[Senate Hearing 116-134] [From the U.S. Government Publishing Office] S. Hrg. 116-134 THE HUMANITARIAN IMPACT OF EIGHT YEARS OF WAR IN SYRIA ======================================================================= HEARING BEFORE THE COMMITTEE ON FOREIGN RELATIONS UNITED STATES SENATE ONE HUNDRED SIXTEENTH CONGRESS FIRST SESSION __________ MAY 1, 2019 __________ Printed for the use of the Committee on Foreign Relations [GRAPHIC NOT AVAILABLE IN TIFF FORMAT] Available via the World Wide Web: http://www.govinfo.gov ___________ U.S. GOVERNMENT PUBLISHING OFFICE 39-599 PDF WASHINGTON : 2020 COMMITTEE ON FOREIGN RELATIONS JAMES E. RISCH, Idaho, Chairman MARCO RUBIO, Florida ROBERT MENENDEZ, New Jersey RON JOHNSON, Wisconsin BENJAMIN L. CARDIN, Maryland CORY GARDNER, Colorado JEANNE SHAHEEN, New Hampshire MITT ROMNEY, Utah CHRISTOPHER A. COONS, Delaware LINDSEY GRAHAM, South Carolina TOM UDALL, New Mexico JOHNNY ISAKSON, Georgia CHRISTOPHER MURPHY, Connecticut JOHN BARRASSO, Wyoming TIM KAINE, Virginia ROB PORTMAN, Ohio EDWARD J. MARKEY, Massachusetts RAND PAUL, Kentucky JEFF MERKLEY, Oregon TODD, YOUNG, Indiana CORY A. BOOKER, New Jersey TED CRUZ, Texas Christopher M. Socha, Staff Director Jessica Lewis, Democratic Staff Director John Dutton, Chief Clerk (ii) C O N T E N T S ---------- Page Risch, Hon. James E., U.S. Senator From Idaho.................... 1 Menendez, Hon. Robert, U.S. Senator From New Jersey.............. 3 Stiller, Ben, Goodwill Ambassador for UNHCR, The United Nations Refugee Agency................................................. 5 Prepared statement........................................... 8 Miliband, David, Right Hon., President and Chief Executive Officer, International Rescue Committee........................ 15 Prepared statement........................................... 16 Additional Material Submitted for the Record Statement Submitted by Raed Al Saleh, Head of the Syrian Civil Defense........................................................ 43 Statement Submitted by David Lillie, Executive Director of the Syrian-American Medical Society Foundation..................... 44 (iii) THE HUMANITARIAN IMPACT OF EIGHT YEARS OF WAR IN SYRIA ---------- WEDNESDAY, MAY 1, 2019 U.S. Senate, Committee on Foreign Relations, Washington, DC. The committee met, pursuant to notice, at 10:19 a.m., in room SD-419, Dirksen Senate Office Building, Hon. James Risch, chairman of the committee, presiding. Present: Senators Risch [presiding], Menendez, Paul, Cardin, Gardner, Shaheen, Romney, Murphy, Kaine, and Markey. OPENING STATEMENT OF HON. JAMES RISCH, U.S. SENATOR FROM IDAHO The Chairman. The committee will come to order. Thank you for our guests being here today to testify. This is a serious and important matter that we are going to take up this morning. And before we get started here, though, I would like to take a moment to remember our friend and colleague, a former chairman of this committee, Senator Dick Lugar, who passed away just a few days ago. Dick was a widely respected senator in his home state of Indiana, as he was around the globe. He was a lifelong public servant. He exemplified the ideals that many of us strive for every day. I was fortunate to serve alongside of him from my very first days in this committee. And I was able to benefit from his wisdom. At the top of the long list of his accomplishments is his work on nuclear nonproliferation in former Soviet countries. Our world is safer today because of his signature legislation, which was no easy feat. On behalf of all of us on the committee, I send my condolences to Senator Lugar's wife and his family, and the many people, who like us, were blessed to know and work with him. He was a true statesman and will always be remembered as such. Thank you, Dick, for your service. Turning to the topic at hand today, March tragically marked the eighth anniversary of a brutal civil conflict in Syria. A war characterized by the indiscriminate deployment of barrel bombs and chemical weapons against civilians. Mass murder, enforced displacement, targeted attacks against medical and humanitarian workers, and the wholesale destruction of critical infrastructure, directed by the brutal dictator, Bashar al- Assad, and his Russian and Iranian enablers. The humanitarian and economic toll has been devastating. More than half-a-million people have been killed. Over 13 million Syrians require urgent lifesaving assistance. Millions of men, women, and children have been forced from their homes, including 5.7 million refugees. And nearly 3 million Syrian children, including 800,000 child refugees, are out of school, and at least 10,000 of whom are unaccompanied, and all of whom are now vulnerable to trafficking, exploitation, and recruitment by armed groups, which we have all seen over the years. Notably, Assad's atrocities have also given rise to dangerous extremist groups, including ISIS, which have capitalized on the chaos, unleashed further death and destruction, committed acts of genocide. They have manipulated aid, and further destabilized an already fragile region. These are people, not just statistics, and they deserve better. These are men and women with families and children, the overwhelming majority of whom have been dragged into a conflict not of their own making; yet, are forced to pay the ultimate price. Unfortunately, there is no easy path forward for them. Of particular concern is the current situation in Rukban. Along the Syrian-Jordanian border, the Rukban camp houses 36,000 Syrians, mostly women and children. In recent weeks, the Assad regime and its Russian backers have blocked access and repeatedly refused requests by the U.N. to deliver much needed humanitarian assistance. The last U.N. aid delivery was in February, and supplies of food and basic necessities have been exhausted. With Ramadan fast approaching, I urge the Assad Regime and its Russian backers to grant access to Rukban and beyond in line with U.S. Security Council Resolution 2449, thereby alleviating widescale humanitarian suffering. The regional implications of this crisis cannot be underestimated. The unrelenting flow of refugees into Turkey, Lebanon, and Jordan has overwhelmed economic and security institutions, and poses the risk of additional regional instability. And while it is easy to focus on conditions in the camps, it is important to note that roughly 90 percent of Syrian refugees live among hosting communities outside of camps. Refugees living in urban setting without access to legal employment or other assets face extreme difficulty in finding shelter and basic necessities. Moreover, they are often difficult to identify, and, therefore, difficult to assist by agencies that wish to do so. This situation is simply not sustainable. It is in the U.S. interest to help Syrian refugees realize their desire for safe and voluntary returns to their homes as quickly as possible. All of this has resulted in the bill that would authorize sanctions against the Assad regime and its backers, and hold these parties accountable for their human rights abuses and ongoing atrocities. This bill, the Caesar Syria Civilian Protection Act, I have worked on with Ranking Member Menendez and others, and both of us, indeed, many of us want this bill to be passed as soon as possible. It was included in S-1. The first bill passed by this Congress, but has become high centered over in the house. As a result, the Caesar bill will be taken up soon at a business meeting of this committee. The Syrian people need our help, and we should not delay this legislation any longer. The United States is the single largest humanitarian donor to the Syrian crisis, providing 9.5 billion since the beginning of the conflict. Now the questions are how do we maintain the momentum of support for these populations, and what programs provide a path to durable solutions for the Syrian people. Such solutions will both address the grievances that perpetuated the conflict, and prevent sowing the seeds of future conflict. With Syria's complex and deadly war entering its ninth year, the United States and other partners continue to work to ameliorate humanitarian conditions while seeking a more permanent durable solution to the crisis. We remain committed to doing what we can to save lives, while acknowledging that humanitarian assistance is just a Band-Aid. A political solution is long overdue. The United States stands with the Syrian people. We are happy to have this hearing today, and we are happy to have the distinguished guests that we have to talk about it with us here today. With that, I will yield to Senator Menendez. STATEMENT OF HON. ROBERT MENENDEZ, U.S. SENATOR FROM NEW JERSEY Senator Menendez. Thank you, Mr. Chairman. Let me first join you in honoring the memory of the late Senator Dick Lugar. I was privileged to join the committee while he was, I believe, the chairman at the time. He was the ultimate statesman. At a time in which there is so much lack of bipartisanship he ran this committee with the comity, with the courtesy, with a respect for all views that we should emulate in our work today. At a time in which Russia is violating the INF treaty, and potentially leading us into a new nuclear arms race, it was Dick Lugar's work with Sam Nunn who made a difference in the world in terms of reeling us back from that arms race, and creating a safer, more secure world for generations to come. And so, I am better off having known Dick Lugar. I am reminded of his work, and I try to emulate some of what he does in the work that we do every day. I want to thank you, Mr. Chairman, for holding this hearing to highlight devastating ongoing human suffering inside of Syria. For more than 8 years the Assad regime has waged unrelenting war of brutality against the people of Syria, forcing millions to flee their homes, upending families and generations to come, destroying a once beautiful country, and enable terrorists and nefarious actors to gain stronger footholds across the region. I had hoped, Mr. Chairman, that we could hear from some Syrians directly today, but instead, let me at least acknowledge among us today members of the inspiring White Helmets, who to this day continue to risk their lives to save others, and to tell the story of Assad's murderous campaign. Raed Saleh is in town to receive a well-deserved award from the U.S. Holocaust Memorial Museum, and I ask that a statement from the group be submitted for the record. [The information referred to can be found at the end of the document:] Senator Menendez. And I thank them for being here today with us. While we may talk of the defeat of the Caliphate of ISIS, violence continues to rage in Syria's countryside and villages. Capitalizing on an incoherent policy from the United States, and fatigue from the international community, the Assad Regime and its Russian and Iranian facilitators at war crimes killed more than 100 people in February in Idlib alone. Nearly half of them were children. Facing Assad's barrel bombs and starvation campaign, as well as horrific violence from terrorist organizations, some 6.2 million are displaced from their homes within the country, many lacking access to adequate food and basic healthcare. More than 2 million children are out of school, risking a lost generation. Five million have fled to neighboring Jordan, Lebanon, Turkey, and Iraq, who have shown an extraordinary openness. The impacts of this crisis, however, are not confined to the region. Nobody can forget the devastating images of dead Syrian children washing up on the shores of Greece, nor the hundreds who were drowned trying to cross the Mediterranean. While some governments have shown extraordinary compassion in welcoming the influx of refugees, this crisis has also fueled existing xenophobic and nationalistic voices seeking to upend the very foundational values and institutions that shaped the past half century. And as Syrians bear the burden, the Kremlin wins on two fronts. The refugee crisis contributes to the political splintering of Europe, and it is able to maintain a foothold in the Middle East to its war criminal patron in Damascus. During the past eight years of war, the international community has failed Syria, failed to resolve the conflict, protect civilians from gross violations of the Geneva Conventions, and the laws of armed conflict, and ensure durable solutions for refugees. Instead of the United States historical leadership and response to this kind of suffering, in 2018, President Trump froze and then terminated stabilization assistance in northeastern Syria, and announced a withdrawal of U.S. troops by Tweet, shocking both our local partners and deployed allies. Since then erratic policy pronouncements have created uncertainty about U.S. strategy, timeline, intentions, and reliability. Rather than providing resources to countries hosting Syrian refugees, President Trump's proposed budget, an unprecedented cut of over 30 percent in humanitarian aid, is something that luckily Congress rejected. But the proposal was reckless, dangerous, and a rejection of American values and global leadership. There are, however, steps we can take to address this crisis. At a minimum the Administration should work to ensure humanitarian access to men, women, and children in need, and to secure adequate funding for the humanitarian response. I am glad to hear in your comments, Mr. Chairman, that we will move the Caesar Civilian Protection Act soon as a standalone bill. I know Democrats stand ready to cast a vote for the bill and send it directly to the President's desk, as it has already passed the House of Representatives. And here at home we must lead by example. For decades the U.S. government was both an author and a champion of refugee protection and principles globally. Sadly, the Administration has slammed the door on Syrian refugees. In 2016, of the 5 million around the world, the United States welcomed over 12,587 of the most vulnerable Syrian refugees, women, children, the sick, and the elderly. In 2018, the Trump Administration barred the door, admitting just 62 Syrian refugees. Sixty-two. It appears the Administration is waging a deliberate campaign to send a message that the United States is no longer that shining beacon for those fleeing oppression, seeking asylum, and a better life. The United States has an ability to be a force for good and restore our international standing. We must stand by our partners, who have fought alongside us. We must push back against those who would seek to exploit a vacuum of leadership and threaten our interests. And doing that requires sustained support for the people of Syria and our allies. We thank our witnesses for the work that they have been doing, for their continued efforts to both expose the devastating crisis, and marshal support, and we look forward to your testimony. The Chairman. Thank you, Senator Menendez. I, too want to note that we have the two representatives of White Helmets here today. Their network of over 3,000 people have save almost 100,000 lives, and it is to be noted and greatly appreciated. Their courageous work on the ground in Syria, while being targeted by Assad and its Russian backers, is to be commended. Thank you. [Applause.] The Chairman. Thank you, gentleman. Now we are going to turn to our witnesses. And I want to start with Mr. Ben Stiller, who is an actor, director, producer, and writer, with a career spanning over 30 years. Mr. Stiller is also a committed advocate and humanitarian supporting the work of UNHCR, the United Nations Refugee Agency, since 2016. Mr. Stiller was appointed Goodwill Ambassador in 2018, and has traveled around the world to meet with refugees. So, Mr. Stiller, we are honored to hear from you. STATEMENT OF BEN STILLER, GOODWILL AMBASSADOR FOR UNHCR, THE UNITED NATIONS REFUGEE AGENCY Mr. Stiller. Thank you. It is great to be here in person all of you. I watch you all on television all the time. [Laughter.] Mr. Stiller. You all look much taller in person. Ranking Member Menendez. We watch you at the movies. [Laughter.] Mr. Stiller. Thank you. Chairman Risch, Ranking Member Menendez, and members of the committee, I am pleased to be here today in my capacity as a Goodwill Ambassador for UNHCR, the U.N. Refugee Agency, to discuss the ongoing needs of Syrian refugees and their host communities. As you've noted, last month saw the eighth anniversary of the Syrian conflict. In 2016, deciding that I just did not want to just keep watching the news of the conflict, but that I wanted to do something, I called UNHCR, which is mandated to care for refugees worldwide. Since then I've had the opportunity to travel with them to meet Syrian refugees in Jordan, in Berlin, and recently, in Lebanon. I've also traveled to Guatemala to meet individuals fleeing horrific violence in our own hemisphere. In my time with UNHCR I've been incredibly impressed by their work. With a staff of nearly 17,000, 90 percent of whom are located in the field, UNHCR works tirelessly to assist the world's most vulnerable. Since the start of the Syrian crisis this committee has remained steadfast in its commitment to the protection and assistance of Syrian refugees, and internally displaced persons, as well as to the countries hosting these refugees. We thank you for that leadership and support. As an American I'm also proud that the United States continues to be UNHCR's largest donor, and that our State Department remains a steadfast partner. In many parts of the world the term refugee has unfortunately become politicized, despite the fact that refugees are real people, with real stories, stories that are some of the most frightening and traumatic I have heard, especially as a father. I have tried to imagine how I would feel if caught in the middle of conflict, and unable to protect my children, if my son was at risk of forced recruitment, or my daughter at risk of unimaginable violence. Honestly, for me, it is not something I want to think about. If any of us were to take a moment to really consider this, we would have a tiny sense of what everyday life is like for millions of people around the world. Getting a chance to meet some of these people and hear their stories firsthand has been a privilege. Immediately it becomes clear what we all have in common, that we come from different cultures and totally different worlds, we all want the same things, to provide a good environment for our kids to grow up in, to laugh, and share experiences with family an friends, to see our children grow up and achieve their dreams. These are things we all want no matter who or where we are. And every time I leave and say goodbye, I'm aware that but for being born in a different country, it could well be me, and not them sitting in a small, cold makeshift shelter, and not being able to do any of these things. These people have lost everything. This reality was all too clear last month when I was in Lebanon, and I had the opportunity to meet a young Syrian family. Binana, her husband Raed, and their four beautiful children. They've lived in Lebanon as refugees for 8 years now, and have desperately struggled, constantly moving, and constantly looking for work. Raed has resorted to trying to sell his kidney on Facebook, and last year when Binana was pregnant with her youngest child, a friend suggested she sell her baby to help make ends meet. Binana didn't do this, but the suggestion sheds light on the family's desperate circumstances. Their children, including amazing eight-year-old twins, Yazan, a boy, and Razan, a girl. These two kids are very special, and I was very affected by Yazan's courage. Just a very sweet boy. He overheard his parents talking about their struggles, and he offered to help by selling vegetables on the street for income for the family. And he is this very little kid. And his parents did not want him to work, but he insisted, telling them that it was better than begging. And his father Raed explained that Yazan is an excellent salesman. And so, I asked him, I said, ``What makes you such a good salesman?'' And he said he's good at selling because he's so cute. [Laughter.] Mr. Stiller. And while his response was funny, and it made me smile, the fact that he is working as a young child, missing out on school, and often going to bed hungry is a reality that is all too common for refugee children. And this family receives cash and assistance, food assistance, through UNHCR, but it just isn't enough for them. The overwhelming majority of Syrian refugees has always been and still remain in the countries bordering their homeland. And while these are mostly middle-income countries, the sheer size of the refugee population and the fragile nature of the region's economic and political situation puts an enormous strain on the hosting countries. The majority of Syrian refugees want to go home one day, but most don't believe that such return is possible right now. They fear for the security of their families as well as the prospect of military conscription, lack of documents, and lack of basic services, or just for their livelihoods there. In Lebanon I heard these exact concerns firsthand. UNHCR is working with partners to address these obstacles. When the time is right UNHCR will be there to support organized large-scale repatriation efforts as it has done in many parts of the world. Some self-organized returns are already happening. These families have made a highly personal decision to go home, and UNHCR respects and supports that decision. UNHCR is present at points of departure in host countries to ensure that returns are voluntary and to provide advice on documentation and other key issues. But in order to fully assist those who return and to monitor conditions, UNHCR and other humanitarian agencies need unhindered access to areas of return inside Syria. While access is slowly improving, it is far from being widespread or systemic. Because it is clear that large-scale return will take time, we should expect a significant Syrian refugee population outside of Syria for the foreseeable future. In the meantime, Syrian refugees have told us what they need, and we should listen to them. They need education for their children and the ability to work and provide for their families. They don't want to be dependent on aid, and to sit idly for years. Refugees have the potential to contribute to the economic and sociocultural lives of their new communities, whether those communities are in neighboring host countries and resettlement countries, or ultimately back in their home countries, where they can help to rebuild after years of conflict. We therefore need to provide the host countries with long- term structural support. We need to help them ensure that their health services, education systems, and livelihood opportunities are available to refugees, and also that the needs of their own citizens are addressed, so that both groups are able to thrive. Done smartly, humanitarian aid and development aid, not only in the Middle East, but in Africa, Central America, and elsewhere, can help address root causes in countries of origin, provide needed support to transit and destination countries, and help stabilize fragile regions of the world. The United States has been the most generous donor to many humanitarian crises, including the Syria situation. And I urge you to maintain this generosity. Eight years into the crisis we must not look away. We cannot let Syrian families go deeper into destitution and cannot let their children be part of a lost generation. We need to ensure that these families can live in dignity and look to the future with hope. We need to ensure that these kids, like my kids and your kids, can have a childhood and achieve their dreams. Ultimately, we need to help create the conditions that will allow the majority of Syrian refugees to return home when the time is right, as they so desperately want to do. Thank you. [The prepared statement of Mr. Stiller follows:] Prepared Statement of Ben Stiller Chairman Risch, Ranking Member Menendez, and members of the Committee, I am pleased to be here today in my capacity as a Goodwill Ambassador for UNHCR, the U.N. Refugee Agency, to discuss the ongoing needs of Syrian refugees and their host communities. As you're well aware, last month saw the eighth anniversary of the Syrian conflict. Like many others, I've seen news of the conflict on a regular basis. I watched the pictures of the refugee crisis in different parts of the world over the years. Then in 2016, inspired by seeing a fellow actor on the shores of a Greek island helping women, men and children who had made a treacherous journey across the Mediterranean, fleeing for their lives, I decided I didn't want to just keep watching. I wanted to do something. I called the U.N. refugee agency, which is mandated to care for refugees fleeing Syria and elsewhere across the globe, and I got involved. Since then, I've had the opportunity to travel to meet Syrian refugees in Jordan, in Berlin, and last month in Lebanon. I also travelled to Guatemala to meet individuals fleeing horrific violence in our own hemisphere. Both international and U.S. law define refugees as persons who are unable to return to their country due to a well-founded fear of persecution for reasons of race, religion, nationality, membership in a particular social group, or political opinion. While refugees are UNHCR's core constituency, the agency also works to protect and assist persons who have fled their homes but not their country; such persons are known as internally displaced persons (IDPs). Frankly, it is easy to read these definitions, gain an intellectual understanding, and move forward talking about refugees and displaced persons, and the statistics describing their situation, without any real understanding of who we are actually talking about. The term ``refugee'' in particular has become politicized in many places around the world, in spite of the fact that refugees are real people with real stories, stories that are some of the most frightening and traumatic I've heard, especially as a father. I have tried to imagine how I would feel if caught in the middle of conflict and unable to protect my children, if my son was at risk of forced recruitment, or my daughter at risk of unimaginable violence. Honestly, for me it is not something I want to think about. If any of us were to take a moment to really consider this, we would have a tiny sense of what everyday life is like for millions of people across the world. Getting a chance to meet some of these people and hear their stories first hand has been a privilege. Immediately, it becomes so clear what we all have in common, though we come from different cultures, and totally different worlds, we all want the same things: to provide a good environment for our kids to grow up in. To have the chance to live freely and do what we want in life. To laugh and share experiences with family and friends. To see our children grow up and achieve their dreams. These are things we all want, no matter who or where we are. And every time I leave and say goodbye to these people whom I'm lucky enough to spend some time with, I am aware that but for being born in a different country, it could well be me, and not them sitting in a small, cold make-shift shelter, not being able to do any of those things. These people have lost everything. In my time with UNHCR, I've been incredibly impressed by their work. With a staff of nearly 17,000, of whom 90 percent are located in deep field and often in hardship locations, UNHCR works tirelessly to assist the world's most vulnerable people. I've had the privilege of meeting many UNHCR staff members in the field and, time and again, I've been moved and inspired not only by their expertise but also by their unwavering commitment to the people they serve. Day in and day out, they are on the ground talking to refugees, gaining an understanding of who they are, and working to ensure that their most basic needs are met. There is nothing easy about this job, about aiming to support people who are on the brink of despair or who have suffered unimaginable trauma and loss. Given severe underfunding, there is nothing easy about making daily difficult choices, like which programs to downsize or which families won't receive thermal blankets during a cold, harsh winter. Even so, UNHCR staff leave me inspired. They stay the course and they manage to deliver positivity and hope in unparalleled fashion. Most of all they offer compassion. In the 8 years since the Syrian crisis began, international attention has often shifted to newer crises around the globe. Yet, this Committee has remained steadfast in its commitment to the protection and assistance of Syrian refugees and IDPs, as well as to the neighboring countries that are hosting the refugees. On behalf of all of my colleagues at UNHCR, we thank you for that leadership and support. As an American, I'm also proud that the United States continues to be UNHCR's largest donor and that our State Department remains a steadfast partner. Recent developments in Syria and across the region have begun to focus attention on the prospect for the return of Syrian refugees to their home country. I know that this Committee will work to help ensure the conditions that will allow for such returns, while at the same time continuing to meet the needs of uprooted Syrians and their generous hosts. I hope that my testimony today will contribute to this vital discussion. global forced displacement I'd like to take a moment to put the Syrian crisis in the global context. Around the world today, global forced displacement is at the highest level in modern history. Nearly 70 million people are uprooted from their homes because of persecution or conflict. That's the population of California and Texas combined. Of those, more than 25 million are refugees while more than 40 million are internally displaced. Another 3 million are seeking asylum. Syria continues to be the origin of the largest refugee population in the world, with 6.5 million Syrian refugees in over 125 countries. A large majority--over 5.6 million--live in the neighboring countries of Turkey, Lebanon, Jordan, Egypt, and Iraq. In addition, Syria is second only to Colombia in the number of IDPs, with 6.2 million Syrians uprooted from their homes but still inside their country. Other major refugee populations include Afghans, South Sudanese, Somalis, and the Rohingya and other minorities from Myanmar, while other large IDP groups include Congolese, Somalis, and Yemenis. Here in this region, people continue to leave Venezuela due to violence, insecurity, and lack of essential services. Over 3.4 million Venezuelans now live abroad, mainly in countries within South America, representing the largest exodus in the recent history of Latin America. In addition, about 325,000 refugees and asylum seekers have fled the northern Central American countries of El Salvador, Honduras, and Guatemala. UNHCR is working in Mexico and other neighboring host countries to enhance protection and assistance for these individuals, many of whom are women and children fleeing unspeakable violence at the hands of powerful transnational gangs. During my trip to Guatemala last year, I met women, children, and men who were literally running for their lives. The danger was so great that in our interviews we could not show their faces or identify them by name. The sheer numbers of the displaced and the growing complexity of humanitarian crises--which includes the protracted nature of conflict and the role of non-state actors--make our work and the work of our partners both more challenging and more needed than ever before. Thanks to the continued leadership and humanitarian diplomacy of the State Department, the strong bipartisan support from the U.S. Congress, and the American public's unwavering commitment to protect and assist the most vulnerable, UNHCR has been able to save lives, protect and assist those fleeing persecution, and help stabilize war-torn areas of the world. the syrian crisis Last month, the Syrian crisis entered its ninth year. In that time, the conflict has reportedly killed about half a million people and has uprooted nearly half of Syria's population. Turkey, with 3.6 million Syrian refugees, is the largest refugee-hosting country in the world, while Lebanon--at one-third the size of Maryland--hosts between a million and 1.5 million Syrian refugees, making it the largest per- capita refugee hosting country in the world. Another 660,000 Syrian refugees are in Jordan, 253,000 in Iraq--primarily the Kurdish region of northern Iraq--and 132,000 in Egypt. Although the world's attention was focused in 2015 on Syrians and other refugees who crossed the Mediterranean to reach Europe, and while a vigorous debate in this country has concerned the number of Syrians to admit as refugees, the reality is that the overwhelming majority of Syrian refugees have always been, and still remain, in the countries bordering their homeland. This is the situation for most of the world's refugees, who rarely cross more than one international border. For this reason, developing regions host more than 85 percent of the world's refugees, while the least developed countries host about one-third of the global total. Although the countries hosting the majority of Syrian refugees are middle-income countries, the sheer size of the refugee population and the fragile nature of the region's economic and political situation puts an enormous strain on these governments and their local communities. Let's remember that many of the countries hosting Syrians also host Palestinians, Iraqis, Afghans, and other refugee populations. In Jordan, I had the honor of meeting with King Abdullah and Queen Rania. They discussed the significant impact that the Syrian refugee population has had on their country, particularly their infrastructure. In Lebanon, the Syrians have strained not only the public services of that small country but also its delicate political and demographic balance. These and the other neighboring countries have all been and will continue to be generous hosts to the Syrians refugees, but clearly they need help if they are to keep the welcome mat out. In the past several months, in light of changing dynamics in Syria and across the region, the prospect of refugee returns has emerged prominently in discussions around the future of the country. However, discussions around returns must not be driven by politics. It's critical to consider the rights and interests of refugees first and foremost, and also whether the situation on the ground in Syria is conducive to return. As is the case in any displacement situation around the globe, UNHCR's position is that return of Syrian refugees or IDPs must be voluntary, safe, dignified, and sustainable. The majority of Syrian refugees tell us that they want to go home 1 day. And those who made a free choice to return should be supported. However, at this point the majority of Syrian refugees don't foresee a return to Syria in the immediate future. They fear for the security of their families, as well as the prospect of military conscription, lack of necessary documents, and a lack of basic services or livelihoods. On my recent trip to Lebanon, I heard these exact concerns first-hand. Refugees say they want to return when the violence subsides, when guarantees are in place for their rights and safety, and when there is a political solution. And UNHCR is working to address the obstacles to return with the government of Syria and other stakeholders. Although UNHCR is not yet facilitating the large-scale return of Syrian refugees, we are aware that some self-organized returns are already happening. In 2018, at least 56,000 refugees returned to Syria from neighboring host countries. These Syrian families have made a highly personal decision to return to Syria, and UNHCR fully respects and supports that decision. While not yet promoting or facilitating such returns, UNHCR is present at points of departure in the host countries to ensure that such returns are voluntary and to provide advice on documentation and other key issues. UNHCR also provides returning Syrian refugees with humanitarian assistance, as it does for internally displaced persons, IDP returnees, and host communities. But in order to fully support those who return, as well as to monitor conditions in place for returnees, UNHCR and other humanitarian agencies need unhindered access to areas of return inside Syria. While access is slowly improving, it is far from being sufficiently widespread or systemic. When the time is right, when conditions allow for safe and sustainable return, UNHCR will indeed be there to support an organized, large-scale repatriation effort, as it has done in so many refugee situations around the world. In the meantime, the 5.6 million Syrian refugees in the region, and the countries that host them, need the continued support of the international community. During my recent trip to Lebanon, and my earlier trip to Jordan, I heard over and over from refugees about their desire to go home. Despite the aid that they receive from UNHCR--including access to legal services and civil status documentation, cash assistance, and emergency supplies--coupled with the generosity of host countries, many Syrian refugees are living on a knife edge. Making ends meet has become more difficult with every passing year of displacement. Until they can return home, life is a daily battle to prevent slipping deeper and deeper in to poverty and destitution. In Lebanon, there are no formal camps for Syrian refugees. While some Syrians live in informal settlements, the vast majority live outside these settlements in urban areas. Five out of ten Syrian households in Lebanon are living in extreme poverty--on less than $2.90 per person per day. Any savings these refugees may have arrived with have been depleted, and limitations on their right to work and the ongoing discrimination they can face can make earning a living close to impossible. Until Syrians can return home, life is literally a daily battle to prevent slipping deeper and deeper in to poverty. This reality was all too clear last month when I was in Lebanon and had the opportunity to meet a young family who has faced the most immense struggles over the past 8 years. Binana and her husband Raed have four children and currently live in a small, unfinished building that is damp and cold with no real door or windows. Their children include beautiful and amazing 8-year-old twins, sister Razan who dreams of being a princess and a doctor, and brother Yazan who dreams of being a pilot but is already working as a vegetable seller on the street to support his family. Razan and Yazan were 4 months old when their parents fled Syria, due to the surrounding sounds of war, the shelling, and the imminent danger. It is worth noting that like most refugees, their life in Syria had been good. Raed worked as a taxi driver, and Binana took care of her family. They had what they needed for a nice, stable life. They have now been in Lebanon, living as refugees, for eight long years. Raed has had difficulty finding work, so they struggle to make ends meet and are in a great deal of debt. They have moved multiple times. They have lived in an old bakery, in something they describe as a birdcage, and also in a stable. Binana even gave birth to one of their younger children in the stable, where she described everything as being dirty and smelling of garbage. She also described a time when their space was flooded and covered with moths. It is hard to appreciate just how difficult these past 8 years have been, but the exhaustion and desperation of the parents are palpable. They have nothing, and they have lost almost all sense of hope. Raed resorted to trying to sell his kidney on Facebook, but Binana was against the idea. When Binana was pregnant with Rajaa, who is now 6 months old, a friend suggested she sell her baby to help make ends meet. She of course did not do this, but the suggestion sheds light on the desperation of the family. There have been times when they've gone without even bread for 5 days straight. Binana told me, ``You have no idea how difficult it is when children ask for things we cannot give them. We have lost hope.'' Sometimes, in the evenings when the kids are hungry, she gathers them together and tells them to imagine and visualize what they would most like to eat. She tells them that when they go to bed they'll all dream this same dream. But when they wake up, they're still hungry. The strength and courage of Yazan, the twin boy, really affected me. He overheard his parents talking about their struggles, and at 8 years of age he intervened and offered to start selling vegetables. It was difficult for the father to even share this story, to acknowledge that his 8-year-old is helping to support the family. Raed and Binana did not want Yazan to work and initially said no. But Yazan insisted and told them it was better than begging. Raed proudly explained that Yazan is an excellent salesmen. I asked Yazan, who, by the way, cannot even reach the top of the vegetable cart, what makes him such a good salesman. With his wonderful smile, Yazan told me that he's good at selling because he's so cute. While his response was funny and made me smile, the fact that he is working as a young child and going to bed hungry is a reality all too common for refugee children. The family recently moved into their current home, so the children have not yet started their new school. Another reality for refugee children is that constant moving severely impacts the continuity of their education, if in fact they are able to attend school at all. Binana and Raed receive monthly cash assistance from UNHCR and food assistance from the World Food Program (WFP). They're surviving, but their day-to-day existence remains a struggle. In Lebanon, I also met a young Syrian refugee mother named Hanadi. She is just 21 years old and lives alone with her three children: 4- year-old Hassan, 3-year-old Mayed, and 2-year-old Abed. Each of her children is more responsible than any child deserves to be, yet still inquisitive and curious. I remember little Hassan who was fascinated with the recording device our team took there. In that moment, he was just a kid with a toy. It was a small moment of levity during a difficult conversation. They have been living in an informal settlement in northern Lebanon for the past 3 years. Informal settlements are some of the poorest living conditions I've seen on my trips with UNHCR. Hanadi's particular space was clean with plastic sheeting for walls, mats on the floor and a separate, small but well organized kitchen. Just like you or I, she takes pride in her space, and the fact that she was tragically driven from her home hasn't changed that. I am always struck by the level of attention and care refugees give their make-shift and temporary spaces. Even her ``kitchen'' area where she went through and showed me all of her cooking equipment and spices, right down to the tomato paste, was impressive. Hanadi fled Homs with her husband and family and sought safety in Lebanon in 2016. Her parents and in-laws remain in Syria, but she lost contact with them, and actually does not know whether they are even still alive. Her husband, realizing the challenges of life in Lebanon, went back to Syria in 2017. Hanadi has now lost contact with him as well. She last heard that he was detained by authorities but hasn't heard anything further. As the conflict carries on, this story of young mothers piecing together an existence in makeshift shelters that leak when it rains and are cold in the winter are all too common. To make ends meet and to afford food for her children, Hanadi works 2 days a week in a greenhouse where she plants tomato and zucchini, leaving her children with neighbors. She earns $3 a day. She can barely keep up with her debts and her $50 monthly rent. She also has to pay for the generator subscription and water, as well as for doctors and medicine if her children fall ill. And make no mistake, her children do fall ill. This isn't a theoretical problem. Hanadi told us about a time when her 3-year-old was sick. She had to make the difficult decision between medicine and lights. The smile on the face of the little girl I saw beside Hanadi in their tent lets you know the choice she made. And these difficult financial choices are happening even with vital assistance from U.N. agencies. Hanadi receives cash assistance from UNHCR, which she uses to buy essentials for her children like diapers and clothes. She also receives the WFP food assistance. But given her other expenses and her debt, she can't always afford to have electricity or to heat her house. Hanadi says that she would love to return to Syria as soon as it goes back to normal, but security and stability are needed. Hanadi doesn't go out much--she doesn't feel free to move about alone as a woman and asks neighbors to get things for her family. Her main hope is to provide for her children. She wants them to be educated, and to live a different life than they're living now. In Jordan, which I visited in December 2016, approximately four out of five Syrian refugees live outside of camps in urban areas. As in Lebanon, their resources have diminished over time, and many refugees have become more vulnerable, risking exploitation to make ends meet. The majority of Syrians in Jordan live in rented accommodation that can cost two-thirds of their income, and the dwellings often suffer from poor ventilation and dampness. A UNHCR study revealed that 78 percent of Syrians in Jordan are living under the Jordanian poverty line. About 36 percent of the school-aged Syrian refugee children in Jordan are out of school, despite the significant efforts to make sure that education is available to all children. While a number of innovative programs have reduced the out-of-school rate, it still remains too high. Obstacles to accessing education include overcrowding in some areas, the inability to pay for transportation or related fees, and often the need to send kids out to work to provide needed income. In fact, Syrian refugee families throughout the region often have no choice but to resort to harmful coping mechanisms such as child labor and early marriage in an effort to reduce financial pressure. They are also at risk of trafficking and exploitation. It's clear that children have been, and continue to be, among the most heavily affected by this crisis--losing out on education and other childhood opportunities. UNHCR regularly conducts needs assessments for urban refugee households to identify the most vulnerable and to support them where possible, within UNHCR's budget limitations. During my trip to Jordan, I met a young family who had recently begun resorting to the coping mechanisms mentioned above. Like so many others, Haitham and his wife Um Khalil fled Syria in 2013 thinking they would be away for only a short time. They had a fruitful life in Syria and left with savings from his work as a farmer. Three years later, when I was visiting, their savings were depleted and Haitham was unable to work due to a health condition. They had eight children and were expecting a ninth. Only one of their children was able to attend school, because, in spite of registering the others, overcrowding in the schools prevented them from attending. Money was a constant worry, so the eldest son, Khalil, only 13-years-old, went to work as a mechanic. He had worked the previous day from 7:00 a.m.--11:00 p.m., an astonishing 16 hours, and his work left his hands stained with engine grease. In spite of receiving UNHCR cash assistance, Khalil had no choice but to work as his family needed his income to help make ends meet. Taking that in, I turned to Khalil and said that was quite a responsibility for a boy. He listened to the translator then quickly and proudly replied, ``I'm a man, not a boy.'' The family was asked about applying for resettlement but rejected it, as they prefer to stay in Jordan with the hope that they can 1 day return to Syria. While UNHCR and its partners work within their means to ensure that all Syrian refugees have access to basic essentials of life, including services such as health and education, life remains a struggle. Even in the camps, where basic services are provided, life is difficult. In Jordan's Azraq camp for Syrian refugees, I met a young and vivacious couple, Mohamed and his wife Alaa. They have two children, 4-year-old Hussein and 2-year-old Sema, and had been in Jordan for less than a year at the time of my visit. In Syria, Mohamed studied to be a veterinarian and worked on a reserve. Alaa is an agricultural engineer; she studied plants and trees and worked as an environmentalist. Notably, she was one of the top 10 students in her class, and her ambition to achieve, to do great things and contribute to her community was as strong when I met her as it was when she was top of her class. However, having no opportunity to work was discouraging and a constant struggle for them both. It was difficult for them to maintain a sense of hope, when they had no idea what their prospects for the future might be. Alaa told me, ``We both have energy inside of us that we want to give to the world but don't have the chance.'' In addition to their own struggles, their children suffered from psychological issues due to the constant sound of bombings they heard in Syria. In spite of all of these challenges and obstacles, Mohamed and Alaa wanted to stay in Jordan, close to the home they fled. Above all, they wanted to return to Syria as soon as possible. a new approach to supporting refugees and host communities In the past couple of years, driven in large part by the Syrian crisis, the international community has begun pursuing a new approach-- a new way of working--with respect to protracted refugee situations. As refugees often spend decades in exile, with no solution in sight, it is critical to ensure that these years are not wasted and that opportunities for greater self-reliance are provided. Let me briefly highlight the key components of this approach. First, we must increase support to refugee-hosting countries--such as Jordan and Lebanon--in ways that will allow them to not only help refugees but also improve the well-being of their own citizens who have taken these refugees into their communities. Second, refugees in these host countries need more opportunities to go to school and earn a living, in order that they can become self-sufficient and contribute to their host communities; we cannot let entire generations be uneducated or waste their potential. Third, the international community needs to provide more opportunities for resettlement and other pathways of admission, such as work visas or scholarships for higher education. Refugees should not be forced to risk their lives trying to find opportunity elsewhere. Finally, we need to redouble our efforts to achieve the conditions that enable refugees to return voluntarily to their home countries. Refugees clearly need access to safety and refuge. But they also need to be included in the societies hosting them and have the chance to create a better future. Given the opportunity, refugees have the potential to contribute to the economies and the cultural and social lives of their new communities--whether those communities are in neighboring host countries, in western countries where they are resettled or where they work or study temporarily, or ultimately back in their home countries where they can help to rebuild after years of conflict. UNHCR and the wider humanitarian community, while providing support to refugees around the globe, cannot by itself address the longer-term needs of refugees and host countries. That is why this new approach involves key partnerships with development actors, international financial institutions, governments, and the private sector. Such assistance--both bilateral and multilateral--is critical not only in the Middle East but in many other corners of the world, including forgotten crises throughout Africa and in parts of this hemisphere such as Central America and the Venezuela region. Aid, done smartly, can transform countries of origin, transit, and destination. Through a coordinated and holistic response to the needs of the displaced and their hosting communities, we can achieve significant humanitarian and development objectives while also helping to stabilize fragile regions of the world. In the Syria region, this new approach is already bearing fruit. With access to World Bank funding and other development and bilateral aid, countries hosting refugees are able to address the long-term needs of their own populations while continuing to host refugees. And more humanitarian funding is now being channeled through national systems-- for health care, education, and other services--rather than creating parallel services. At the same time, host countries have been more willing to expand livelihoods opportunities for refugees. Turkey and Jordan, for example, have already provided more than 150,000 work permits for Syrian refugees according to their figures--which has benefited refugees, their hosting communities, and the local economy. key messages Mr. Chairman, Ranking Member, and members of the Committee, I would like to leave you with three key points to keep in mind as the situation in Syria continues to evolve. First, we must enhance support for the Syrian refugees throughout the region. Syrian refugees have told us clearly what they want, which is what all of us want: hope for the future. They want education for their children and the ability to work and provide for their families. They don't want to be dependent on aid and to sit idly for years, wasting their time and their talents. They want to be agents of change in their own lives, and they are more than capable of doing so if we just give them the chance. Second, the neighboring countries that have so generously hosted Syrian refugees for 8 years continue to need our help. They urgently require more long-term structural support so that they can keep their doors open and keep hosting Syrians as well as other refugee populations. Much has been already achieved through the engagement of bilateral and multilateral actors in both the humanitarian and development arena, but more needs to be done. We need to help host countries ensure that health services, education, and livelihood opportunities are available to refugees and that the needs of their own citizens are also addressed, so that both groups--refugees and nationals--are able to thrive. Finally, we know that the majority of Syrian refugees want to go home 1 day. All refugees have a fundamental right to return. These returns need to be voluntary, safe, and sustainable in order to prevent another refugee outflow. The international community should do whatever it takes to depoliticize the issue of return and instead place refugee perspectives, rights, and interests at the center of discussions and decision-making. While self-organized returns are beginning to happen, and while more and more refugees will likely return as the situation evolves, it is clear that large-scale return will take time. This means that we should expect a significant Syrian refugee population outside Syria for the foreseeable future. The United States has been the most generous donor to many refugee crises and to the Syrian humanitarian situation, and I urge you to maintain this generosity and this leadership. Eight years into this crisis, we must not look away. We cannot let Syrian families go deeper into destitution and cannot let children be part of a lost generation. We need to ensure that these families can make ends meet, live in dignity, and look to the future with hope. We need to ensure that these kids--like my kids and your kids--can have a childhood and achieve their dreams. Ultimately, we need help create the conditions that will allow the majority of Syrian refugees to return home--when the time is right--as they so desperately want to do. Thank you. The Chairman. Thank you, Mr. Stiller. We appreciate your testimony in that regard. And thank you for your commitment to this cause. Next, we are going to turn to the Right Honorable David Miliband. Mr. Miliband is president and CEO of the International Rescue Committee, where he oversees the agencies humanitarian relief operations in more than 40 war-affected countries. From 2007 to 2010, he was the 74th Secretary of State for Foreign Affairs of the United Kingdom, driving advancements in human rights, and representing the United Kingdom throughout the world. Thank you for being with us today, Mr. Miliband. And the floor is yours. STATEMENT OF THE RIGHT HONORABLE DAVID MILIBAND, PRESIDENT AND CHIEF EXECUTIVE OFFICER, INTERNATIONAL RESCUE COMMITTEE Mr. Miliband. Thank you very much, Chairman Risch, Senator Menendez, distinguished senators. Thank you all for your leadership at this critical time in international affairs. I want to particularly applaud your determination to hold this hearing to look at the humanitarian consequences of the war in Syria, because our experience over the last 8 years is that far too often the danger that untended humanitarian crisis leads to geopolitical instability is not sufficiently appreciated. And the willingness of this committee to do so seems to me to be very important. I am conscious of the need to get on to the questions, so I won't repeat things that others have said. But let me make a few introductory remarks. I had the privilege of testifying before this committee in 2015 and in 2017, when the inhumanity of the Syrian conflict was a major news story. Today, Syria is mainly out of the news, with the suffering of well over half of the Syrian population. The population numbered about 25 million in 2011. Well over half have been affected by the war. Their suffering has not abated. In the last 24 hours, bombing raids in the northwest of Syria by the government of Syria and Russian forces have caused death and destruction. I got in touch with our team on the ground this morning. They reported to me that today there have already been 50 air raids and attacks. We know that yesterday there were at least 20 aerial attacks, and in addition, 22 using barrel bombs. Our evidence is that three-and-a-half thousand have been displaced even in the last 36 hours. I want to pay tribute to Ben Stiller and our partners at UNHCR. But I also want to recognize the over 2,000 International Rescue Committee staff on the ground in Syria, Jordan, Lebanon, and Iraq. In 2018, in significant part thanks to the aid that America was willing to provide, we were able to offer emergency aid and long-term services to one and a quarter million uprooted Syrians and their hosts in neighboring states. My testimony, my written testimony, focuses on four humanitarian priorities. First, the war that is continuing in two large chunks of Syrian territory in the northwest and in the northeast. You know well that the politics and the military balance in both areas is complex, but over 4 million people live in those areas. Cross-border aid keeps them alive, but the State Department yesterday described the situation of these people as dire. My written testimony gives details, including of those who used to live in Baghouz under ISIS rule and are now in the Al Hol Camp where we are working. It is a high priority to prevent humanitarian meltdown as the government of Syria and their Russian and Iranian allies seek to retake ground in the northwest and northeast of the country. Second, as all of the speakers have so far said, the 8 years of war have taken their toll on the refugees in neighboring states. For too many of these people, life is a miserable existence. Poverty, early marriage, inadequate health and education are the norm. The host countries have their own challenges, and are delivering a global public good in providing sanctuary to these people. They need support, not lip service, to be able to continue to do so. Third, we hear from refugees that they are scared to return to Syria. Notably scared of conscription into the Assad army and of persecution. But also scared about the destruction that's been wrought on their homes and businesses. The primacy of the multilateral U.N.-led diplomatic process has been to a large extent displaced in the last 3 years by a Russia--Iran-- Turkey troika. However, a sustainable peace can only be built with full international as well as national engagement, and that takes sustained diplomatic muscle. Fourth, the most vulnerable refugees, abused women, victims of torture, those with medical conditions, depend for their future on resettlement to third countries. As Senator Menendez said, the U.S. has historically led the way. He rightly drew attention to the fact that in fiscal year 2016 only 62 Syrians were allowed in the country. The figure for this fiscal year so far is 250. I want to draw attention to the fact that albeit with reduced numbers the Administration has committed to admit about 9,000 refugees for resettlement from the Middle East alone, but so far, nearly 7 months into the fiscal year, they have achieved less than 7 percent of that regional target. And it seems to me worthy of great attention to make sure that they do actually hit their own target in the course of the rest of this fiscal year. Mr. Chairman, Syria over the last 8 years has become a poster child for what I call an Age of Impunity, when the laws of war are considered optional, civilians are fair game, aid workers are seen as unfortunate collateral, and diplomacy is toothless. I thank you and the members of the United States Senate for the opportunity to provide the International Rescue Committee's perspective on this defining humanitarian challenge. I look forward to addressing your questions, and to an important conversation. Thank you very much, indeed. [The prepared statement of Mr. Miliband follows:] Prepared Statement of Rt Hon. David Miliband Chairman Risch, Ranking Member Menendez and distinguished Senators, thank you for your important decision to hold this full Committee hearing on the continuing humanitarian impact of the Syrian civil war. Since I last spoke to this Committee just over 2 years ago, battle lines have moved, Syrian territory has changed hands, ISIS, or Daesh, has been driven from its territory, and Syria has largely dropped off the front pages--but human suffering has been constant and in some ways growing. Last year 1.5 million Syrians were newly displaced by the fighting, including a period of civilian displacement at the beginning of 2018 higher than any other since the war began. Throughout the conflict humanitarian concerns have come too low down the priorities of key decision-makers, with devastating consequences for well over half the Syrian population. It is heartening that this Committee has not forgotten their plight and is ready to hear the arguments for urgent international leadership to ease the situation. That leadership needs to focus on four priorities: preventing humanitarian meltdown as the Assad government, with its Russian and Iranian allies, seeks to capture territory in the North West and North East currently out of its hands; promoting livelihoods, education and dignity for refugees in the neighboring States by renewing support for them and for the States hosting them; re- establishing multilateral (UN-led) engagement with the parties to the conflict and the Syrian people to promote sustainable peace; and helping the most vulnerable refugees with resettlement to third countries, including the U.S. These priorities and my testimony are based on what my colleagues see on the ground. The International Rescue Committee operates across the arc of crisis--directly in the midst of conflict in Syria, in refugee hosting nations like Lebanon, Jordan and Iraq, on refugee transit routes like Serbia and Greece, and in 26 cities across the United States where we have assisted over 400,000 refugees to rebuild their lives since our founding by Albert Einstein in the 1930's. There are currently 2,190 dedicated IRC staff working in Syria and neighboring States. In 2018 we provided emergency aid and long-term services to 1.25 million uprooted Syrians and within the communities that host them--including 954,000 inside Syria. In total we have reached more than 5 million people in the region since 2012. None of this would be possible without the support of the international donor community, including the United States. For example, IRC's enduring partnership with USAID's Office of Foreign Disaster Assistance (OFDA) allowed us to provide lifesaving services to more than 300,000 conflict-affected men, women, and children across Syria and Iraq in Fiscal Year 8. In the region, the IRC has partnered with the U.S. Department of State's Bureau for Population, Refugees, and Migration (PRM) to reach millions of Syrian refugees. We are grateful for USAID and the State Department's continued commitment to assist Syrians in need, and their continued confidence in IRC's ability to provide effective and efficient programming that helps Syrians in Syria and the wider region to survive, recover, and gain control of their futures. We know that Congress has played an absolutely pivotal role in appropriating funds for these purposes, and on behalf of our clients we express our sincere gratitude. Independent assessments give us high confidence in the value and quality of these programs. More aid, better delivered, remains a pressing priority. But so does a surge of diplomacy that brings the needs of civilians to the forefront in the conduct of the war and the making of peace. The Syrian conflict has been a poster child for a new Age of Impunity, where war crimes go unpunished and the laws of war become optional. A recent report has revealed that chemical weapons, expressly forbidden by international law, were used over 330 times against civilians over the 8 years of the conflict. There have been 355 attacks on hospitals during the war, including at least 13 bombings of IRC-supported hospitals in the country. Just last year, 102 people were killed in attacks on medical facilities. The number of attacks on hospitals in Syria has actually gone up since 2016 when a U.N. Security Council resolution called for them to cease. These attacks on healthcare come at a time when civilians account for at least 85 percent of all war casualties. The statistics suggest a terrible new normal: civilians fair game, humanitarian aid workers unfortunate collateral, investigations and accountability an optional extra. Even the limited mechanisms that do exist for accountability in Syria, the Independent International Commission of Inquiry (COI) and the International Impartial and Independent Mechanism (IIIM) can merely bear witness to the violations, but cannot hold those responsible to account without the political will of U.N. Security Council. The U.S. Government, and Congress, therefore face important choices not just about humanitarian aid but also about diplomatic and military engagement. Our plea is to put civilian needs at the center of those decisions, in the name of humanitarian need but also in the interest of geopolitical stability in a vital region of the world. the situation inside syria Since I last addressed the Committee, the Assad government has retaken control of large swathes of the country, and ISIS has been driven from its centers of power. However the conflict continues in significant parts of the country, and civilians pay the price, with 6.2 million people currently internally displaced. Our priorities are to see the U.S. use its diplomatic muscle to prevent a resurgence of fighting with devastating impact, to increase and extend the impartial provision of humanitarian aid, including for those who suffered under ISIS rule, and to see the international system re-establish a multilateral basis for planning a sustainable future for Syria and its people. In Northwest Syria, in Idlib province, currently home to 2.7 million Syrians, IRC has more than 300 people working to help people access vital healthcare, to protect vulnerable women and children, and promote economic livelihoods opportunities, while also responding to emergencies driven by the conflict. In this part of the country, an agreement between Turkey and Russia averted a humanitarian crisis by halting an impending military offensive last September. Since then, ongoing and increasing violence in areas of the so-called ``demilitarized zone'' has undermined the fragile standoff. Shelling has risen steadily since November, with over 120,000 people displaced since February. While the Brussels Conference was underway earlier this spring, Russian airstrikes on March 14th killed 10 civilians and injured 45 others. At least 90 civilians were killed in March, half of them children. Two weeks ago, we saw the highest number of people killed in 1 week since this zone was agreed to. Just last week, one of our sister NGO's reported attacks on two schools they support and the deaths of three more children. In total, more than 200 civilians have been reportedly killed in Idlib since February, and we continue to fear a major offensive on the province. Estimates suggest as many as 800,000 people could be displaced--two to three times the number of people who were displaced during fighting in Southern Syria in mid-2018. In Northeast Syria, more than 450 IRC staff work to provide healthcare, protection, and economic recovery and development across three governorates via cross border access from Iraq. This is clearly an area of high political tension, with Syrian, Kurdish, Turkish, Russian and US troops in close proximity, plus the remnants of ISIS. ISIS lost its last zone of territorial control in Syria on March 23. The brutal impact of its tactics and ideology have yet to be fully addressed, as have the grievances and disempowerment of local communities. In addition there are very difficult questions about how to identify former ISIS fighters, how to bring them to justice, and how to deal with their families, including large numbers of children. The aftermath of the fight against ISIS has led to a burgeoning humanitarian crisis. At al Hol Camp, catering to people previously living under ISIS rule in Baghouz and other parts of Deir-ez-Zour , the population has risen since December from 11,000 to more than 73,000 people. Most of them have arrived highly vulnerable--with trauma, malnutrition and disease common. As of April 11, 249 people died on the journey to al Hol or soon after arriving at the camp. According to an analysis in March of the first 123 reported deaths, a quarter of those deaths were of newborns under 1 month old, two thirds of deaths were of babies under 1 year old, and 80 percent of deaths were children under 5 years old. The population in al Hol is diverse. There are more than 30,000 Syrians, 30,000 Iraqis, and more than 11,000 people with foreign citizenship across 30 countries. Of the camp population, 93 percent are women and children, 65 percent are children under 12. Most are in desperate need of basic services, education and psychosocial support to recover from the horrors they've experienced. These children are innocent victims of conflict and should not be held responsible for any crimes that may have been committed by their parents. But we also recognize the concern about the status and position of former ISIS fighters, and the need to address, and prevent, radicalization. We support the initiative of a number of countries, with U.S. support, to take back their own citizens, including children born under ISIS rule and call for other States to follow suit. We welcome the support the U.S. recently provided to Kosovo as it repatriated 110 of their citizens, mostly children and their mothers. In the education and health programs we run in Syria, we see what a difference mental health support and safe learning spaces for children can make even in a short time. The children we work with who get this support are less aggressive, less violent, and are more successful in school. The humanitarian crisis persists in and around Raqqa as well. When Raqqa City was retaken, IRC was the first organization to undertake emergency cash distributions for vulnerable households and treat more than 65,000 people through mobile medical units. Since that time, tens of thousands of people have returned to a city where their homes have been destroyed, water and electricity are scarce, and functioning health facilities and schools are few and far between. Raqqa is so heavily contaminated with mines and other unexploded ordnance that it could take years to fully clear the city so people can be safe. The city's infrastructure has been decimated, with major bridges vital to traffic and transportation of goods destroyed or unusable. In Rukban, an arid remote area in southern Syria near the northeast border of Jordan, some 40,000 people remain stranded, isolated from humanitarian aid deliveries that are rare and intermittent, in a desperate state without regular access to food and medical care. Rukban is an example of a place in Syria where it is not ``hard to reach'' civilians with humanitarian aid, but rather, where aid is regularly denied. Out of hunger and desperation, some people are beginning to take their chances by leaving Rukban. But although it appears that several thousand people left the enclave over the last few weeks, there have been concerning reports that some have been detained and even executed. Finally, it is important not to lose sight of the situation in areas that have been retaken by the Syrian government, such as Dara'a in southern Syria, where people are still struggling to recover. Before the government took control of this territory and the border crossings that served it, the IRC, with its network of Syrian partner organizations, was the largest health-care provider in southern Syria, supporting more than a quarter of a million Syrians. Now we are shut out, with no access to those people in need. Even before the government offensive to retake Southern Syria, the state of healthcare was dire: the area had 1,000 medical personnel in 2011, but just 150 in 2018. During the offensive, eight hospitals were hit by airstrikes. In March of this year, the U.N. reported that the majority of health facilities in Dara'a are either partially or completely destroyed and that there is a lack of health workers. The assurances from the Syrian government inspire little confidence in light of the conditions in other areas previously retaken by the State, such as Ghouta, east of Damascus. Given these unrelenting realities inside Syria, there is a pressing need for the United States and other donors to fund the humanitarian response plan (HRP) to ensure that resources keep pace with the needs-- yet only 65 percent of the $3.36 billion requested in the 2018 Humanitarian Response Plan was met. Within this shortfall, several sectors have been woefully underfunded, including just 10 percent of the request for protection services and just 30 percent for early recovery and livelihoods. In 2019, the HRP is almost the same as in 2018 at $3.32 billion--and needs to be fulfilled. The international community also needs to ensure that humanitarian assistance is delivered in a principled manner via the most direct routes. More than 4.5 million Syrians, many in acute need, are reliant on life-saving cross-border assistance authorized by U.N. Security Council Resolution 2449, which was last renewed in December 2018. Cross-border access to Northwest and Northeast Syria is critical to meeting needs in these parts of the country, and the international architecture that supports that aid delivery should be maintained. Our experience in Southwest Syria has demonstrated what happens when this cross-border access is shut down--lack of access to hundreds of thousands in need, fears for the safety of our clients and staff, and little to no information on what aid is being provided in our absence. the strain in neighboring states The Committee will be aware that the Syrian humanitarian situation is part of a global trend: there are record numbers of refugees and displaced people around the world today. They are fleeing conflict and persecution that makes it unsafe to remain at home. This displacement is lasting longer than before--at least 10 years for the average refugee. Once refugees are displaced for at least 5 years, as is the case for most Syrian refugees, the average rises to 21 years. Eight 5 percent of the world's 24.5 million refugees live in low and middle- income countries, which already struggle to educate their populations and expand their economies. Just 10 countries, with 2.5 percent of global GDP, host over half the world's refugees. Syria's neighbors are all among these top 10, and the Syrian crisis epitomizes these challenges. However, the international community's humanitarian efforts have remained short-term in nature, rather than offering a coherent, strategic, multi-year effort to promote self-reliance and resilience amidst a protracted crisis. Syria's neighbors in the region, namely Lebanon, Jordan, Turkey, and Iraq, are hosting 5.6 million Syrian refugees. Lebanon has taken in 1.5 million Syrians and Palestinian refugees from Syria, accounting for 30 percent of Lebanon's population, at a time when one-third of the Lebanese population already live in poverty. The Syrian war has disrupted cross-border trade and deterred foreign tourists, and GDP growth that reached double figures almost a decade ago is set to fall to 1-1.5 percent this year. Jordan has taken in 650,000 registered refugees, straining the country's resources, especially scarce water and agricultural resources, at a time when the country is midway through an austerity program. And while Turkey has a greater size and economic capacity, it is host to 3.6 million refugees. These countries deserve significant support from the international community for the generosity they have shown Syrians fleeing violence and persecution even as they face their own domestic economic and social challenges. The pressure on refugees in the region is severe, and all signs indicate there is no immediate hope of returning home. Refugees tell us that they are scared to return and are not ready to do so. Less than 6 percent believe they will return to Syria within the next year. Although the overwhelming majority hope to be able to return 1 day when it is safe and conditions are in place, just 19 percent think they will ever be able to return home. When asked what concerns they have related to returns, refugees cite the lack of security improvements, limited livelihood opportunities, lack of access to shelter, compulsory conscription and military service, limited access to basic services and education, fear of detention, and absence of a political solution. We have seen the power of effective aid combined with policy reforms to make a real difference in the lives of Syrian refugees. For example, Lebanon has instituted a second shift for Syrian children to attend school, and Jordan has opened up its health care system to refugees. In Lebanon, World Food Program cash-based interventions between 2012 and 2017 injected around $965 million into the Lebanese economy. In Jordan, revisions to work permit restrictions have allowed vulnerable Syrian refugees to register their home-based and micro businesses and through work permits in construction, agriculture and manufacturing without employer sponsorship given refugees more control over their lives. But overall this effort has not been sufficiently strategic or comprehensive. The economic situation for Syrian refugees in neighboring States remains precarious, which exacerbates challenges for the most vulnerable refugees: women and children. More than half of Syrian refugees in Lebanon are unable to meet the ``survival needs'' of food, health, and shelter. Fifty 8 percent of refugees in Lebanon live in extreme poverty, and many are falling deeper into debt without consistent financial resources to meet their needs. In Jordan, despite the commitments and good will of governments to make some work permits available to Syrian refugees, many refugees lack documentation or the means to pay the costs associated with obtaining a work permit, and while 139,000 of the target goal of 200,000 work permits have been issued, just 40,000 are in active use. As a result 85 percent of Syrians in Jordan remain below the poverty line. These impacts are felt hardest by women and children in these refugee communities. In conflict situations, there is often an increase in female-headed households and these are often the most impoverished as women face unique barriers to entering the work force. In Lebanon, 93 percent of refugee women are not working, significantly higher than the 44 percent unemployment rate among refugee men. Even when governments take steps to bring refugees into the formal economy, women are often left behind. In Jordan, only around 4 percent of work permits have gone to women despite 22 percent of refugee households being headed by a woman. As poverty rates rise and refugee families remain excluded from the formal economy, child labor and marriage has become all too common. Forty 3 percent of the 1.7 million school-age Syrian refugee children were out-of-school in 2018, an increase from 34 percent in 2017. This is a particular challenge in Lebanon, where a recent IRC survey in Lebanon found that children as young as 6 years old were working, and 79 percent of all working children surveyed were not accessing any form of education. Child marriage is another negative coping strategy for impoverished families. The percentage of married 15 to 19-year-old girls among Syrian refugees in Lebanon increased to 30 percent last year. Compared to the Middle East more broadly Syrian refugee girls face an increased risk of gender-based violence, higher rates of child marriage, and are more likely to drop out of school. The priorities in the neighboring States therefore fall into three categories: economic support to address poverty; expansion of education and protection services to help children, especially girls; and macroeconomic support for the neighboring States to contain tension arising from the challenge of hosting refugees for nearly a decade. The more this is addressed as a short-term issue, the less effective it will be. Acute humanitarian needs and medium-term development challenges need to be addressed together. The Committee could usefully engage with the continued evolution of the Regional Response Plan as a basis for intelligent accountability for donors and implementers and partnership with host governments. IRC has argued from the beginning of the Syrian civil war that the strain on the neighbors should not be seen only through the lens of short-term need. We were convinced this would be a protracted crisis that needed tools of development as well as humanitarian aid. We welcome the fact that the World Bank took important steps to change its financing models through the Jordan and Lebanon compact agreements. The Bank along with other donors used levers beyond aid, such as trade concessions, to incentivize host countries to reform their policies to allow refugees to work, move freely, and attend school. These are the types of changes we need to see in host countries in order to ensure a sustainable response, as well as enable refugees to become self-reliant and become net contributors to their local economies. While some of the initial experimentation has shown mixed results, the international community and international financial institutions should continue to innovate in their response. Even the small step of providing multi-year financing, rather than the short-term grants typically provided in humanitarian response, could have a big impact given the protracted nature of this crisis. The U.S. can be a voice for four steps to further improve on these approaches: Aid, trade, and other incentives for policy reform: International actors, including the U.S. Government, World Bank and other donors, should align their aid and ``beyond aid'' support, such as trade and other concessions, to enable host governments to make necessary policy reforms that open up pathways for refugee self-reliance. Restrictive policies are often one of most significant barriers that refugees face in being able to support themselves. Host governments often need the right international support to implement more progressive policies, such as allowing refugees freedom of movement, the right to work and the right to attend school. This is where the U.S. Government in particular could lean in with its diplomatic and financial weight to drive real, sustainable change. Define the right outcomes to identify the right solutions: Clear, measurable and context-specific outcomes will ensure that aid results in measurable improvements in refugee and host community lives. In Jordan, for example, a focus on jobs or increasing income levels-- versus work permits--may have directed planning to more cost-effective solutions. The same is true for Lebanon, where a focus on improved socio-emotional and academic learning outcomes for refugees would have led to a refined focus on addressing the traumas faced by refugees that can impact learning, rather than primarily focusing on enrollment numbers. Multi-year Financing: IRC has argued from the beginning of the Syrian conflict that the strain on the neighbors should not only be seen through the lens of short-term need. Our experience with conflict- driven displacement globally convinced us this would be a protracted crisis that needed tools of development as well as humanitarian aid. We welcome the fact that the World Bank took important steps to implement longer-term financing models through the Jordan and Lebanon compact agreements. Multi-year financing allows implementing partners to plan and staff against longer time horizons, reducing administrative costs and enabling organizations to create programs that put people on a path to self-reliance rather than more dependence on aid--like educational attainment and reduced poverty levels. Refugee voices: It is vital systematically to include refugees and other affected populations when designing solutions. Early and periodic consultation, and inclusion in decision-making, are critical to making sure solutions defined by donors and the government meet the real needs of refugees and host communities. If refugees are left out of this process, there is a risk that solutions will not align with what refugees need nor help them overcome the barriers to self-reliance that they experience every day. u.s. leadership The Syrian crisis has raised profound issues for geopolitics. The Committee will no doubt discuss how Russia, Iran and Turkey became the pivotal outside players in the course of the conflict, almost to the exclusion of other players, and what are the lessons. From the point of view of the IRC, the growth in stature of the Astana process at the expense of the UN-led political process which started in Geneva in 2012 is a striking development. It carries considerable challenges for the future. Russia and Iran have filled the void, leaving Syrian civilians, humanitarian access, accountability for IHL violations, and civilian protection without effective champions. At my last appearance before this committee in 2017, I warned there could be no effective foreign policy without effective humanitarian policy and urged this Committee and the Senate more broadly to push back against the administration's proposed cuts to humanitarian assistance in its foreign aid budget. Since then, we have been grateful for the Senate's enduring commitment to the people of Syria and to humanitarian assistance more broadly as you pushed back against proposed cuts to humanitarian aid. I hope you will do the same this year. Global contributions to respond to the humanitarian crisis in the region are not keeping pace with the needs. In 2018 only 52 percent of the $5.61 billion requested in the Regional Response Plan (3RP) was met. The proportion of the 3RP that has been met by international donors has steadily declined every year since 2013, when 73 percent of the 3RP appeal was met. In 2019, the 3RP is almost the same as in 2018 at $5.5 billion--and needs to be fulfilled. The United States has an important role to play as a donor in its own right as well as a catalyst for other donors to commit. Syria's neighbors need to be provided the necessary resources to shoulder the burdens of hosting millions of refugees, but also incentivized to reform how they treat them. Finally, U.S. leadership on Syria manifests itself in the resettlement of refugees, and in the lack thereof. In Fiscal Year 8, the United States resettled just 62 refugees from Syria, fewer than were killed in chemical gas attacks. So far in Fiscal Year the figure is 285. Nothing has changed about this population except their vulnerability. As we have demonstrated in this testimony, 8 years into the Syrian conflict, with all reserves depleted and with opportunities deeply constrained in countries of first refuge, the situation for Syrian families continues to worsen. The dramatic drop-off from the 12,587 Syrian refugees the U.S. resettled in Fiscal Year is significant in and of itself, but also has contributed to a broader departure from international commitments by Western governments. In 2016, 25,000 of the most vulnerable refugees were resettled from Lebanon to third countries. In 2018, with the U.S. leading the retreat, just 8,500 were resettled globally. This is an unjustified rebuke to the generosity of countries like Lebanon and Jordan shouldering far more than their fair share. I encourage you to work toward reversing this trend and fulfilling the Administration's regional target of 9,000 refugees from the Near East and South Asia, which includes Syria, in Fiscal Year 9. Last year, the Administration failed to meet its own target, admitting just 22 percent of the regional total and less than half of the global total of 45,000 refugee admissions. The world's greatest superpower should not reject the world's most vulnerable in their greatest time of need. It is a symbolic show of solidarity with the neighboring countries, and a life-changing, lifesaving intervention for the individuals concerned. I thank you and the members of the U.S. Senate for the opportunity to provide the IRC's perspective on this defining humanitarian challenge. I look forward to addressing your questions. The Chairman. Thank you very much, Mr. Miliband, for your testimony. And also, thank you for your commitment to this cause. We are going to do a five-minute round. I am going to start with a single question to Mr. Miliband, if you would. USAID's Office of the Inspector General is charged with rooting out waste, fraud, and abuse in U.S. foreign assistance. According to the inspector general it appears even lifesaving humanitarian assistance to Syrians is not immune to corruption. I think the corruption issue around the world is largely unknown to Americans, but it is ubiquitous, as we all know the work around the world. Could you please discuss for a minute why it's so important to institute and enforce zero tolerance policies when it comes to corruption in humanitarian assistance? Mr. Miliband. Thanks very much, Mr. Chairman. I am glad you have raised that. I think there are three reasons that I would cite. The first is it is absolutely vital to maintain the confidence of taxpayers that their international aid is going to the people who need it, not being diverted to people who want to profit from it. And I know from my own experience in political life that it is absolutely essential to ensure the principles of value for money, of cost effectiveness, as well as cost efficiency are built in from the beginning in the way programs are organized and delivered. Secondly, I am a very strong believer that it is important to have a culture of zero tolerance, because that means you are preventing fraud as well as taking defensive measures to investigate and tackle it. We, for ourselves, but I know that other NGOs do the same, do extensive risk analysis to make sure that we are working in ways that protect taxpayers' money. We are vigilant in following through where aid reaches. And perhaps of most interest to the committee, we use the views of beneficiaries themselves as an early warning system when things are going wrong. Because of course, the first people to know that the aid isn't going where it needs to is from people who are meant to be getting it. That seems to me to be essential. The third element of this that I think is very important, indeed, is obviously to ensure that the NGO community, with the multilateral agencies and the donors work in an efficient and effective way to tackle that fraud and abuse. One element of this is that NGOs have to fund this for themselves. We don't really get funded by our multilateral donors to be able to do this. And I can speak for my own organization. We are now having to invest significant sums of money that we raise ourselves to ensure that we meet the higher standards, always vigilant that in our recruitment and our practices we are able to meet the higher standards. The Chairman. Thank you so much. I appreciate that answer. Senator Menendez? . Thank you both for your testimony and your commitment. Mr. Miliband, you present a disturbing, rather gloomy picture, one which not only do I believe we have a situation where we can lose a generation of Syrians, but we will buy ourselves in the international community a generation of problems, problems that will go to unsettling what is happening in Europe, problems that lead to people who are despaired, who will then be turned and proselytized to fights that we are presently having against terrorism. This calls for our response not only in a humanitarian context, but in our own national interest and in our own national security interest. Let me ask you, the international community sends much of its humanitarian aid from Turkey and other frontline states to vulnerable citizens inside Syria. Last year, the U.N. Security Council authorized only a one-year extension of cross-border aid deliveries to Syria. If humanitarian organizations lose cross-border access and are only able to program for Damascus, how is that going to affect the Syrian humanitarian response? Mr. Miliband. Thanks very much for the question. I think the most chilling statistic that I saw in preparing for this hearing was that when it comes to cross-line aid, that means aid that is going from a government of Syria-controlled part of the country into a rebel-held part of the country, only three percent of aid agencies' applications to do that cross- line aid are accepted. That gives you an indication of the priority for cross- border aid that is going from Turkey, or from Iraq, or from Jordan to reach people in need. The U.N. figures are that about 3 million people depend on that cross-border aid. And we know from our own staff who are in areas that were previously under rebel-held control, where we were delivering cross-border aid, I am thinking particularly about the southwest of the country, Daraa, where the Syrian Civil War started, and where we were the main healthcare provider. Now that the Syrian government has taken over, those services have been lost. And so, you are immediately seeing that for the people in the northwest and the northeast of the country, still in rebel-held areas, cross-border aid is literally a lifeline. Three million people in total depend on cross-border aid, and they depend on a multilateral coordination mechanism through the United Nations as a Syria response plan and a regional response plan covering the neighbors that is delivered in a coordinated and organized way. So cross-border aid is a lifeline. Senator Menendez. And obviously, in the absence of cross- border aid it increases the Assad Regime's ability to leverage assistance only to the areas where supporters of the regime reside. Is that a fair statement? Mr. Miliband. Yes. I think the experience in Ghouta as well as in southwestern Daraa bears that out. Senator Menendez. Let me ask you what message does the Administration slashing of refugee admissions to 30,000 this year send to countries such as Jordan, Lebanon, Turkey, who are already hosting millions of Syrian refugees? I worry that when we lead by example, we can get other countries and urge other countries to perform their fair share. But when we fail to do so, we lose the ability to advocate for others to do so. And in the case of Syrian refugees, they are the most vetted of anyone who comes to the United States. They go through the most vigorous background checks of anyone who comes to the United States. And we take only among the most vulnerable women, children, those who are highly infirmed. And so, it seems to me that we need to be the leader in order to get other nations in the world to continue to join in the responsibility. What do you think is the effect of that? Mr. Miliband. I think the best way of answering that is to say the last time I was in Jordan I was told by a very senior member of the Jordanian government that there was a very clear message, which is that they felt like they were ``on their own.'' And that is the danger that I see in this. We know that in 2016, when the then Administration raised the number of refugees who were being allowed to come into the country, other countries around the world increased their refugee resettlement commitments by about 100 percent. And so, you saw for the first time an uptick in the number of refugee resettlement commitments around the world. The parallel, or the concomitant is that when the U.S., as the global leader in refugee resettlement, reduces its numbers, that also acts as a disincentive around the world. There's a final point I just want to make, I think you are absolutely right to stress the need for effective security vetting. I have been in this job for 5 years, and I am the first to say we want there to be effective security vetting of everyone coming into the country. You are right that it is tougher to arrive in the United States as a refugee than through any other route. The Administration was perfectly within its rights when it came in and said it wanted to review the vetting system. And it now has a vetting system that it says is up to scratch. And so, I think in those circumstances there is no reason why the most vulnerable should not be allowed in in numbers that are on a par with the kind of global scale of the problem that we face. Senator Menendez. Thank you very much. The Chairman. Senator Paul. Senator Paul. Thank you both for your work and trying to help this terrible humanitarian disaster. I think when we look at it, it is easy just to talk about what we should do to help the refugees, but we also should think about what caused this to begin with. Worldwide it's either a natural disaster, you know, lack of food, lack of water, or war. More often than not it is both. Both war and, you know, naturally difficult land to harvest crops from. But if we don't understand that war causes refugee crisis and war causes humanitarian crisis, we are not getting anywhere. And there really does need to be a discussion of how did we get here. To me, there is a certain degree of irony that we, and our allies, and Qatar, and Saudi Arabia, and UAE, we sent tons, thousands of tons of weapons into Syria. And then after the aftermath of all of these weapons coming together in this clash of civil war, now we are going to be asked for the humanitarian disaster as well. Maybe we should try to have, you know, less involvement in these civil wars, less escalation of these civil wars. ISIS. We had to go back in and fight ISIS. Where did ISIS come from? The chaos of this civil war, you know. Terrorism breeds in chaos. And so maybe really need to rethink when we get involved in these civil wars, and whether our involvement is good or bad. People say, ``Well, if we wouldn't have gotten involved, Assad would have won the war.'' Yeah, he probably would have won the war in the first six months. Would there have been oppression? Yes, there would have been oppression. But do you think that's worse somehow than the millions of people that are displaced, and the hundreds of thousands of people that have been killed in this. And these are things we should think through. My question to Mr. Stiller is, you said that you require-- in order to meet the humanitarian needs you required unhindered access. Do you think more sanctions on Syria will lead to less hindered access, or do you think more sanctions might actually lead to more hindered access to develop humanitarian aid? Mr. Stiller. I won't venture to speculate on sanctions in my role as a witness to the humanitarian plight that I have seen for UNHCR. Senator Paul. Right. Mr. Stiller. I think it is obviously an incredibly complicated political situation. And what I would speak to at the UNHCR and to what International Rescue Committee is doing is it is about figuring out the best way to have access within Syria to allow a path for these people to go home, to have a safe place for them to go back home. So, it is a very complicated issue. Senator Paul. Right. Mr. Stiller. I don't do it for a living. But I would say that it is--when you see the fact of it in person, and I agree with you, these root causes have to be addressed. I think that is the key. But when you see the face of it in person and what is going on there now, I think it is just very important that we do everything we can to help. Senator Paul. And I think the thing is, is that some see sanctions as war by another name. It is a softer form of war, but it is a war that goes on. It is not acknowledging that basically the war is over, and that somehow the tide is going to change, and Assad will be defeated by sanctions. Now I don't think he will be defeated by sanctions. I think the humanitarian crisis continues and actually probably grows from not sending aid in and putting sanctions on people who would send aid in. So, I think we really do need to rethink this. Sanctions is not going to change the outcome of the war in there, but I think it will change the ability for the country to recover. You know, I am no fan of Assad. I am not glad that he won the war, but the war is largely over. There still are pockets of resistance in different places, but the war is largely over. And if want to correct the humanitarian crisis, forbidding trade with Syria is probably not a good way. Embargoes lead to starvation, you know. There was an embargo on Japan before the war, embargoes on Germany. They didn't prevent the war. They actually may have brought the war on as well. So, I think we ought to rethink what we're doing as far as how we treat this. There is one thing to give money and to feed people, and that is admirable, but it is another to continue the war and think that somehow we are going to change the outcome. That is all I have. Thanks. The Chairman. Thank you, Senator. Senator Cardin? Senator Cardin. Well, let me thank first both of our witnesses. Mr. Stiller, you are a face that can get significant support in this country and around the world on these issues. So, I thank you for taking your time for this extremely important humanitarian need. And Mr. Miliband, your reputation and your leadership has been indispensable. Let me just respond very quickly to Senator Paul. For the people of Syria, whether you call it a war or not, there is not peace. And the circumstances on the ground are extremely dangerous for the population in Syria. And we can talk about all the different problems we have, including a final resolution for a government that represents all the people of Syria, which is desperately needed. We can also talk about the need for access for humanitarian assistance, which is what this hearing is about, and how we deal with refugees. But yesterday I attended a--or Monday I attended a meeting of the U.S. Holocaust Memorial Museum. The White Helmets were honored the night before, and we congratulate you. It is an incredible inspiration to all of us, the work that you do. But there is an exhibit there on Syria, the 8 years of atrocities, and I encourage as many of our colleagues to see that exhibit, if they can. Because what the museum about is ``Never Again.'' It is a memorial to the victims, but it is also our commitment of never again. And we are seeing it over and over again. So, Mr. Miliband, you mentioned the point--your final summary was pretty sobering. And I think you will find many of us that agree with you, the failure is in so many different areas. But let me just mention one of the issues you mentioned, impunity in Syria. If it is never again, those who committed these atrocities have to be held accountable. We included, working with Senator Rubio, legislation I authored dealing with the Syrian war crimes accountability. It was the law of our land. Now this Administration has defunded that effort in the budget. But if we don't hold accountable those who commit atrocities, we are going to see this movie again. We have to take steps to make sure that does not happen. And I know this hearing is focused on the humanitarian needs, but I would just urge us all to recognize that we have a responsibility to humanity, that those who are responsible for these atrocities are held accountable. I want to drill down a little bit on the point that Senator Menendez mentioned about U.S. leadership. Because U.S. leadership is so vitally important, and you had a chance to comment in regards to the Syrian refugee numbers here in the United States. But it goes beyond that. Take a look at the Administration's budgets on humanitarian aid, and cutting aid in so many of those areas. Look at our immigration policies generally. Look at the rise globally of nationalism, anti- migrants, so that when we look at the politics within the region of Syria it's becoming more and more challenging for the neighboring countries to accept and maintain their commitment to refugees because of the politics, global politics of refugees. So, Miliband, I just want to give you another opportunity to--this committee has historically taken a very strong position for the U.S. leadership on dealing with vulnerable populations. And we are concerned that the U.S. leadership is not where it needs to be today as we ask other countries to do things, and keep borders open with Syria, and maintain refugee camps, and allow humanitarian aid, which is a real burden to their own political stability in their own country. Where we need to be, the Western powers, to show by example. Yes, the refugee numbers are critically important, and our numbers, to be so far behind, a very, very modest number, when you look at the numbers of surrounding countries of Syria, and the numbers that they have, and the percentage of their population, we need to show leadership. So, I'll just give you an opportunity to respond to that as to how this is affecting your ability to carry out your mission. Mr. Miliband. Well, thank you very much. I think the Age of Impunity that I referred to is driven by two things. One is a crisis of diplomacy. And to speak to Senator Paul's very important point, the roots of these refugee crises are in civil wars. And the tools of diplomacy for wars between states are not well suited to the crises that exist within states. And so, the tools of diplomacy have to be reinvented for a civil war situation rather than an interstate conflict. Secondly, though, the crisis of accountability that you referred to speaks directly to the fact that essentially war crimes, and in many cases, literally war crimes, are not investigated. And that is the absolute foundation for this. We all know that the U.N. Security Council is being blocked from effective investigation of crimes inside Syria. It has been left to NGOs, some of them based in Germany, actually, who have done an outstanding job in highlighting particular individuals who have been the focus of this. The U.S. has shown leadership in respect to the Magnitsky Act in a different context, where it has targeted particular individuals. And I think that from my own experience, but also from what I see now around the world, U.S. leadership provides leverage. When you give more aid, you're then in a stronger position to say to the Gulf countries they have to step up. When you expand your refugee resettlement numbers you are in a better position to say to the European Union, ``You have to step up as well.'' And then perhaps to tread into more difficult territory. When the U.S. embraces the notion that civilian casualties need proper independent investigation, it also sends a very important message about what we really mean by accountable government and by liberal democratic principles. And it seems to me that is the message that goes out, that when you set an example, you get leverage. And I think that is what we see. And when that example is not set, I am afraid it incentivizes the worst of behavior rather than the best. Senator Cardin. Thank you. Thank you, Mr. Chairman. The Chairman. Thank you. Senator Gardner? Senator Gardner. Thank you, Mr. Chairman. Thank you to both of you for your time and testimony today. Mr. Miliband, thank you for the work that you do through IRC. We met with some individuals from the office in Denver. Thank you very much for the work, and certainly the work that takes place in Colorado as well. I was here, and I believe it may have been the 2015 hearing that you testified to this committee for. You talked at the time about the internally displaced, not just in Syria, but throughout the region. You talked at the time about the overall global refugee situation being greater than any point since, I believe at that time it was World War II. Could you talk perhaps today in this context, in 2019, what is different about the refugee situation either in Syria specifically or globally than it was in 2015, and how that difference has occurred. Mr. Miliband. Thank you very much, Senator. I hope I can say that the fact that you went to meet refugees who had been resettled in Colorado and Denver sends an incredibly important message. And I think it was a message of humanity that really resonated. So, on behalf of my team I really want to thank you. Directly, I think three things have changed. First of all, there are more refugees and internally displaced than there were in 2015. We are now up to 68.5 million in total, 28-and-a- half million refugees and asylum seekers who have crossed borders. Forty million internally displaced. Secondly, the political context in which many of them find themselves has become more complicated. In 2015, we were not talking about 800,000 people under the rule of Boko Haram in northeast Nigeria. We were not talking about so-called HTS, the Al Qaeda affiliate in the northwest of Syria. So, the localized politics and the danger of radicalization I think has become greater. Thirdly, the refugee situation has expanded geographically. Just to speak for our own agency, we have had to deploy to Bangladesh because 700,000 Rohingya Muslims were driven out of Myanmar. We have had to deploy into Colombia because of the very significant number of displaced people coming out of Venezuela. So that is the third aspect of this, the geographical spread has grown, too. Senator Gardner. Thank you. And to either one of you. Mr. Stiller, perhaps you talked about going to Jordan and visiting refugees in Jordan. I think we all share a very similar experience when you traveled through Amman, and the people you travel with point out which settlement or location occurred during which conflict, and you can say refugees from this era, and that era, and the challenge they face, and the education challenges they face. And then, of course, you talk to somebody in Jordan, and they talk about how this market here used to be a Jordanian market, but this group of refugees has now displaced the local business people, and have now taken over that. And now there are Jordanians, or whatever country it is, that are out of work. And so, the conflict that creates within the country can be immense, from an education standpoint, from a resource standpoint, from just people who feel that perhaps they were displaced from work that they were doing prior to that because of a refugee policy. Can you talk about what you saw in Jordan and what you see, and how we can better adjust our policies to impact education resource needs? Mr. Stiller. Yes. Thank you for the question. Yeah. I've seen that, too. The reality of this huge influx of refugees coming into these very small countries, neighboring Syria and Iraq, Jordan, such a small population. And the percentage per capita of refugees coming in is huge. And it just overwhelms their infrastructure and their ability to provide for them. And at the same time, refugees in these countries really do not have many rights, and the ability to work freely. And it is different in different countries. But I think one of the things that I saw were children being forced to work because their parents couldn't work. When I was in Jordan, I went to the Azraq camp, which is a huge camp where I think 30,000 or 40,000 refugees are, where they have no ability to work at all. So, they just have to form a community and be able to try to be productive as they wait for their lives to continue. And then the vast majority that are outside the camps are trying to make ends meet, and a lot of the times the parents can't work. So, I met a child named Khalil who was 13 years old, one of, I think 6 or 7 kids in a family. They had come from Aleppo, and they had been there for about 3 or 4 years. And his father could not work due to medical issues. So, this boy, Khalil, similar to the boy I was talking about, Yazan, had to work at an auto body shop for about 12 to 14 hours a day. He is 13 years old. And very war-weary face, I would say. Beautiful green eyes. I remember him very well. And I said to him, ``Boy, you work very hard for a young boy.'' He said, ``I am not a boy. I am a man.'' Senator Gardner. Hmm. Mr. Stiller. I think that is the reality. He is missing out on his education. It is a whole generation of young Syrians who are not having any access to education. And the host countries are overwhelmed. I had a chance to meet the king and the queen in Jordan when I was there, and they talked about the huge pull it has on their infrastructure. So, I think it is very important to be able to help these host countries so that they can provide for their own citizens, and provide for the influx of refugees. Senator Gardner. Very good. Thank you. Thank you, Mr. Chairman. The Chairman. Senator Shaheen? Senator Shaheen. Thank you, Mr. Chairman, and thank you both very much for being here today, and for what you are doing to try and address what is a horrific crisis that the world has not paid enough attention to. Mr. Miliband, last summer I had the opportunity to travel in northeast Syria. Senator Graham and I spent a day there, and we were in Manbij Village. What we saw was a largely stable area where refugees were coming back. ISIS had been defeated. Our troops there had made a huge difference in providing reassurance to the people of that part of Syria, that they were not going to see a resurgence of ISIS or other forces that would harm them. Sadly, later in the year we saw the President tweet, and the situation changed in northeast Syria. Can you talk about how important it is for U.S. presence in that part of Syria, especially given, as you point out, the deteriorating multilateral negotiation situation, where talks have not moved forward? And as we look at the presence of Iran and Russia, and what happens next, how important it is for the United States, and giving us the leverage that you talk about. Mr. Miliband. Thanks very much. I mean obviously we are a humanitarian organization, and we are careful about the boundaries between humanitarian policy and---- Senator Shaheen. Right. Mr. Miliband.--military policy. What I can report to you is that in our judgment there is no question that the U.S. presence is a force for stability in that part of Syria. I can report that to you as an evidential point rather than an opinion of military---- Senator Shaheen. Sure. Mr. Miliband.--strategy. It is a precarious situation because you have the government of Syria, you have the Turks from the north, you have the danger of a resurgence of ISIS, you have Russians, who encroach there and met their American match last year. And our plea is that every single political and military decision has the humanitarian component built in. And the danger, obviously, is that any change in that precarious and fragile military balance sets off a chain reaction that has devastating humanitarian consequences, most obviously a new flow of refugees or displaced people, or the danger of radicalization and a resurgence of some kind of organized ISIS/Daesh cell there. I think if you do build in that humanitarian component you would speak to the stability that is essential to try and preserve. Senator Shaheen. And how concerned are you about Turkey's incursion into that part of Syria when the United States' troops are completely gone, and potential for further disruption and humanitarian to further--to make a difficult situation even worse, if that happens? Mr. Miliband. I mean I think the first--the most important thing to say is that in thinking about any part of this complicated jigsaw, we recognize other parts. So, I promise I will come to the point of what happens if a Turkish area is established. But I think one has to preface that by saying Turkey has 3.7 million Syrian refugees in the country. The population is 80 million, so obviously a much richer country than Jordan or Lebanon. It has greater capacity to cope. It has done a genuinely heroic service. Senator Shaheen. It has, and I certainly agree with that. Mr. Miliband. So, I think it is important to put that on the record. Equally important to say that for a variety of reasons, when inside Turkey, the Turkish State and its organizations deal with all the refugees. And it's not international NGOs who are providing the support. And we know when Turkish authority is established in other parts of Syria, there isn't a place for the international NGOs. So, the most obvious and direct consequence of the development that you described would be that international NGOs would no longer be playing the role that they have been in the past. Certainly, we have health centers at Tell Abyad, and elsewhere in the northeast of the country. And they would no longer be there. And so that speaks to this very fragile political, military, but also humanitarian standoff that exists. Senator Shaheen. Thank you. Mr. Stiller, you talked in your opening statement about the role that UNHCR has been critical in playing to provide assistance both inside Syria and where refugees have fled. Can you talk about what you saw and what UNHCR sees as the most pressing needs of the refugees in the areas that you visited? Mr. Stiller. Yes. Thank you for that question. I mean when you go there the first thing that you experience is people living in extreme poverty. And these are not people who came there necessarily in extreme poverty. I mean I think it is really important to remember that nobody chooses to be a refugee, and a refugee is not some poor wandering person who decided to leave their country. Refugees are people who were forced to leave due to persecution. So, they are doctors, lawyers, farmers, cab drivers. They are regular people who literally had their--their house was bombed, and they had to leave. So that reality is then, you know, they are dealing with the fact that they can't work. They don't have the right to work. So, they are living in very, very tough conditions. And I think that is one of the biggest issues that UNHCR deals with, is trying to help these people make ends meet, and to be fed, and to be able to take care of their children, and then to provide access to education. So, all of these interconnected issues that David has been talking about also are, you know, the root causes are there, but the reality of the humanitarian issue is that these people are trying to survive until they can have a chance to go forward in their lives, and to provide for themselves. So UNHCR is working to provide education assistance, helping the host countries, as I was speaking about earlier, to provide education within the country, and just services to have access to food, and to cash assistance, to be able to pay for food, and to be able to pay for the rent for these places that they have to stay in, that are very, very, you know, tough, very tough conditions. Everywhere I have been I have seen people living in one- room or two-room dwellings, a lot of times with no access to plumbing. Women living alone. Just to be a woman who is a refugee, living on your own is incredibly difficult and dangerous, and let alone what the children have to deal with. Just to be able to go to the bathroom, if the bathroom's not in your own dwelling, is a dangerous thing. So, I think it is providing help for the people who are living there in terms of just access to basic needs, but then helping the host countries work with programs to allow refugees to be able to work within those countries. That is a lot of the work that UNHCR is doing, so that they can figure out systems, so that these people can work and provide for themselves while they are waiting to go home. Senator Shaheen. Thank you very much. I am out of town, but your point about the importance of the U.S. support for UNHCR is absolutely critical, right? Mr. Stiller. Yes. Senator Shaheen. Thank you, Mr. Chairman. The Chairman. Thank you, Senator Shaheen. Senator Romney? Senator Romney. I want to thank both of you for being here today, and making the trip to join us, and appreciate the work that you are doing to help alleviate human suffering. A question for each of you. Mr. Stiller, first of all, I am sure as you have gone to these various places in the world where refugees are located that you not that there are some places that are doing a better job than others. There are some countries that are doing a better job than others in helping refugees. There are some organizations that are doing a better job in providing relief. And I wondered whether UNHCR is actually, or has actually put together, if you will, almost a handbook or a guide as to these are the best thing you can do to help refugees in your country. Is there an effort, if you will--in the business world it is called best practices, where you lay out the best practices of one enterprise, to learn from it. Is that happening? And do you have a sense of the kinds of things you would want to see in listing these are the best things you can do to help refugees that come into your country? Mr. Stiller. Thank you for the question. I am not aware if there is a specific handbook of that type, or guide, but I refer you to my colleagues at UNHCR who I am sure could tell you about that. I mean I think in terms of my experience, one of the-- besides the things we have been talking about, I think one of the most important aspects of this is just how people relate to refugees in the world, and how they experience them. And I think right now my concern is that there is this politicization, there is this demonization from some places of what a refugee is, this cause for fear that refugees are dangerous. And the reality is, it is the opposite. Refugees are fleeing danger. And all of these people are not trying to come and invade our country or any other country. They are trying to come and just live until they can go home. And resettlement with refugees I think is also a big--there is a misunderstanding about that, of the millions and millions of refugees, I think it is 0.4 percent are actually resettled in a third country, 0.4 percent of all refugees. So, I think it was 56,000 worldwide last year. So, the reality is this small number are the most vulnerable. As Senator Menendez was saying and Senator Risch were pointing out, these people are the ones who are the neediest, who are going to a third country. I think we can help by supporting organizations like UNHCR that are helping the host countries. And I think it is 85 percent of the refugees are going to these neighboring countries, and these countries are overwhelmed. So, I think that is a huge part of it. And I would say just attitudes towards refugees, humanizing them, seeing them as people, and not something to be feared. Senator Romney. Thank you. Mr. Miliband, I think we were all drawn by the comments of Senator Paul, who I think correctly pointed out that civil war is one of the great causes of humanitarian crisis throughout the world, and refugees being displaced from their homes. And he raised the prospect that perhaps we should just let these things run their course, and not be involved when an authoritarian ruler decides to abuse their people. Of course, the challenge with that idea is that it would send a very clear message to some of the world's worst actors that the United States of America and other nations that value human rights are not going to come to your aid. And it would only open the door and create a green light for some of the world's worst actors to pursue policies to oppress their people. That being said, I do wonder whether there are things that the West or other nations could have done throughout the process in Syria that would have alleviated human suffering to some degree. And I recognize that with conflict and war there was going to be some human suffering, but the extent of it in Syria is just overwhelming, and the humanitarian crisis that has occurred is unthinkable. And for those that have not been in the region, it is hard to communicate through words. As you stand back and look at what happened in Syria, or perhaps in other conflicts, are there lessons learned about what we could have done, if not to prevent civil war, are there things we could have done to have made the human suffering less intense and less extensive? Mr. Miliband. Thanks very much, Senator. Can I first of all answer your first question? Senator Romney. Yes. Yes. Mr. Miliband. Because I think your value for money point, your effectiveness point is incredibly important. Because the truth is the humanitarian enterprise has to change. Historically, it was keep people alive until they go home. That might be months or a few years. And that was relatively straightforward. They were in refugee camps. You gave them health services. You fed them, and then they went home. But last year less than two percent of the world's refugees went home. They are displaced for, on average, if they are in a camp, 17 years. And so, we can't just say we have to help them survive. They have to have the means to thrive. And I would really commend you, we do have a guide for what to do. It is called the International Rescue Committee Outcomes and Evidence Framework. It is online. I would urge you to type into Google, IRC Outcomes and Evidence Framework, and you can see what our field managers see. It is split down across five outcomes, which we think is really important to be led by what are you trying to achieve. It then documents what is the evidence that we know from different humanitarian settings around the world about what works. And just in parentheses, it is tragically difficult to raise money to fund evidence making. We know in development context, stable settings, that there has been a revolution in the last 20 years, largely pioneered by the Gates Foundation, to really focus on what works. There have been only about 120 evidence studies ever in the humanitarian sector. We have done about 40 of them, and we have got another 18 on the go. But you can see, if you type in IRC Outcomes and Evidence Framework what we know, what our field managers know, and a couple of things come through very clearly. One, if you give refugees cash you help them and you help the local population, and you diffuse tension that some people have referred to. And we can show you how much of a difference it makes. Secondly, our services are always open to host populations as well as refugees. So, you don't get Lebanese or Jordanians saying, ``Well, hang on. Why is there an employment program for them, but not for me?'' The same thing with health services. Thirdly, half of the world's displaced people are kids. And I don't think it is wrong to talk geo-strategically as well as morally about the utter shortsightedness of failing to educate generations of people who are in the midst of war, even if they are then living in stable settings. So, Lebanon and Jordan, we don't have the ``excuse'' that it is a war zone, so they can't get educated. The international community simply has not stepped up, and you will be shocked, I hope, that less than 2 percent of the global humanitarian budget goes on education, when half of the world's displaced people are children. So, we have huge work to do to make sure that the outcomes and the evidence are really the guide to practice. Sorry to go on about that. Have I got time to answer his next---- The Chairman. Very briefly. Mr. Miliband. It is a small subject, which is how do you stop war, so it won't take me very long. [Laughter.] The Chairman. In a sentence. Mr. Miliband. In a sentence, I put one thing on the table. What has been missing throughout the Syria crisis, and is the lesson of Afghanistan, is the lesson of Iraq, is that if you are not clear about the political settlement that will share power in a credible and legitimate way, then no development policy, no humanitarian policy, no military strategy can ever have a clear destination. And the sentence that has not been filled in, frankly, in the Syrian context is there will be a transition from President Assad, but we have never completed that sentence, what is that a transition to? We know what it is a transition from, which is autocratic rule. It has never been clear what there is a transition to. And that has been the missing link tragically for the last 8 years. The Chairman. Thank you. Senator Murphy? Senator Murphy. Thank you very much, Mr. Chairman. Thank you both for being here today. This has been very good. Mr. Miliband, yesterday the State Department issued a statement expressing alarm over the escalation of violence in Idlib, in northern Hama, and they said it specifically, or there have been reports citing more Russian and Regime attacks on civilian infrastructure and humanitarian targets. And I guess my question to you surrounds what the tools are at our disposal to do something about this other than just raise alarm. The two words that populate talk about the U.S. role in the region today seem, to me, to be confusion and irrelevance. Confusion is obvious, given the back and forth nature of this Administration's policy on what kind of presence we will have there. But irrelevance is also an apt description, given the fact that, as Senator Menendez mentioned, we have essentially been pushed out of the diplomatic process. Russia, Iran, and Turkey met again in Kazakhstan on April 25th, and once again, the United States was not there. There is vague talk about conversations we continue to have with Turkey about how to settle their claims to the region in a way that does not spur more violence. But my question to you is how did the United States get pushed out of this diplomatic process? And is it too late for us to get ourselves back in? Because it does not seem like we have many tools at our disposal other than complaint, if the Russians, the Iranians, and the Turks have committed to convene a process that will never, ever include the United States again, despite the equities that we have. Why have thousands of troops in Syria if somebody else is plotting the future of the country without us? Mr. Miliband. Well, thanks for a very difficult question. I think that I would say, first of all, in some parts of the country you have more equities than others, notably in the northeast, and you don't what to give away those equities cheaply. Secondly, the Russians and their friends know that they can't rebuild Syria alone. They are going to need the rest of the world to rebuild Syria, and that gives you leverage. Thirdly, this country is blessed to have wide-ranging relationships with every other country in the world. And the question is where Syria fits on your docket for the issues that you want to raise with the Russians. And if it is not in the top three or the top five, then it will get consequently less of a role. And you know as well, better than I do, the story of what happened after 2015. The Russians entered the Syrian conflict in September 2015. But until the U.S. shows it matters to them, then obviously you are not going to be playing the kind of central role that could be a force for stability in Syria and the wider region. Senator Murphy. I do not disagree that the United States will have to play a major role in reconstruction. That is hard to see as this Administration continues to draw down the funds available for it. But why on earth we have decided to sit out the conversations about an ultimate political settlement, when everyone acknowledges we will have to play some, at the very least, monetary role is beyond me. Mr. Miliband, I wanted to also take advantage of the fact that you are before this committee as we are about to vote on an effort to override a presidential veto regarding an effort, a bipartisan effort here in Congress, to pull the United States out of the disastrous civil war in Yemen. I just came back from the region where I received maybe the most disturbing briefing I have received on Yemen, in which our humanitarian agencies there told me that there are 250,000 Yemenese today that are starving, and are likely beyond saving, are beyond help. And there is another 10 million who are risk of falling into that category. The state of the economy is in shambles. The Saudis have made all sort of deliberate decisions not to do things that are perfectly within their control to prop it up. And what was maybe most interesting to me was when you lay down a map of where these quarter million are, that are literally weeks and months away from death by famine, they are distributed between the Houthi territory and the territory controlled by the coalition, a coalition of which the United States is part. And so, this is not just about the Houthi stopping aid from getting in. This also about a decision by the coalition to allow for a campaign of starvation to exist in places that it controls. Do you share this bleak assessment of the situation on the ground in Yemen? Mr. Miliband. Yes, I do. We have about 800 International Rescue Committee staff on the ground in Yemen. I was in Yemen myself in September. The malnutrition that you speak to is profound. And there are two critical variables that need to be affected. One is that the war strategy of the coalition has failed. Eighteen thousand bombing raids have not, far from ending the war, they have fueled the war, and they have radicalized the population, and left Iran stronger, not weaker. And so, it seems to me the leadership role that you have been playing has been outstanding, and has been bipartisan, has been very, very welcome. Secondly, you are absolutely right. The Houthis have also got responsibilities. And we take our humanitarian opportunity to talk to all sides, and to press them both directly and indirectly about their responsibilities in respect to the Stockholm process, which the U.N. convened in January, and which has not been followed through. And I think it is that twin track that is absolutely essential. Senator Murphy. Thank you. Thank you, Mr. Chairman. The Chairman. Thank you. Senator Kaine? Senator Kaine. Thank you, Mr. Chair. And what a great hearing. So, I have a thank you. I have an observation for my committee leadership, and a question for you. So, the thank you is to both your organizations, the IRC and the UNHCR. You guys do amazing work. And I've seen it there as well as in your testimony here, and we really appreciate it, to the White Helmets. And I want to thank an American group, the Syrian American Medical Society, what SAMS has done to provide medical care. Our Syrian-American physicians have been heroic, and I want to acknowledge them. A comment for leadership is a frustration. We have a great bill, Senator Risch, your bill, the Caesar Syria Act, that I am a strong supporter of. That bill would have passed through the Senate unanimously. It passed through the House unanimously. So, we have the Caesar Syria Civilian Protection Act, and it was bundled together with another completely bipartisan bill, the U.S. Jordan Defense Cooperation Act, and another completely bipartisan bill that I was a cosponsor of, the U.S. Israel Security Assistance Act. And it was bundled together in Senate Bill 1. You mentioned that Senate Bill 1 is high centered in the House. Let me explain why. These were three great bills that were completely bipartisan that would have passed nearly unanimously. The decision was made on the floor of the Senate to add a fourth bill, the Combatting BDS bill, that was highly controversial. And it was added because of a thought that it may split democrats and republicans for a political purpose. It was more important to make a political statement and divide people about BDS than to pass these bills that were nearly unanimously supported here. We could have had a separate floor debate about the BDS bill, but instead it was put in the middle of bills that were completely bipartisan. This bill would have been--the Syrian bill that you sponsored that I strongly support would have been on the President's desk and would have been signed, but because the BDS provision was included, and the BDS provision gives state and local governments the ability to punish contractors who are peacefully supporting the BDS movement, it has been held unconstitutional in three different states most recently in the last two weeks in a case in the fifth circuit. So, I think it was John F. Kennedy who said the perfect is the enemy of the good. Well, the partisan can be the enemy of the good, too. So often when we have things that we all agree on, instead of doing that, we throw like in a Jenga game, or something, the one last piece on it that screws the whole thing up. And I hope that we will have a chance to pass the Syria Caesar Act, and I hope we will have a chance to pass the Israel and Jordan Cooperation Acts. When we can agree on some things that are really good, why muddy them up with things that are just--that the stunt becomes more important than the substance, and I find that frustrating. And I do not demean anybody's position on the BDS bill, but we could have had that as a separate debate, and discussion, and vote, and it would not be complicating our support for Syrians. Let me ask you a question about this. You really cued up my question, and it is just one issue. Seventeen years was the phrase you mentioned. We can think about refugee status as if it is something temporary. We should not think of it that way. In Deuteronomy, ``My father was a wandering Aramean, who went into Egypt and sojourned there, and grew into a nation great and powerful.'' I mean refugees from the beginning of time have been with us. It is not an episodic emergency. But we often think about it as an emergency thing. So, it is going to be tents, and porta-potties, and water bottles, when maybe we should be thinking about permanent structures, and water treatment systems, and building schools. I have been with Syrian refugees in camps in Adana. I have been with them in urban drop-in centers in Ghazi and Turkey. I have been with them in sort of urban settings in Beirut. If the normal lot of a refugee now is more like a 17-year lot than a 2-month lot, what should we be doing as we are providing financial support, as we are working with our NGOs, to take account of that reality of refugees? Because it is a different model in terms of what to fund and what to support if you acknowledge that 17-year reality? Mr. Miliband. Thanks very much. I think it is a great point, and just to add to the statistics, once you have been a refugee for 5 years, the average goes up to 21 years. Senator Kaine. Mm. Yeah. Mr. Miliband. So, the Syrian war has been going on for 8 years. Most of the refugees have been refugees for at least 5 years. So, it is long term. What is the answer? One, we need the humanitarian development systems to work together rather than separately. We can cut the bureaucracy, but we can actually also improve the outcomes. And we need to drive the short-term interventions in such a way that they are actually linked to the longer-term interventions. Secondly, we have got to take education seriously, because we are neglecting the next generation. It is an absolute no brainer. Senator Kaine. That 50 percent, 2 percent---- Mr. Miliband. Yeah. Senator Kaine.----is really vivid. Mr. Miliband. I am glad that registered. Thirdly, we have to mobilize the international financial institutions in an even more activist way than we have so far. The World Bank, the IMF, but also the regional banks as well. Because the truth is, we are not going to get the government of Jordan to extend rights to work to refugees while they have 26 percent unemployment of their own population, and they have a debt-to-GDP ratio of 94 percent of GDP, up from 55 percent. So, we need to think strategically about the way in which the international system accords benefit to those countries that are delivering on this global public good. And it has to be a shift of mindset, from short-term Band-Aids to long-term strategic intervention. And if you can get the education right, get the employment right, get the macroeconomic support right, you can create conditions that this does not become a toxic fight of the host community against the refugees, but actually become something that, like in Uganda, has actually been managed well, has got people off aid, and actually created a benefit for both sides. Senator Kaine. Thank you. We could talk about that for a long time. I appreciate it. Mr. Chairman. Good. Senator Kaine. Mr. Chair. The Chairman. Thank you, Senator Kaine. Senator Markey? Senator Markey. Thank you, Mr. Chairman. I want to thank our witnesses for your commitment to this important issue. And I want to thank the representatives of the Syrian White Helmets for being here today. Your dedication and your personal sacrifices deserve our respect, and our admiration, and our thanks. National security experts from both Democrat and Republican administrations have recognized the strategic benefits to the United States of robust refugee resettlement. Unfortunately, as other senators have mentioned, the Trump administration is dismantling the U.S. refugee admissions program. Last year, President Trump cut our refugee admissions ceiling to a record low of 30,000 people. Less than a third of the historical average of 95,000 admissions to the United States. And now almost halfway through the year, only 12,000 refugees have been welcomed into the United States, including fewer than 300 Syrians. Mr. Miliband, I could not agree more with your statement that the world's greatest superpower should not reject the world's most vulnerable in our greatest time of need. Three weeks ago, I introduced the GRACE Act, which would prevent this administration from continuing its efforts to slash refugee admissions. This bill would prevent any U.S. president from settling the annual refugee admissions level below 95,000 each year. We already have 12 senators who have co-sponsored it, and we are going to continue to build momentum on that. Mr. Stiller, Mr. Miliband has spoken eloquently on the need for American leadership. Can you give us your statement as to why you believe it is the role of the United States to play this role? Mr. Stiller. Yes. Probably less eloquently, but I will try. I mean I was speaking about this a little bit earlier, but I feel the U.S. has always been a beacon for welcoming refugees. We are a country of refugees. As you were pointing out, as the U.S. goes, so goes the world. So, this is a global issue, too. But the reality is that refugees are additive to our communities, to our economy. They literally contribute billions of dollars in tax money and revenue to the economy. There is a statistic, 40 percent of all Fortune 500 companies were either started by a refugee, or immigrant, or their children. I mean it is just part of the fabric of American life. And it is distressing to me to see the numbers go down as they have, because we have to lead the world in this. And the reality is that it is only--these people are only the most vulnerable, who are being admitted. And it is 0.4 percent of all refugees in the world. So, I think it is very important for the U.S. to lead on this. And we have the ability to, and it has been proven to actually help our country. Senator Markey. Thank you. Mr. Miliband, you have been the leader on this and on climate change. When I was made the chair in 2007 of the select committee on climate change over in the House, my first witness in my first hearing was General Gordon Sullivan, four-star general, commander of the Army. And he testified that when he looked back at the decision which he had made in Somalia, which was in Mogadishu, which became to be known as Black Hawk Down, and he sent in our personnel, that he did not fully understand why we were there. And now testifying before my committee, on behalf of 12 other four-star generals and admirals, he wanted to say that he now realizes in retrospect that it was a drought caused by climate change that had brought factions closer and closer together, fighting over limited resources, and that then the United States had to go in in order to try to separate them and to provide aid to those who had been affected. Could you talk about that? Talk about Syria, too, and the effects of climate change, and how you see that playing out, not just in Syria, but in other parts of the world, and what the responsibility of the United States has to lead on climate change as well. Mr. Miliband. Thanks very much. I think that the best way to understand this is that climate change increases resource stress, and resource stress is a conflict multiplier. There is a legitimate and credible line of argument that the drought in the northwest of Syria in 2008 to 2011, which drove hundreds of thousands of people into the cities, was a contributor to the revolt. Although, I always remind people that in 2005 the Damascus Declaration sowed the seeds of the demand for accountable government before that drought. So, it is multi-factorial. But we know from our work around the world, the Lake Chad Basin being an obvious example, where you have got northeast Nigeria, Chad, Cameroon, Niger, climate change is happening. It is causing resource stress. Resource stress does drive conflict. And when it is combined with corruption, mis- governance, poverty, religious ethnic difference, you have a tinderbox. And the truth is that we are going to be living with this for many decades to come, and the danger is that we neither mitigate not adapt ourselves to that situation. Senator Markey. Thank you. Thank you both so much for your leadership on this. The Chairman. Thank you, Senator Markey. Well, thank you all for being here today. Senator Menendez and I want to close up just briefly with a couple of remarks. Mr. Stiller, you undoubtedly were impressed with the king of Jordan and his wife. They come and see us, gosh, I bet, it seems like quarterly, but it is probably just once every six months, but it is really unfortunate we do not have leaders like that all over the Middle East. We would not have the kind of issues that we have. They do remarkable things, and particularly being hosts, albeit involuntarily, to the refugees, thousands and thousands of refugees in their country. Mr. Miliband, I was a little disappointed, I guess, in whoever it was that made the remark to you about--from Jordan, saying, ``Well, we kind of feel like we are on our own if the United States doesn't do X and Y.'' One of the great untold stories that most Americans have no idea is we are doing a tremendous amount there compared to the rest of the world. I mean we are the ones that are funding--are providing the funds so that Jordan can take care of those people in those refugee camps. And it is a tremendous humanitarian crisis there. And it is our money that is sustaining it. So, the Jordanians are not alone. And I can tell you the king and the queen do not feel that they are alone in this. Every time they come to see us; they are very strong in their thanks to the people of the United States of America for helping in those refugee camps. So, I don't know what the context of that conversation you had with that Jordanian person, but I can tell you that the king and queen, every time they come to see us, are not dragging their feet about how important the U.S. help is, has been, and will be. So, with that, Senator Menendez. Senator Menendez. Thank you, Mr. Chairman. And I agree with you, the king and queen are very appreciative of U.S. assistance, driven to a large degree by the Congress, and also--but while they are so appreciative of our assistance, they have a bigger, huger dynamic. And so, it is the rest of the world community that needs to be engaged equally as well. The Chairman. I agree. Senator Menendez. Mr. Stiller, in your professional life you bring us humor, you give us insights into our lives, you talk about, through your medium, our humanity. And in this regard, I was thinking about some of the stories that you told briefly in your visit most recently. Can you share any insights, in Lebanon, for example, it is my sense that Hizballah and the Lebanese government are pressuring refugees to return back to Syria, 1.5 million. Did you glean from your visits there a sense of--you describe life as it is. Did you glean from your conversations how Syrian refugees see their future? Did you glean from your interactions a sense of what it would take for them to return? I am pretty much of a view of why they do not return right now, but there are some who question why they do not return. Can you share any insights in that regard? Mr. Stiller. Yes. Thank you for that. I feel that, almost to a person, everyone I talked to there desperately wanted to return, or wanted to return in a very real way. Whether or not the reality of that was possible is a different question. I met a woman in Tripoli who is living alone, I was talking about her earlier, who her husband had gone back, decided to go back, I think, a year or a year-and-a-half ago, and he disappeared. And she has not heard from him since, and she does not know what happened to him. And I think, you know, that is indicative of the reality for these people is that they just do not know what they are going back to, and they have to make this very difficult decision on their own. And it is a very fluid situation. So, I think there is a--they know that they have to make a life where they are, but they also have a strong desire to go back. You know, I find in the camps it is a little bit more-- there is less hope sometimes, because they are just in this sort of limbo, and they have no opportunity to work at all. I think people living outside of the camps are trying to find work where they can, but, again, they do not have the right to work most of the time. The children, I think, is the biggest issue, because those two young twins I talked about in the beginning, they have lived outside of Syria their whole lives. They actually do not even remember Syria, because they left when they were six months old. So I was at a settlement where a group does puppet shows for the kids that tell them about Syria, and tell them about the places in Syria through characters talking about it in a way that actually it is towns that we hear about, Aleppo, and Homs, that we hear about in a very negative way here in America. In this puppet show they are talking about these places as these wonderful places where these kids will someday go back to. The purpose of it is to educate these kids about their home country, so that when they someday go back they will have a connection with it. And I think that is the concern. I do not know what the reality is for a lot of these people, but I know that they have a strong desire to go back. But the reality right now is that until it can be a safer place for them to go back, it is hard to recommend--for anybody to recommend they go back. They have to make that decision on their own, which is really difficult. Senator Menendez. Thanks. The Chairman. Thank you so much. Senator Menendez. If I may, Mr. Chairman. The Chairman. Go ahead. Senator Menendez. Mr. Miliband, one last question. We have had violations of international law and humanitarian response in Syria as we have never seen maybe at any other time, certainly in modern history. Are you familiar with the Caesar Syria Civilian Protection Act? Would that strengthen our hand in holding accountable perpetrators of violence and violations of international law? Mr. Miliband. Thank you, Senator. And I know many of you, including the chairman, have shown great leadership in leading on this Caesar act. From our point of view, the fact that you have included a humanitarian carveout to make sure that humanitarian effort is not undermined by this is a really smart and good development. We see this as a useful intervention that could really make a difference, if it is part of a wider strategy, because I think one of you said on its own it is not a silver bullet, but as part of a wider package of development, diplomatic, political engagement, it has got a real role to play. If I may, just having the floor, I want to associate myself very strongly with what you, Mr. Chairman, said about the role that the king and queen of Jordan have played. The queen sits on our Board of Overseers, having been on our Board of Directors. The context I was asked was one in which the number of refugees being resettled from Jordan has dropped from 19,000, 3 years ago, to 3,900, then to just 52 coming to the United States. And it was in that particular context that so many Jordanians feel that they are ``on their own.'' And the king himself, I thought in a very telling and honest way, said in a recent interview publicly, I am sure he said the same to you privately, he said publicly, ``For the first time, we can't do it anymore. The dam is going to burst.'' And that really cuts to the core of both the moral issue that so many of you have raised, but also the geopolitical issue, because Jordan is such an important ally of the U.S., and there is both a moral reason to help the refugees, but also a geopolitical reason to help ensure the people who are trying--leaders who are trying to do the right thing have the international support to be able to do so. The Chairman. Thank you. Appreciate it. Thank you to both of you. Votes have gone off, and we are going to have to go out and cast our vote. But this will conclude our hearing today. And I want to thank both of you sincerely for taking the time out of your busy schedules to come here and be with us. We are going to keep the record open until the close of business on Friday. Questions can be submitted. We would ask the witnesses to respond to those as promptly as you can, if you will. And with that, also, I would like to note that we have had a request for written testimony to be entered into the record from David Lillie, the Executive Director of the Syrian- American Medical Society Foundation. That will be included in the record. [The information referred to can be found at the end of this document:] The Chairman. Again, thank you all for attending today. This hearing is adjourned. [Whereupon, at 11:54 a.m., the hearing was adjourned.] ---------- Additional Material Submitted for the Record Statement Submitted by Raed Al Saleh, Head of the Syrian Civil Defense Dear Chairman Risch, Ranking Member Menendez, and distinguished Members of the Committee: Thank you for holding this important hearing on the humanitarian impact of the conflict in Syria. So often, the conversations about the humanitarian crisis revolve around numbers--more than half a million dead, 12 million displaced, and 50 percent of the country's critical infrastructure destroyed. But for the Syrian people, especially for emergency responders like ourselves, the humanitarian crisis is represented by more than numbers: it is etched on the face of every civilian who lives in constant fear of bombardment, starvation, torture, and execution. Millions continue to endure the most appalling crimes. In the face of those crimes, Syrians still find the courage to live with meaning in a world that, through its inaction, has behaved as if their lives held none. On their behalf, I urge this Committee and the American people to stand with the Syrian people. I ask that the world provide meaningful protection for Syrian civilians. I recently arrived in Washington, DC. to accept the United States Holocaust Memorial Museum's Elie Wiesel Award on behalf of my fellow volunteers at the Syria Civil Defence, better known as the White Helmets. We do our best every day to live up to our motto: ``To save one life is to save all of humanity.'' To date, our brave volunteers have saved more than 116,000 people. Yet, despite international rhetoric that the ``war is over'' and ``Assad has won'', the conflict in my country shows no sign of abating. In the past 2 months, a ``demilitarized'' zone in Idlib--supposedly protected by Turkey and Russia through an agreement struck last year--has become the latest target for Syrian and Russian airstrikes. These strikes have killed more than 190 people and displaced 200,000 more since February. The consequences of a regime assault on Idlib province are dire. Assad and his allies' horrific campaigns throughout the country displaced hundreds of thousands of civilians to Idlib, which is one of the last remaining areas that lie beyond the regime's grasp. Idlib now swells with more than 3 million civilians. Civilians are left with nowhere to flee. Fearsome memories of what our brothers and sisters endured in Aleppo and Ghouta hang heavy in the air as Idlib's residents await their fate. The White Helmets have not escaped targeting by the Assad regime and its allies--in fact, we are deliberately targeted because of our pledge to save any human life, regardless of age, creed, or political affiliation. We work under constant threat of retribution by the regime and the extremists it has empowered. Last month, two of our volunteers were killed as they rushed to help the injured. Just yesterday in Hama, one of our depots was bombed, leading to the loss of more than $500,000 in vehicles, ambulances, and equipment to conduct our life-saving work. These strikes maximize civilian suffering and portend even worse attacks to come. As the bombs continue to fall, I worry constantly about the volunteers and the people they are risking their lives to protect. If the situation escalates any further, it will become very difficult for us to carry out our mission effectively to protect civilians. The dangers of inaction facing a regime onslaught are compounded by recent decisions by the United States and its European partners to cut funding to civil society groups in the northwest, citing the presence of extremist groups. The decision has worked cross-purposes, leaving the very civilian population that rejects extremist groups and Assad alike instead squeezed between them, in desperate need of assistance. Further, hundreds of thousands of civilians live in displacement camps, where they are vulnerable to both airstrikes and extreme weather. Earlier this month when floods swept through the camps, destroying shelter and belongings, White Helmets volunteers came to help people and divert the floodwaters. Without international support, this work is unsustainable. In 2012, the late Mr. Elie Wiesel urged the international community to stop the massacre of Syrian civilians and to hold perpetrators of war crimes to account. In 2012, the death toll in Syria was 25,000. Today, the world has stopped counting our dead. The need for accountability and an end to the massacres is more important than ever. As Mr. Wiesel said: ``We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.'' I ask people around the world to take the side of the Syrian people. We have been failed by politicians, but we still have hope that ordinary people will hear our pleas. Chairman Risch, Ranking Member Menendez, and other Members of the Senate Foreign Relations Committee--thank you for holding this hearing. I hope that you will continue to press for protection of civilians and accountability for all crimes in Syria. It is critical that the voices of the men, women, and children of Syria be heard rather than ignored. ---------- Statement Submitted by David Lillie, Executive Director of the Syrian- American Medical Society Foundation Chairman Risch, Ranking Member Menendez, distinguished members of the Committee, thank you for holding this hearing and providing the opportunity to highlight the significant humanitarian impact of the war in Syria. Throughout the past eight years, members of this committee have conducted many hearings, briefings, and meetings on the situation in Syria. Each time, the numbers have been shocking and the challenges great, but this committee and the United States Government have continued to provide critical humanitarian support to the Syrian people and to affected countries in the region. Despite this, and despite the overall decrease in the level of violence in Syria, the humanitarian situation continues to worsen, not improve. According to UN OCHA, more than 13 million Syrians are currently in need of humanitarian assistance, 2 million Syrian children are out of school, and nearly 83 percent of the population inside Syria is living below the poverty line. This is not to mention the significant needs faced by Syrian refugees in neighboring countries, primarily in Turkey, Lebanon, Jordan, and Iraq. These host governments, as well, continue to shoulder heavy financial and social burdens which have strained multiple sectors, and in many cases increased social tensions. Beyond these overall figures, there are even more acute needs and challenges. In particular, the lack of access to healthcare, lack of educational opportunities, and increasing vulnerabilities among women, children, and people with disabilities in Syria and neighboring countries. My organization, the Syrian American Medical Society Foundation, has been on the frontlines of providing healthcare in Syria since the conflict began, in addition to providing health services to refugees in neighboring countries. Since 2011, we have spent more than 190 million dollars providing assistance, and provided more than 8 million medical and mental health consultations. Today, we employ nearly 2,000 medical staff in Northwest Syria, in addition to implementing medical projects in Turkey, Jordan, Lebanon, Egypt, and Iraq. This work has given us firsthand experience with the challenges mentioned above, and from these experiences we have also developed ideas and plans to address them. ACCESS TO HEALTHCARE The conflict has restricted access to health care across the board. The systematic targeting of health facilities and health workers has decreased the capacity of the health system, while the lack of trained staff has also contributed to this decreased capacity. Poor economic conditions have made the costs of services in private facilities unsustainable for most families, while the dire conditions in IDP camps have further increased the strain on the already overwhelmed health system. As a result, today we are witnessing increasing rates of malnutrition and anemia, low levels of vaccination which have led to the re-emergence of deadly diseases such as polio, a decreased life expectancy, and decline in quality of care. In addition, the situation has particularly worsened for expectant mothers and their newborn children, with an increased infant mortality rate and a higher rate of complications. Further, the lack of access to care for specialized treatment and chronic illnesses remains a significant challenge. For example, in Northwest Syria, which has a population of more than 3 million, there is no treatment facility available for cancer patients. The only option for these patients is to apply for treatment in Turkey, which currently provides treatment for 30 patients per month. To put this in perspective, only 30 patients among a population of 3 million needing cancer treatment is the equivalent of saying that there are only 15 cancer patients in the entire state of Idaho. Sadly, we know this is not the case. What this results in are innocent patients, including women and children, enduring tremendous suffering and ultimately death due to lack of access to cancer treatment. The situation is similar for other chronic illnesses, as well. In the regional countries, access to healthcare is often a challenge of capacity and resources. This is particularly the case in Lebanon and Jordan, where the existing health systems are unable to cope with the large number of refugees, and are often only able to provide basic primary care services, if anything at all. This leads to similar gaps in secondary and chronic care, with refugees often unable to access this care. LACK OF EDUCATIONAL OPPORTUNITIES With over two million Syrian children out of school, education poses both short-term and long-term challenges. I would like to highlight the particular gap in access to secondary education and specialized programs. As a medical organization, we have witnessed firsthand the significant shortage of health workers in Syria and in the neighboring countries. Since the conflict in Syria began, more than 70 percent of health workers have fled the country or been killed. This has resulted in a significant gap in the health sector. Yet without training for new health workers, including doctors, nurses, and midwives, these gaps will only continue to grow. The lack of access to specialized education is a major inhibitor to future peace and stability in the region, as the population will lack the necessary skills to support itself. This current problem can be traced to two key impediments: lack of funding, and lack of cooperation from host countries. Donors have simply not done enough to prioritize educational opportunities for specialized programs and vocational training, particularly in the form of multi-year funding. As most of these programs are multi-year, it is essential that funding be allocated for the entire duration of study. At the same time, host countries such as Lebanon and Jordan could do significantly more to increase access to educational opportunities for Syrians, including granting permissions for study and providing scholarships at public universities. VULNERABILITIES OF FEMALE POPULATION The Syrian conflict is first and foremost a protection crisis. In addition to hundreds of thousands of casualties, the conflict has also resulted in maimings, kidnappings, sexual and gender-based violence, arbitrary arrests and detention, and other protection concerns. Beyond the protection risks directly associated with conflict, such as death or serious injury, women are also at a higher risk of experiencing sexual and gender-based violence. Sexual and gender-based violence can happen to anyone, and while a greater degree of attention and response is needed to the SGBV experienced by men in Syria (especially in detention), women remain the most affected segment of the population. Notable forms of sexual and gender based violence in the conflict have included rape, forced and underage marriage, and domestic violence. In addition to SGBV, women also face limited economic opportunities, whose negative impacts disproportionately affect female-headed households. Women and girls are also often denied educational opportunities, and their freedom of movement is limited more than their male counterparts. More support is needed for all survivors of SGBV, and especially women. ATTACKS ON HEALTH Lastly, it is important to also raise the subject of attacks on health, an issue of particular importance to my organization. According to Physicians for Human Rights, as of the end of 2018, nearly 900 medical professionals have been killed in Syria, making the country the most dangerous place on earth for health providers. In addition, the Syrian Network for Human Rights reports that there are currently 3,000 humanitarian workers currently detained by the Syrian government. Hospitals have been regularly targeted by airstrikes, artillery shelling, and even chemical weapons. Between 2014 and 2018, one third of all the facilities attacked were supported by SAMS. From January 2017 to December 2018, SAMS documented 243 attacks on health. That's 243 instances where the lives of medical staff and their patients were targeted, a clear violation of international humanitarian law and the basic rules of war. Just this past weekend, two hospitals in the Northwest of Syria were targeted by shelling and forced to close. We cannot continue to let these heinous attacks go unanswered. The UN Security Council spoke with one voice when it unanimously passed Resolution 2286 in May 2016, condemning attacks on health and calling for accountability for perpetrators. Sadly, however, after three years this resolution has not only failed to stop attacks on health, but actually witnessed an increase in the number and rate of attacks. The status quo is not acceptable. In addition, the Syrian government and its allies currently maintain a policy that all humanitarian workers who perform work in non-government controlled areas are formally classified as terrorists. Such a classification is not only in direct violation of international humanitarian law, but also puts the very lives of these individuals and their families at risk. We have seen the consequences of this policy in ``reconciled'' areas such as Daraa and East Ghouta, where humanitarian workers have been systematically tracked down, arrested, detained, and even killed for their work. All because they provided life-saving care to innocent civilians in need, all in full accordance with IHL, and often with the support and funding of the US government and UN agencies. Such clear violations of human rights cannot, and should not, be tolerated by this committee. RECOMMENDATIONS While the humanitarian needs remain significant, there are steps which this committee and the US government can take to improve the humanitarian situation. Increase funding for health programs. Additional funding for health programs in Syria and regional countries is an effective means by which to address the current gaps in access to health. In Syria, funds for specialized care, primary health, and mental health are especially needed. Regionally, there is a need for more funds for chronic illnesses, persons with disabilities, and secondary care. Multi-sector programs, such as the consortium in NW Syria funded by OFDA, are ideal models, as they increase the efficiency, transparency, and overall impact of the funding. Provide greater funds for education, as well as engage with regional governments to grant more access to educational opportunities. Increasing US support for educational opportunities, particularly in specialized fields like medicine and engineering, will help train the future leaders of Syria, while also building the capacity of the Syrian population in regional countries. This support should also include increased collaboration with regional universities and Syrian diaspora networks to increase the long-term impact of the programs. In addition, this committee and the broader US government should use its influence with the host countries to ask for an increase in permissions for Syrian students to pursue higher education and vocational training. Continue to prioritize the protection of vulnerable populations, including women and girls, both diplomatically and programatically. The root cause of the conflict's protection issues is ultimately the conflict itself. The US should continue to support negotiations that reduce the overall level of conflict in Syria, including ceasefires and de-escalation agreements. On a programmatic level, an increase in US support for protection initiatives, such as child protection programming, gender based violence prevention and response programming, psychosocial support initiatives and de-mining efforts will help countless of women, girls, men, and boys live safer, more dignified lives. Increase efforts towards accountability for attacks on health and protection of healthworkers. The lack of meaningful accountability for attacks on healthcare has led to impunity. The US has the opportunity to change this trend by working with like-minded countries to adopt tangible, meaningful accountability measures for parties found to have intentionally targeted health facilities or health workers. The US should also support and encourage the UN-led deconfliction mechanism in Syria, which enables humanitarian organizations to formally declare the coordinates of their facilities to the parties to the conflict, in order to prevent them from being targeted. The subsequent investigations which occur if one of these deconflicted facilities is attacked should be conducted in a timely, transparent manner in order to hold the perpetrators accountable and to deter future attacks. Finally, the US should make the status of healthworkers in Syria a top priority of its Syria priority, and utilize all diplomatic tools to ensure that healthworkers are no longer targeted or criminalized for their profession. [all]