they work through local partners but ones that they know. they get their regular reports. but in addition to that because it's a relatively sophisticated society, syria was a middle-income country, really and people have cell phones and so on. so we actually have a system where when food is delivered, they can send a picture taken from the cell phone with the bar code so we know exactly where it went and when it arrived. >> well, thank you. let me interrupt you here a second. >> we have multiple systems like that going on. >> to safeguard. let me ask about majority of assistance. to go through the u.n. and third-party implementing partners or directly to the party? >> and thank you for that question, chairman. about 72% -- through a joint effort, really, in terms of collaboration. you know our number one humanitarian objective in this

crisis is to get as much aid through as many channels as we possibly can. whoever is best placed in certain circumstances are the ones that we ask to deliver. obviously to the extent that they are comfortable delivering given all the challenges that are actually there. you asked, in particular, about the crossing lines and cross-border ranking member deutsche. since the resolutions have passed in the security council, we've had about 54 of those aid shipments reach about 600,000 people in terms of the cross-border efforts. that doesn't mean that we're keeping up with need though. so i don't want you to be left with a good-news story. the needs are vastly outstripping the humanitarian aid that we're able to provide. tom mentioned the enhanced monitoring. we, too, on the u.n. at least the u.n. refugee agency and others that we support have asked for enhanced monitoring plans. >> thank you. >> in terms of diversion -- >> my time is up. and we have -- >> okay. >> -- votes on the floor. but would you like for me to recognize you or break?

mr. deutsche. >> one observation. we have to go to the floor for votes. but i just -- before we leave, i just wanted to say that listening -- listening to the two of you give your testimony and respond to the questions, i think reminds us that as a good reminder of why we're proud of the americans. >> amen. thank you very much. excellent work. and we will be back. and mr. smith will chair the remainder of the hearing. with that, our subcommittees are in recess. thank you. the hearing will resume and we'll be joined by mr. deutsche who is under a time constraint. i will yield to him when he comes back. let me first of all thank you again for the tremendous work you're doing in saving lives.

and i think you know, sometimes people are very critical of foreign aid. they should know the robust efforts you, the administration, the congress in the supportive role is undertaking to save lives of the most precious and the most vulnerable people, particularly women and children. again, let me echo what we all said i think in our openings just how grateful we all are for the work that you're doing for people who have been displaced, the refugees the idps, women and children who are being savagely attacked and women who have been raped. i'll never forget years ago during the balkan wars, i had hearings with women who had been raped. and one, she was so traumatized, and she thought she could handle speaking what other women were experiencing during the balkan wars. bianca jagger was here speaking to that, and she froze. she had been so utterly

traumatized. and i know you're helping women who have been so horrifically violated. so thank you for that as well. i do have a question. secretary clements deputy assistant secretary you mentioned in regards to vaccination 2.9 million children require life-saving vaccinations. i wonder if you could break that out a little bit. they have not gotten it or some of those have already received it, what vaccinations are we talking about? you know i've always believed that vaccinations like antibiotics as well as anesthesia are among the wonders of the world in terms of how they mitigate disease and pain. so the question would be 2.9 million, what are they lacking, and what is being done to try to get those vaccinations to them? >> thank you very much chairman smith, and thanks for your kind

words. i have to say to follow up on a point that the ranking member made before he left it is a moment to be proud as an american in terms of what the u.s. taxpayer is doing to help us provide this kind of humanitarian aid to so many people in need. and we deeply appreciate that. in terms of the vaccination question, and we can take that back and get some more granularity for you certainly but between usaid and the state department's humanitarian programs both inside syria as well as the neighboring countries, very strong network of health providers. and obviously through unicef and through the world health organization with a large number of implementers, there has been a great effort under way to try to vaccinate as many kids as possible. i can speak more to the refugee side of things in terms of in the neighboring countries. but it is a core part of the health services that we're providing every day. >> yeah. thanks for that question. it's important i mentioned the polio vaccine. and that's an indication that

they are actually able to get out to a lot of places that you might not think they could. it's still not perfect, and we continue to try to get out as far as we can. last week when i was in jordan i visited one of our implementing partners, and they have been able to establish and are continuing to expand their network of field hospitals and clinics in opposition-held areas from across the border. and that's another way we can start to push out the reach of health care including vaccination. but that's a critical issue. >> let me ask you a question with regards to -- i mean we all know from history that the spanish flu epidemic, of course, had nothing to do with spain, but it was a terrible pandemic. following world war i, infected some 500 million people, the estimates are upwards of 50 million. some say more some say less actually died. 5% of the world's population. health services have been

disrupted with more than 73% of hospitals, 27% of primary health care facilities and 65% to 70% of the pharmaceutical companies out of service. a couple weeks ago i met with dr. peter who has been here before to testify. he is the leader on neglected tropical diseases. and as a matter of fact i have a pending bill that we wrote with his very, very insightful suggestions on what it should look like. but i know he has said that he has concerns that a pandemic could arise out of syria or the region, war conditions, lack of sanitation, cholera, all the other attendant problems. the longer this conflict goes on, and again, the spanish flu occurred near the end or at the end of all of the bloodletting in world war i. and i'm just wondering what your thoughts might be on that. you know, i know we're far more advanced than they were back in

1918. but when we and people like you don't have access to contested areas or health care workers are being killed simply because they're trying to assist, it makes it harder and these things could happen. what's your thoughts on that? >> i wonder sometimes whether or not you've read so much into my bio that you know that my husband works on pandemic preparedness at usaid, actually. in terms of this, obviously it's a huge concern with the war that's raged on now for over four years, the concern in terms of the health system inside syria, losing 30 years in that time at least. and as you well know, the medical facilities and the personnel delivering those services have been under attack. and until very recently actually, even in some of the cross-border cross-line operations, some of the partners we're trying to get aid out to could not put any kind of medical help into their kits, into the aid that they were delivering in communities. so it is a real concern. i think we do the best we can in

terms of the areas we can access. i think our support systems are much stronger in the neighboring countries. in jordan, in particular, and lebanon. and the iraqi/kurdistan region and so on in terms of what we're trying to do. and obviously turkey has done a tremendous amount on the health side. but that's something that we need to continue to work on to try to prevent what you've just outlined. >> and i might add it's all the more reason why it's important this u.n. resolution last year, 2165, being able to work cross-border so organizations like w.h.o. then can move across those lines of conflict. and we need to continue to support that. the other maybe helpful mitigating factor is that syrians are used to getting vaccination. and they demand it. okay? some refugees we work with or people in underdeveloped countries are not used to it. they are used to it, and so they're looking for vaccination,

and that does help mitigate some of the problems. >> ranking member deutsche? >> thank you. mr. chairman. ms. clements, i'd like to -- and thanks again to both of you and thanks for being so patient for allowing us to do the other part of our job. ms. clements, another issue i've raised several times on this committee, what are we doing to increase our support from the international community? it's really frustrating as i said in my opening statement and as you referred to as well, it's frustrating to learn that last year was only 50% funded. it's clear that even if there's a political agreement -- if there were a political agreement tomorrow in syria, the humanitarian crisis is going to continue for years to come. so how do we get our partners around the world to not only continue to care about the humanitarian crisis and talk about the humanitarian crisis but to actually do their part to help alleviate the suffering? >> thank you very much, congressman. this is the key issue.

we have in terms of the syria crisis right now appeal levels of $8.4 billion. i mean that is more than 2 billion more than last year. we're approaching a year where we're dealing with and we've talked about this a little bit, the global humanitarian crises. we have sudan. we have c.a.r. we have iraq. all of that adds to the attention that's being diverted somewhat from this crisis. so i think it's very important, for example, for this hearing to take place and to continue to bring attention to it. we've worked very hard with other governments, with traditional and nontraditional donors to try to increase support. and obviously we continue that effort. tom and i were actually in kuwait city about ten days ago at a top donors group meeting that was hosted by kuwait to try to bring attention to the syrian response what we're going to do this year. and perhaps even more importantly, what comes next year and the year after. and given that this is going to

be protrablgtcted we need to continue that support to jordan and the other neighbors shoulder shouldering the burden. so it's a very high priority. there's a lot of engagement at various senior levels of our government. and that will continue. >> and what -- what's the response? and i appreciate that there's engagement. >> i think, as i outlined in terms of the number of crises, the places that we're asking people to put their money, unfortunately it's increasing rather than decreasing. we have seen for example saudi arabia, when wfp as you mentioned in your opening statement, had their fund-raising campaign in december, it was saudi arabia that stepped forward with, i think, $72 million to help to close that gap. that was unexpected. we just saw the e.u. last week announce a $1 billion package for both development and humanitarian support. the uk, the visit of prince charles and the secretary of state just announced another 100 million pounds. so we are seeing donors step forward. the problem is we're not able to get to the levels, the

astronomical levels now in terms of trying to meet the need. >> okay. i would just make the observation that we're devoting -- we're about to begin to debate about aumf to combat isis. we're devoting an enormous amount of resources on security in the region already in addition to the security arrangements that we have within the region that benefit, in particular, those countries that we have asked to step up in providing humanitarian assistance. and i trust that in terms of engagement, that those points are made loudly and clearly to our allies when we have those discussions. mr. stall i want to return to a topic that i focused on in each of the hearings that we've had on humanitarian needs. and i'd just love an update. and that's the issue of branding. chairman ross lehtinen and i visited a camp in jordan this

summer. we saw a temporary housing with korean flag, saudi arabian flag, we didn't see a lot of u.s. flags. and i understand the difficulties of branding inside syria. and we would never want to put aid workers at risk. but in refugee camps and in communities, have we increased u.s. branding so that the syrian people know that they have the full support of the united states. >> yes, thank you very much for that question, ranking member deutch. it is an issue that we continue to discuss with our partners. as you mentioned, inside syria, it's very dangerous. and so we don't require that. within the surrounding countries, we are asking them to step up their branding. it may not be on every bag because some of that goes into syria and some doesn't. so it's difficult to differentiate. but at least to put up more signs around and portray that. and also just in discussions

with the officials who are working in those camps to make sure they understand where the assistance is coming from. and, in fact we're able to do that even within inside syria in a quiet way to let people know the local organizations that we're working with where it comes from to get the word out. >> comments? >> a quick add because we're very familiar with the zatri example. we've had a number of discussions actually with unhdr and with harper in particular about the visibility issues related to zatri. the challenge has been as soon as a u.s. flag goes up it comes down. and so we have a requirement actually in our contributions that u.s. flags should be on items that we have actualliment issed, particularly in for example, in jordan and northern iraq. places where it's quite safe and we want to get the word out. but it's a challenge keeping it visible for extended periods of time. >> and i appreciate it. thank you to the witnesses and,

again, i would just ask if you would please pass on our sincere thanks and appreciation to all of those on whose behalf you appear here today. thank you. >> thank you very much. mr. meadows. >> thank you, mr. chairman. and i thank each of you for being here. this particular issue is not as telling from a standpoint of getting the american people to act as perhaps other things that we see on tv on a regular basis. but yet when it comes to asking for people to give either personally or allow their government to give on their behalf, it's the one thing that typically can unite people on both sides of the aisle. the american people are very generous and caring and giving people. it's hard for them when ms. clements when you make statements like well the american flag goes up and it

gets ripped down and it also makes it very difficult for a lot of people to continue to say why give money for humanitarian purposes when they don't care? so i think getting back to the branding issue that the ranking member was talking about, i think it's important for us to tell the stories of the impact and the lives that we really are affecting because not only in syria and jordan and some of the other places where the refugee and the migration from this conflict is huge we're making a real-life differences to moms and dads and kids and we've got to do a better job of sharing that if we can. and so i guess my question to both of you is how, as a member of congress, can we do that?

how, as either ngos or the like, how can we do a better job of thanking the american taxpayer back home and telling the stories? i mean, we see ads all the time of starving children and people willingly give because they believe that they're making a difference. how can we do a better job of that? >> thank you very much, congressman. i actually could not have said it better than the way you just did. in terms of telling individual stories. because i think with the way that this war has raged on and the number of people it has affected, that unfortunately the public has become numb to the numbers. and so to try to pull out those stories of people we're actually assisting and what important work the partners that we're supporting are providing every day under difficult circumstances, to try to disentangle saving lives from the broader morass of extremist

takeover of certain communities and assad's aggressions and that sort of thing, if we can keep it focused very much on the life saving, we might have a better chance. unfortunately, we have those pictures to go along. >> sure. >> with the devastation. but the individual stories, i think, tell the best story. >> okay. >> if i might add, congressman meadows, thank you very much for that question. it is sometimes tough, i know i've got relatives back home, and they ask, okay, you know, what's happening with all this assistance? and, you know there's a big story, and then there's the individuals. and as you say, that's so important. you know and the big story, even though you've got 12 million people displaced, yet there's been really no major malnutrition problems, no -- we had a small outbreak of polio, but that was quickly put to you know -- stopped. and from a life-saving thing, nobody froze to death because of the winter. we were able to get

winterization. so on a big scale, actually, it's pretty good. and then even in our protection programs, for instance, we've been training women in peacekeeping. and it's actually made a difference. okay? there's a place like in -- what they call ruth damascus it's sort of the rural areas around damascus. with women peace circles they were able to negotiate 20-day cease-fires, okay. you know, in eastern kurdish region, the women negotiated an end to price fixing that was some of the -- the merchants were doing. so they were able to step in and make a real difference to people on the ground that way. and then when i visited the hospital in northern jordan where they're getting refugees coming out who have been injured, it's not only medical support, but we're actually providing psychosocial support. and i visited with a small child that had been injured.

and obviously, they had not only the physical injuries but the psychological injuries. and part of our work was supporting, training women who then provide psychosocial support to that child. so that their issues can be dealt with. >> well, let me close with a sincere thank you for your work. but also a request. on those individual stories, like the story you just shared. if you can get that to committee, most of the members of congress can tweet out, facebook out and reach, you know, hundreds of thousands of people. and if we can help tell that story, because if we don't, the american people will grow weary of giving. and if they don't see that they're making a difference it will become very difficult to continue to fund worthwhile projects. so thank you both. and i yield back.

i thank you for your leadership, mr. chairman. >> thank you very much, mr. meadows. mr. higgins. i'm sorry. ms. frankel. >> thank you, mr. chair. thank you for your service and for your testimony today. i want -- i know that humanitarian aid by its nature the purpose is to save lives and alleviate suffering. i maintain human dignity. i was interested in your discussion with mr. deutch because i have heard people say that when you get to people's -- if you give them food and medicine that helps shape people's minds also. so my question is, the overriding goal of trying to defeat isis and assad and so forth, i'm trying -- i want to understand how the humanitarian aid plays into that. and do the folks who are receiving the aid, do they know

that it's coming from -- do they have any idea where it's coming from? and does humanitarian aid help shape their thoughts or ideas? in your opinion? >> yeah, thank you. that's an important question, not always easy to quantify. certainly through our aid programs, even within syria, our partners are working through local organizations. and they make sure that the local organizations know even though it's not branded, that they know that it's coming from the u.s. and that it's taxpayer -- u.s. taxpayers that are providing the funding for that. so the word is getting out. not as much as we'd like, and it's an ongoing challenge but i think that's important. and i think part of it is yeah

you have to provide the immediate humanitarian assistance, but you also need to do it as much as possible in a way that protects their dignity okay. and so we're trying, as much as possible to move to a system of distribution of our assistance that just doesn't make them totally dependent on handouts. so that's part of the reason we've gone to these ration cards. i actually have one in my pocket here. and so that way, instead of getting a bag of rice and, you know, a can of vegetable oil they get a card. they can go to a supermarket and buy the goods that they think they need. that gives them a little feeling of dignity and of course, it helps the local economy. >> may i just change -- you can answer that. why don't you answer the other question that i have also which is this in terms of our aid

workers, first of all, do we have aid workers in syria? and given what we just saw happen with kayla mueller, i think we all have a concern whether our aid workers in the region are safe. could you also speak to that? >> maybe if i could just respond to the last and let tom. >> please do that. >> respond on the other. i think it was congressman boyle that mentioned this being a regional issue. and often when tom and i are talking about syria we'll talk about iraq too, because we do view this as very much a regional issue. and we in terms of the anti-isil fight humanitarian support is one of those lines of effort. but it's not to battle isil. it is to aid those victims and those people in need. so we try very much to keep it as a needs focus as opposed to part of the fight. so it's a distinction that's very important to protect the safety of humanitarian workers allow us to continue to save lives.

i just wanted to make that clear. >> good. thank you for that. you want to -- can you answer the question on the safety? >> yes, thank you, congresswoman frankel. certainly it's a dangerous place. i think i mentioned in my written testimony 150 humanitarian workers have been killed over the last three years. it's something that we had continually have on our minds. the partners that we're working with and through both u.n. and international ngos are all ones that are well experienced in working these kind of regions and these conflict areas. so they're even more careful than we are. they work primarily through local partners, the ngos. some of the u.n. folks are there in damascus especially in the government-held areas. but in the opposition areas it's primarily the ngos. and they in turn, work through local organizations. so there's very few of our

international staff going in. it's more focused with the local organizations who know the scene. >> and this is in syria? >> in syria. yep. >> thank you, mr. chair. >> thank you, ms. frankel. the chair recognizes mr. yoho. >> thank you, mr. chair. i appreciate the testimony here today. as you were stating that merge's largest single donor in that region, and then mr. staal, in all the places you've looked you've not found people starving, did i understand that correctly? are you talking about the refugees that are outside of syria or the ones within syria that you work with? because reading my notes here, it says there's a lot of nutritionally deprived people there. what's the dichotomy or the difference there? visibly? i mean is it distinctive? >> yeah, thank you very much congressman yoho. it's an important distinction.

certainly within syria they're worse off than outside of syria. and they are new transitionally deprived, but they aren't to the point of starvation. >> okay. and that leads into my other question. when you're going in and trying to get access into syria, i mean, you've got to worry about the assad government forces. and then you've got to worry about, you know freedom fighters and, you know, isis and all those other ones. you know, it just seems like one of the things i've seen on these other meetings that we've had in particular, i think it was afghan last year when we were talking to dr. shaw, he said that afghan was allocated or appropriated a billion dollars in foreign aid through usaid. but they couldn't account for $300 million. and as you're going from, you know taking our aid -- and i would feel a lot better if it was branded. that's the american taxpayers' money, and i agree with these other people that if we're sending our money over there well, i think they need to know where it's coming from.

and i know that's an issue in itself because that causes resentment. but as you go into those areas, what are the biggest obstacles you're running into to make sure that we have accountability of those products or whatever it is you're taking in there? and that it's not falling in hands where they're using it to raise revenues? >> yeah, thank you. that's an important issue that we track very carefully. the branding issue is, it's less about the resentment. it's more about the protection of our partners. because if they're seen as, you know, working for the americans then that could put them in danger. so that's the real issue rather than the resentment issue. >> how do other countries handle that? and this is another question. we've given $3 billion since the beginning of this. are the collection of other countries, have they come close to that? as far as monetary input ms. clements? >> sure. actually, we're about 30% of the

overall giving last year was from the united states. >> okay. >> and collectively, we're obviously the largest single donor, but no. it's burden sharing. >> okay. so you're seeing other countries step up and help out? >> yes. >> you know, this is only going to get worse until we have a resolution to the problem within syria. and i think it's going to wind up being a regime change, which at this point i think the rest of the world would be safer off and the people of syria obviously. when you're going in and you're putting in, say, water are you building infrastructures, or are you just taking supplies in like bottled water? i saw you had jerry cans and all that stuff. are you putting in wells, septic tanks or sewer systems? >> that's a critical question. thank you very much. we are indeed putting in some small-scale infrastructure, as much as possible where we can in opposition-held areas and even in some of the government areas.

but it's on a small scale, but certainly we're doing both water and other types of local infrastructure repairing health clinics, schools, things like that. >> when you go in there like in a host country that's housing the refugees is the government working with you or are you finding them an impediment of making the situation better? >> no, i was just referring now to within syria, but certainly -- >> okay. zoo -- in the surrounding countries in jordan, in lebanon and other -- the neighboring countries, we've really stepped up our programs. jordan, for instance we've even put in a second deputy director for u.s. aid and increased our assistance to the jordanians to build up their systems to handle this huge influx. >> okay. >> so, you know additional schools, additional water systems and so on. >> well, i appreciate the work you're doing. i'll get right back to you. that you're doing. and if you could, over the course of the work you do over the next course, let's say two or three months, let us know

what we can do better here to help you do better there especially on the accountability so that we're not wasting our money. ms. clements you had something to say? >> thank you. we really do appreciate the support. it's hugely needed. just on the water issue, both inside syria, tom had mentioned part of it but i'll give you an example. the international committee of the red cross, for example, has worked very closely to try to put stopgap measures in place to actually make clean water available for about 10 million people. this is not building big waste treatment plants, that sort of thing. it's just trying to get the system that currently exists function. so that's just an example of support that's been tremendously important. >> mr. yoho, thank you. and follow-up to your question, could you provide the committee a breakdown of what each country has pledged and how much they have actually, you know, lived up to their commitment? and secondly for this new round, what countries are pledging so we can get -- i mean 30% is

certainly very, very generous on the part of the american public the administration and congress. but it would be nice to know where the laggards are and where those, as you mentioned, saudi arabia stepped up on the food issue, so that you know, we have contacts all of us, all the time with people from these countries, it would be good to say hey do more or well done. so if you could provide that, that would be very helpful. >> if i can just respond to that chairman smith there is at the end of march, the kuwaitis have already invited the donors to come to kuwait for a major pledging conference for syria and the neighboring countries. and we are already you know, encouraging our friends out there to be ready to step up with some major contributions. >> would a letter from members of congress bipartisan letter be of any help you know in terms of backing what you're trying to accomplish? you could give us some insights on how you think that might be you know, might boost the

aggregate. >> right. especially to the parliaments of some of the countries that we work with. >> very good point. ms. frankel. >> thank you again. another different point of view here, so -- and thank you again for your testimony. i wanted to just follow up on a line of questioning that i had when i was sitting at the other end of the table. this is one way to move up in rankings, right? send everybody else away. i think i understand your testimony of separating the humanitarian effort from the fight against certain forces. so my question is in syria, for example, is isil or assad, are their forces -- do they try to keep the humanitarian aid from getting to the syrians?

that's one question. >> yeah, that's a very important question. and it's something we watch carefully in our partners, again. as i mentioned earlier, we actually have some pretty robust systems that is really tracking our aid very carefully. literally truckload by truckload that goes in there. and so we have a pretty -- very good idea of where it's going. there's been very little pressure really to divert or try to control it. when it does happen the partners we're working in, they're experienced. they've worked in afghanistan, in iraq, in south sudan, in somali and places like this. so they push back very hard. if it gets to the point where they feel they have to pay a bribe or you know allow some of it to go to a local official they'll just stop. and we don't go into that town. and that has happened. there are times when we just say okay, we can't work there. but then the surrounding towns continue to get it and then we

find they come back and say okay, well, we'll let it in after all. >> and the other -- did you want to respond to that? go ahead. >> i would. thank you very much. yes, they are inhibiting humanitarian aid workers from delivering aid. just to give you an example we talked earlier in the hearing about those in besieged areas. about 212,000 that are besieged. about 145,000 of them are besieged by the regime. so they are not allowing aid workers or aid organizations to get in. we probably come closest to your example of starvation in a place like yarmouk where it's been extremely difficult for the palestinian u.n. agency to get in and actually provide health and food and so on. so it's administrative obstacles, bureaucratic obstacles, barrel bombing in terms of just not being able to get into key areas. but it's been a huge issue. thank you. >> and in the surrounding regions, which countries are

actually helping you or assisting, both with resources but actually are friendly towards the efforts? >> we are so fortunate to have the neighbors that we do surrounding syria. i mean we could go through them one by one, but jordan first and foremost. 650,000 registered refugees. probably many more that are in communities. most are being supported outside of those two camps that are in jordan. billions of dollars spent, you know, in terms of gdp are lost economic revenue and so on. there is a tremendous -- there has been a tremendous outpouring of generosity and support from these neighbors to welcome refugees in. but the welcome mat is starting to wear thin because of how many refugees there are and the needs and the burdens and so on in terms of economic system and the infrastructure and water and health education, you name it. but i think in every

circumstance, every -- of those five, we have support from the government. and in terms of being able to help us help them, in terms of responding to these massive needs. >> so i think what i hear you saying also is that -- and you may have said this before. is that this humanitarian aid not only is to reduce suffering and give dignity and so forth, but giving relief to some of these neighboring countries that will prevent destabilization. >> it's a really important point, congresswoman, because we try very hard not just to target aid towards the refugees or the displaced but also the host communities. and aid in state programs in the partners we're serving, it's very much a dual approach because we do not want to increase tensions. and we see tensions rising. and as you said, it's absolutely essential for regional stability.

>> thank you very much, mr. chair. i yield the rest of my time. >> just a few final questions. and then if my colleagues have anything further, if you would answer those. as i think you may know, i'm the prime author of the trafficking victims protect act of 2000. and it is a very aggressive law that seeks to prevent, prosecute the traffickers and protect women and children especially who are overwhelmingly the victims. syria is a tier 3 country. and in the recommendations page of the tip report, it talks about child soldiers. and i'm wondering if you could shed any light on how many child soldiers we are talking about from either side or any side. in your testimony, mr. staal, you very strongly pointed to, you know, the barbarity selling girls as young as 12 into sex slavery. i'm wondering if any of them are being rescued. how many are we talking about? just like how many child soldiers are we talking about?

is there any guesstimate as to how much of this abuse is going on? and what happens when there is a rescue? some young 12-year-old who has been so brutally abused finds their way particularly in the area of psychological treatment? you mentioned that generally for those who are suffering trauma of war. and i'm wondering, too, an additional question, is our response integrating a faith-based response muslim or christian, with best practices for psychological help? you know, one of the things i've learned being in trafficking shelters all over the world is that the healing process the sense of personal reconciliation with the trauma and coming to a point where -- not reconciliation but reconciliation with how you are a victim you are not in any way responsible for this happens more effectively in a faith-based setting where there's also the best psychological practices by

psychologists or psychologists being employed. and i'm wondering what we're doing along those lines. and again if you could speak to the trafficking part. mr. staal. >> yes thank you. critical issues that you raised chairman smith. as i mentioned, in all of our humanitarian assistance programs, we include protection issues. in addition to that, we've put in $26 million specifically in protection programs gender-based violence issues, child protection and so on. included as a piece of that has been tracking abuses that could someday be, you know, a way of keeping records that could someday be used later, as you mentioned, with the icc or whatever. and then also, state department drl program is continuing to try to track those kind of abuses for future issues. we'll have to track you know, get back to you on the child soldiers.

i don't know that we have a number on that. >> are you coordinating with the tip office on this? >> yeah. >> with regards to syria? >> yes, perhaps i can respond in terms of the trafficking piece because obviously this is something that's of high priority to us, as it obviously is to you as well. all of our programs actually have a gbv or prevention element. and when i say that protection is important. there are a couple of things that we've tried to do very explicitly. civil registration and identity documents, because often we find that those instances of trafficking is because they don't have something to be able to provide for themselves in terms of livelihoods or what have you. so we have made a special effort through partners to be sure that that's certainly in place. we found that the best defense is robust assistance. so making sure kids are in school, for example, that information is flowing in terms of the dangers of early marriage. these sorts of things all combined have a comprehensive

approach to try to at least decrease the scourge. but yes, in fact i was just talking with a trafficking office yesterday about this very issue. >> that would be great. >> any further, for the record that you could provide on that particularly as it relates to sex trafficking and child soldiers, that would be greatly appreciated. you pointed out that 85% of those killed are men. i'm wondering, with regards to the women and especially pregnant women, are they getting to safe venues to have their children? are they -- do they have access to safe blood for example if there's an obstructed delivery to a cesarean section or has maternal mortality gone up because of the lack of that in syria, the way we have seen in other war-torn areas? >> yes. a critical question. you know, i think we have a partial answer but not a great answer. i mean, i think there's still a lot of women who aren't able to get to, you know, a proper

facility, as you've mentioned. their health facilities have been targeted, especially by the regime. and that's really reduced our ability to help. on the other hand, that is a major focus of some of our programs. i mentioned earlier that the hospital i visited in jordan last week, they have an outreach program and are setting up field hospitals in opposition-held areas in southern syria. and so those kind of things we're trying to address that issue. but, you know certainly in isil-held areas we're not able to get there and provide that kind of assistance. it's an ongoing problem, no question. >> just a few final questions, if i could. you mentioned mr. staal that history has been made in the number of dart teams as you have said four disaster assistance response teams and three response management teams have been deployed. could you elaborate on that?

because many people, particularly those watching, the c-span audience, for example, what is a dart? i've actually been in areas where they have been in operation, and it is amazing how effectively they coordinate. if you could elaborate on that? >> yes, thank you, chairman smith. that's one of the things that i think we as americans can be most proud of. that's a unique aspect of our humanitarian assistance that other countries can't do. and that is to actually put people on the ground within hours and days of a crisis. whether it's a tsunami or an earthquake, or in this situation, you know, a conflict-related crisis. so a dart is a disaster assistance response team. and we send them out to the affected area, literally within hours or days sometimes even if it's -- we know there's a big typhoon coming we'll send them out a day or two ahead of time. and they include whatever is needed in terms of technical

specialties. they coordinate the assistance. ebola, for instance, we have a huge d.a.r.t. there. we coordinate the assistance provided by cdc, the world health organization, other donors. the d.a.r.t. provides that platform, and it works great. the rmt, the response management team, is the operations center back here at headquarters that provides all the support that responds to your questions about what's going on and to our leaders in the administration. so it provides that sort of ops center for that. and with soef a d.a.r.t. for iraq, a d.a.r.t. for syria that has people both in jordan and in turkey. we have a d.a.r.t. for south sudan. and then we have the huge d.a.r.t. for ebola. >> thank you for that explanation. and for that work. you point out in your testimony mr. staal, that we have improved water and sanitation for 1.3

million syrians in all 14 governants. you are absolutely right, in times of crisis clean water and sanitation are critical to survival. how much -- how integrated or how expansive is our o.r.t. the oral rehydration therapy salts, those packets being disseminated for children especially since diaryrhea diarrheal disease is one of the leading killers of children? >> yes, thank you. i don't have the exact details. if you like, i can try to track those down. >> i would like that, yes. >> but it's certainly a part of whatever we do in our health -- in our programs, wherever we're working. there are still areas we can't reach. but as i said, i think it's important that our humanitarian assistance also address some of those resilience issues so that people are not as dependent on humanitarian assistance. if they've got clean water then they're less likely to get sick.

if we've got a program providing flour to bakeries across line so that people can get bread, that also helps the economy. so we try to do our humanitarian assistance in a way that builds resilience, reduces cost, and then reaches out to the people. >> you've testified that 9.8 million syrians are food insecure. is that number declining or worsening? >> yeah, i think i would -- i'll have to look at the exact details, but i'm afraid to say it's probably declining. i mean excuse me, worsening. their situation is declining because of the scale of the crisis. >> and one final question. you've pointed out that since 2011, prm has expended $1.4 billion. has that impacted funding from other programs? have you had to deplete some accounts or draw down from other accounts? and have those accounts been

replenished, whether it be in africa or anywhere else so that there's no diminution of assistance to those other crisis areas? >> thank you very much, chairman, for the question. it is thanks to you and congress that i can say that we have not taken funding from africa or other important programs to meet some of those other mega humanitarian emergencies because you appropriated a generous amount to us in 2013, 2014. and again in 2015. so we appreciate that hugely. and you will see you know in terms of numbers on our congressional presentation document, a significant upturn, not just in the middle east, but in other regions as well. >> thank you. ms. frankel? >> thank you, mr. chair. i want to go back to my questioning on sort of i guess the domino effects of humanitarian aid or not having it. i do believe in humanitarian aid, but i want to play the

devil's advocate because what we may hear constituents saying i think some of my colleagues mentioned it. there is so much suffering in this world all over the world including the united states of america. and so i would like to hear your thoughts again in terms of what if we were not -- we did not provide this aid? what are some of the dominos? what would we see happening? what would be worse? what's the spin-off? and how does it affect you know, somebody who lives in florida? >> it's a terrific question congresswoman, in terms of not being able to provide aid. we touched on it a little bit earlier in terms of regional stability. i think in terms of humanitarian aid, the best way to be able to support those that need to flee syria is being able to provide that aid to the host communities

and the neighboring countries to keep that protection space open. to make it possible for people, because it's much easier for us to assist those in jordan and in lebanon, frankly, than it is inside syria. you would see an implosion. you would see, you know, massive malnutrition rates, for example, global acute malnutrition, mortality rates through the roof. most of the deaths now unfortunately, are because of the war. we would probably see in terms of social indicators a much larger humanitarian catastrophe without aid. >> yeah, and i might add, obviously if we -- if possible, we want to try to get our assistance to people in their homes so they don't have to flee. they need to be able to flee if they feel they have to, but it's better to get it there, and then that reduces the strain on the surrounding countries. and as you mentioned jordan is

a critical partner for us. the same with lebanon. we're very concerned about their stability and those countries, that's critical. and frankly, terrorism. you know a young man growing up, he can't feed his family. he hasn't got a job. he's going to be much more open to the lure, if you will, of people asking him to do bad things. >> thank you very much. i think i got my question answered. >> thank you, ms. frankel. mr. yoho? >> yeah. going back to the aid that you're giving, and when you go into the different countries, there's turkey, syria, lebanon, jordan, iraq where the refugees are going. when you're going into the different countries like, say, turkey, you know, the human rights that we stand by, that we believe in this country are going to be different in those other countries, is that correct? you know freedom of religion, freedom of expression, you know

those kind of things? and so when chairman smith brought up you know the different areas of abuses like gender abuse, women's rights and things like that how do you go about enforcing that? and is it different between country to country? and how do we hold that government accountable? >> that's an interesting and important question, congressman. i think -- i can't remember whether it was you or chairman smith asked about working with faith-based organizations. and we do work with that. and in fact, ms. clements and i visited with the archbishop in kurdistan when we were there to talk about the work they're doing. i know the king in jordan has been very open in meeting with different religious leaders both

from a sort of an islamic perspective to reduce the lure of isil but also how do we work with the various religious groups. and syria was one of the most tolerant countries in the entire middle east before all of this took place. so it's important, but there are many groups there that we work with. and that is a way to try to reduce the tension that's going on. >> but is there a way to hold those areas that you have the refugees in, you any, they're going to school, and they're being abused, you know, with whatever type of abuse it is, you know, the human trafficking thing is just uncon shonnable. but gender abuse, we'll say that. how do you go about making -- you said you're helping those countries deal with that. and you're trying to you know make sure that they're protected. but how do you go about holding that country or that government of that country accountable? they're giving aid helping out

a bad situation and they're not living up to that standard? what do we do as far as holding those people accountable? or do we not get into that? >> well, we do in the sense that there are international >> there are international standards. and so that is one advantage if you will with working through the u.n. system we can hold them accountable for those standards. >> did you feel it's working or is it something we turn a blind's eye to it saying we dealt with it but we know it's not getting done? i've seen that in other parts of the world. >> maybe to give an example of trafficking cases. normally the aid partners we would work with if those cases are brought forward they would work with the local authorities in terms of ensuring followup. or for example refugees are

detained seeking access for example to prisons to find out whether or not that was a rightful detention or what the due process is for that case to be able to be made. that's part of the protection part of what the organizations do that we support. i think broader issues goes well yopd the humanitarian sphere, but obviously connected. >> you brought up there has been 150 approximately aid workers killed. does that take into account missing ones is there a number of missing people that more than likely could wind up as hostages and we'll see them on tv one day and we'll regret seeing that? do you have a sense for how many that are unaccounted for that were aid workers? >> as far as we know right now, there are no americans held that are unaccounted for that we know of. most of those 150 frankly are

local syrians who are working with different organizations that we support. and so it's that way. >> i i appreciate your time. will chairman thank you for the extra time. >> thank you very much. tank you for your tremendous leadership, for providing the two subcommittees with your very fine insights and testimony. does help us. and of course by extension we then brief other members of congress. you're saving lives every single day. and i do think the american public -- i remember after the tsunami, i was in sri lankavee lisa sri lanka and i've never been more proud of people trying to make the situation better.