over there from a health care perspective. now we are adding to this jury by ebola. the nature is adding to the countries with ebola outbreak. the first focus needs to be on simple things to decrease mortality in west africa. suggesting aggressive intervenous hydration place be electro lights, managing fever and super imposed infections, relatively inexpensive measures

that can be part after package delivered to west africa. there is a critical need of the best as i mentioned and the most effected countries. proper training and protection needs to be provided to the hospital staff taking care of the cases. and a burial staff dealing with the corpses. there are complex ethical challenges which are bound and later to be used if untested interventions, quarantined, special case and other issues. in the u.s. national institute of health biomedical research always played a critical role in physical and mental health. yielding significant socio economic benefits. centers funding has been a corner stone for nih, nih has been the corner stone for the american biomedical research sector that leads investment and innovation. and stagnated at 2003 and

declined after 2010. the cost of conducting biomedical research has rapidly increased both at the same time. this was further heard by the reejen budget cuts in sequestration. in order to secure america's position as a global leader in biomedical research for the foreseeable future, there need to be huge significant investment. there is no evidence so far that we have appreciated in the soon tistic literature that says that closing borders will cause the disease to stop to come to a specific nation. we also need to deal with some of the other ethical factors in terms of foreign health care workers. should we do that? yes, we should accept those workers. we must make special commitment to health care workers that are currently working in these particular countries. front line, dealing with the disease that is extremely deadly. those doctors and nurses must be

promised not only high quality of training and protective equipment going forward but also that if something happens, we must take care of them. someone must take care of the heros. not just civilians, but the 3,000 troops in the hot zone when we come back. we have to make sure that they are taken care of. and somebody also there are signs that epidemic is slowing down. it is not effective but it is in bigger devastation than we could ever think about. a safe vaccine i believe is the only hope for containing the outbreak but the u.s. investment in vaccine research is a drop in the bucket. the u.s. is needed in this funding and u.s. department of defense but research and development and advance

therapeutic as well as diagnostic devices. we also have to make a concerted effort to develop manufacturing facilities right here in the united states. for diseases such as ebola and other infectious diseases that we might encounter in the future are emerging threats. countries, ngos and agencies, private and public, need to pledge. only 17% of pledges so far have been filled. countries promise and private institutions promise and pledge. those pledges never come through. they need to stand up and fulfill their commitment. and the last word is, remember, diseases do not observe boundaries. so we can have these diseases come to the united states or any of the part of world if we do not -- if we are not -- if we are only reactive and not proactive. thank you. >> thank you, yonah.

with dr. alexander's permission, and i guess more importantly our media colleagues' approval, i will speak from the table here rather than the podium. i appreciate the opportunity of being here. i have been asked to speak a bit about terrorist and insurgent groups that are operating, not just in africa, but also in other parts of the region. and a little bit about how that affects the potential for humanitarian disasters in the region. there is plenty of literature analyzing these groups. some of the best is done here in this building. so i'm not going to go into what al qaeda is all about or what isis is all about. except for just a little bit. but what i want to do is talk about the activities of these groups and the potential for the development of true humanitarian crises in the region. and that is primarily through

the issue of refugees and displaced persons. now i got some statistics here i will rattle off. the sources of these and most of the united nations, high commission for refugees or the undersecretary-general for humanitarian affairs. in africa, boca horan, a group that has certainly made headlines recently, there are probably 10,000 nigerian refugees in cameroon. i don't know if anybody would go to cameroon to seek refuge, but there are 10,000 nigerian refugees in cameron. there are probably 50,000 refugees in niger. and there are displaced persons within nigeria. maybe even up to a million because these numbers of coarse keep changing as things evolve.

moving further north in the mally situation and in the activities of al qaeda and islamic further in the north and mali and nigeria, there are 30,000 displaced people. i mentioned 50,000 in nigeria, those come from mali. for yellow fever, and this sort of thing. though i want to emphasize that humanitarian disasters that can happen are certainly more than just medically related disasters. in libya, which one can argue is kind of the beginning of this whole process especially in northern africa. and there are 60,000 internally displaced persons within libya, a country where the -- any sort of government, whether the

central government or regional governments, their reach does not extend very far beyond the building in which they are meeting. there are also a million refugees, eye cording to the u.n., in tunisia. president of tunisia, who will be president at least for another month or six weeks, says that it is up to 2 million libyans in tunisia. maybe even one-third of the 2011 population. now tunisia has capable medical capabilities. there is a bit of a joke about that. if we have time, i will tell the joke about tunisia and the medical. but this really taxes the capacities of countries to handle these people. now, let's talk about isis a little bit. and i will talk about the refugee situation, which dwarfs

the other numbers relatively. then i will talk a little bit about isis myself at the end of my remarks. the u.n. says there are 3.2 million registered refugees. registered refugees, registered with the u.n., from the isis syrian civil war and sectarian fighting within iraq. there are refugees, more than a million each in jordan, from both iraq and syria. and jordan has been -- has seen successive ways of rerefugees, from 1948 until this year. about 1.3 million in turkey. these are registered. 1.2 million in lebanon. 500,000 syrian refugees are in iraq. they went from syria, from the frying pan to the fire, or the other way around, depending on your perspective. and they sought refuge in iraq.

and there are 900,000 internally displaced people in iraq. there are about 4 million syrians that are displaced within syria. now some go to cities and live with relatives. not necessarily all in refugee camps. but this certainly is a lot more than 3.2 million refugees. as winter gets close, about 5.2 million people in iraq, says the united nations, will be in need of humanitarian assistance. as winter sets in. fuel, shelter, that sort of thing. and in iraq and syria, there is a chilling statistic and i'll talk about that towards the end, there are now about 10 million people living in areas controlled by isis, the islamic state. 10 million people.

in sir whiy 10 million people. in sir whiria and iraq, both countries. that's larger than the populations of most of the states and the region. now, that of course creates a large refugee population camps, emergency needs, and there are, as we've heard, by our previous speakers, and i don't mind going after previous speakers. i learn a lot from the folks that spoke before me. there are a lost obstacles with the government and organizations and ngos. there are obstacles providing the humanitarian assistance. ranging from the -- well, seemingly ridiculous teams that are vaccinating for polo and pakistan are there to sterilize your daughters.

so don't let them into the village. in fact, several have been killed. medical workers are actually bringing ebola into your part of the country. to stay away from those people. it remind me of the black plague picture with the vinegar. it is misinformation and it is also propaganda that we have to counteract. obviously there are terrorist attacks and insurgent attacks going on in all these countries that i mentioned. and that threaten especially foreign ngos. but not just foreign ngos. intin generalous also. in niger. the government said that any ngos, any humanitarian teams providing assistance need armed escorts outside of the capital. that certainly inhibits people

flocking to help victims there. there are kidnappings and abductions of humanitarian aid workers in maui. isis has targeted humanitarian workers also. and we have seen the beheading of two -- of two brits that were there for humanitarian purposes. the undersecretary-general of the united nations for humanitarian affairs and i'll quote her says we have had 60 -- and this is in the syria, in both civil war and isis. we've had 66 humanitarian workers who have lost their lives since the start of that conflict and hundreds more have been kidnapped and abducted. this is what she says. within syria. that is certainly an obstacle to bringing assistance necessary to take care of these people. and as we've seen in refugee

camps in jordan and probably elsewhere, the war if sir why and sectarian fighting in iraq can spread to camps themselves. in other words fighters from each side can infiltrate camps, go there as refugees, and carry on the fight within the camps. which is really stresses both the national security service, the u.n. if they are running camps, and other organizations. so we've got this situation with millions of people facing -- and it wouldn't take much, to have a medical humanitarian crisis. but certainly other crises in terms of food, water, shelter, and these camps. now, let me talk a little bit about isis. because this represents a new situation. we call it isis. that's what our government insists on calling it. i'm no longer part of the government. i'm an ex fed, not a fedex, but

ex fed. i actually retired and so i'm speaking just from myself but our government insist on calling it isis. islamic state in iraq and syria. but isis has its eyes on a lot more than just iraq and syria. if their map of the worldwide -- it masks something that never existed in the history of islam. most of northern africa, south asia, it is a very globally looking, whether they have the capacity to execute it is another story. but they have this vision of this worldwide calfet. this is the first organization of its kind that has been able to control territory in the daytime as well as night. and this is key territory. these are cities. infrastructure.

roadways. rivers. that sort of thing. key territory. 10 million people live in the area they control. they have -- we can say that aqim and groups like that strike the desert, that's true. but these people control territory. they displaced the national governments such as they existed and the more traditional trieblg authority, that sort of thing. in the places that they controlf thing. in the places that they control of thing. in the places that they control of thing. in the places that they control sort of thing. in the places that they control sort of thing. in the places that they control authority, that sort of thing. in the places that they control. but they haven't filled the governance vacuum that had been growing before they came upon the scene. places like in iraq and syria. they are not providing services to the people, these 10 million people that live in the area. they don't even seem to care about providing services to these people. or interested.

now i don't surf the jihady websites to see what is going on, but i haven't seen anything from isis that seeks to show how they have made life better for the people in mosul. now that malachi and that all of the propaganda beheadings and this is the totalitarian in the sense of the world. if you're not one of us, we'll kill you. and they don't toe the line and believe what we do and do what we do, we will kill you too. so this is a different -- a very different organization of al qaeda. al qaeda never really took that live. now we're seeing isis sort of clone type organizations in northern africa that are swearing allegiance like they did before, to al qaeda.

al qaeda central to isis. certain elements, boca horan are doing that. so we are getting the almost nilistic totalitarian organizations that are controlling a lot of territory. very little o getting into these places that isis doesn't approve. the red cross says that it did manage to provide some medical equipment to a hospital in mosul. which isis controls. and the icrc says it has established contacts with some people inside in iraq. but these are very small efforts. so that's the situation as i see it. and in that particular region. and we're fating a large region,

as our previous two speakers said. thank you. >> oh, and foreign fighters. no one mentioned foreign fighters. and i'm a grand faerm. young men, wold wide, find ways to get in trouble. i don't care where they're from. and in tunisia and other places are no exception. it could be through video games or drugs or through alcohol or something like this. but fortunately, at least in the west and europe, outlets for getting in trouble are much wider and much less lethal than they are in that particular. it is not surprising that young men of that age would see something -- everybody wants to, you know, be the person in the video games. a lot of you too neeshians, say,

before the revolution in tunisia, were drawn into these groups. when they were in europe, they left tunisia to go to new york to find a better life, which they didn't find. they were there for -- because they were separated from their real families, they today find a virtual family on the internet, and they got sucked in. now they are recruiting within tunisia itself. there is a lot you can blame on the job, economics, social despare they have. but essentially, there's always a group of young men that are going to find ways to, for excitement and to get into trouble. >> there are comments now -- or -- okay. [ inaudible ]

many of you have come to these programs of yonah's and there is one golden thread that runs through them. that's the gold, the richness of what is said. i find it difficult to put it all together in my head. but i think that today we have a fairly common set of themes. i mean, i thought initially we would be talking about the fear. but i think we are really talking about the underlying reality so we don't have to get into the sort of excessive reaction. someone mentioned core fear. i think that's kadlec. let me talk about isis briefly. we had a program about isis before. i think it was called isil at

the time. i think yonah or someone called it terrorism. but i think it is probably deeper than terrorism. terrorism is simply one of the things that's spawned. i think this is something we really have to be concerned about. i think we've seen the collapse probably of the middle east. or it is interesting, someone mentioned that yesterday, other day, was the 91st anniversary of the turkish republic. i wonder when people will turn against the turks for ending the califate. the problems are profound. i thinksome of these problems, when -- fear comes from ignorance. but even if you're knowledgeable and are not afraid. i think it is hard to get a total grip on the underlying reality of the people. this is something we will come back to again and again. yonah has been drawing that picture and it will keep growing and deepening.

it is definitely there. on the other side, i didn't see how we link ebola to this but now i see. it is really inadequacy of our ability to cope. yes difficulty in coping with isis but maybe even a greater difficulty coping with ebowl why and then possibly boyo terror. and then in america, we get our priorities. i would say tea party republican. now this inclination to spend money on private goods, the belief that private life is what it is all about, the beautiful houses, the meals, we think there is something wrong with our man hood on wanting to spend money on public goods. as pointed out, we have our peril. yonah said before as we cope with security problems, we mustn't neglect our civil

liberties. i believe completely with the lawyer. lawyers tend to believe that that. so much of our liberties is related to our freedoms or unwillingness to have this sacrifice and short and long-term. and even in the face of emergencies what we are not is marines. and the military has a discipline, the civilian publics of the west do not have it. so we will lurch and lurch and lurch. and incrementally your word a little better and hope we don't have to succumb to fear in the process. >> we will open up discussion here. it is not the question of fear, as the question of -- oh, so -- the big issue is that we tend to

exaggerate sometimes, the fear and also the hope, you know, we pray, we hope. so we have to start some sort of a realistic -- [ inaudible ] anyway, you know -- >> thanks very much. >> i spent many years in counterterrorism. and the more we work on the ebola issue with a group called the global health response reliant. i think there is some parallels in fighting things especially by president bush was we fight them overseas before tle can hit them here. one thing about fighting ebola is to try to contain it in

africa. as you all know, describing it with the efforts to help the people there. and there's a certain irony here that in counterterrorism, we spent millions of dollars in training other countries to beef up counterterrorism force, is in fact kind of overlook the time benghazi joined and indonesia, broke up a couple rings and tried to attack embassies. and in the bioareas, you know better than i do, we try to improve the capabilities of other countries. but now we are running into a problem. you try to encourage health work gores overseas. and doctors without borders, and with reuters today saying that there is a chilling effect by the quarantines, opposed in new york and new jersey and governor christie admitted he didn't talk to health officials. we have two major allies, canada

and australia, which are good health systems or very reluctant to send health care workers because they are worried about training them. so being counter productive to have quarantine to discourage people from going overseas. and there is another effort going on and hasn't had much publicity. here is where i disagree with you a little bit. the only solution is not vaccines. proposals to develop sort of a phase 2 to develop quarantine or develop containment zones in areas countries are already effected in countries to keep ebola from spreading. at idea is to help educate villages to abandon some of their burial practices which the cups, of the dead person to pass around the family. and other things.

the onus made some progress, there are teams going out there but a basic effort is to try to educate the villages and put in some teams to deal with the psychological and other aspects of phase 2. and this group which include mainly a group of public health specialist and former military people and from dhs is trying to put that together. my point is that when you have to look not only in the immediate problem of getting enough people and health workers and train them up for where it exists now and also to develop a better way of containing it before it spreads further. >> so i agree with you that developing a vaccine is not the only way to deal with this

problem. but what i wanted to emphasize was that if you really wanted to get rid of this problem for good, we need to have a vaccine. you know, the primary things that is needed is to provide the effected countries with the basic needs and the basic needs are just from beds to iv fluids to antibiotics for example. and so kboing from there we've got to understand and appreciate that we've got a cultural bias that we've got to deal with in those nations. and that has to deal with the way that they deal with food. and the practices. dr. kadlec said very clearly that rain forest and you know, deforesting, a lot of land in africa and what that is doing is it is bringing the food back into close proximity.